Radiation therapy at UAB started as a unit within the Department of Radiology, which consisted of both a diagnostic and a therapeutic section. This was the typical arrangement found at most facilities in the United States at the time. With encouragement from then Radiology Chairman Robert E. Roth, M.D., Dr. Clifton K. Meador, the Dean of the Medical College, agreed to separate the therapeutic portion from the remainder of the Department of Radiology in 1969. With this strategic action, the Department of Radiation Oncology was born. Dr. Roth, with fellow physicians Merle Salter, M.D., and Donn Brascho, M.D., medical physicist Benjamin Blackburn, and technical program manager Norbert Black, RT, formed the foundation of our first radiation oncology staff. 

The 1970s was a decade of rapid growth and change for the newly formed department. Many clinical advances were achieved, and the groundwork was laid for the development of our educational mission. A new facility, the Lurleen B. Wallace Tumor Institute, was built and opened in 1976 to fulfill a regional void in essential cancer treatment facilities. The new facility housed Radiation Oncology and Medical Oncology (which later moved to the Kirklin Clinic). UAB also began providing traveling dosimetric services for brachytherapy patients at other facilities in Alabama during this decade.

Many innovations in radiation oncology during the 1970s were related to treatment planning. Donn Brascho, M.D., was a pioneer at using ultrasound for improving the accuracy of treatment planning. Medical physicist Ben Blackburn developed a 3-field, perineal technique using special compensators with the Cobalt unit, which allowed for more tolerable doses to be delivered to patients.

The 1980s brought about an effort to transform UAB Radiation Oncology into a nationally recognized program. The department’s first chair Dr. Roth retired from practice in 1985 and his first medical resident, Merle M. Salter, M.D., assumed the chair position in 1986. Under her leadership, involvement in clinical trials was followed by key faculty hires including Ruby Meredith, M.D., Ph.D., and radiobiologist Donald Buchsbaum, Ph.D., who established the Radiation Biology Division at the turn of the decade.

In the short interim between Dr. Roth and Dr. Salter, Albert Lobuglio, M.D., then chair of the UAB Comprehensive Cancer Center, provided leadership to the department. He was also pivotal in the future, leading the recruitment efforts of our third chair James A. Bonner, M.D., from the Mayo Clinic.

By the 1990s, the department flourished with increasing patient volumes, a larger faculty and support staff, and a growing residency program. The department became a national program in Gamma Knife radiosurgery mid-decade and began treating with IMRT in 1999. Multidisciplinary cancer clinics became a staple of the department, highlighted by the Interdisciplinary Breast Clinic. As a result of this success, many other multidisciplinary clinics, including Head & Neck, Urology, and Neuro-oncology, became commonplace.

The Division of Radiation Biology was established in 1990, led by Director Dr. Donald Buchsbaum, who developed innovative approaches to radioimmunotherapy using novel targeting molecules. In 2023, upon Dr. Buchsbaum’s retirement, Lewis Shi, M.D., Ph.D., was appointed as Director of Radiobiology.

In 1998, Dr. Salter retired and James A. Bonner, M.D., became the third chair in our department’s history and was named the Merle M. Salter Endowed Professor and Chairman.

Under Dr. Bonner’s vision and leadership, The Kirklin Clinic at Acton Road (TKCAR) opened in 2002, offering medical oncology care and radiation oncology care in the same location. Initially equipped with both a Varian linear accelerator and a tomotherapy unit, this facility also provided patients with the same high-quality care offered at the core facility.

In 2006, Dr. Bonner released standard-of-care altering research for head and neck cancers. This research, published in the New England Journal of Medicine, was cited by the American Society of Clinical Oncology (ASCO) as one of the top six cancer discoveries in 2006 and received international acclaim.

From 2006 to 2008, the department recruited physician scientists working in kinomics, DNA damage, and cancer genetics. This set the groundwork for basic science discovery and more investigator-initiated investigations. Dr. Bonner also served as co-chair of the Experimental Therapeutics Program in the O’Neal Comprehensive Cancer Center for nearly 12 years spanning this decade.

By 2008, UAB’s GammaKnife was the fifth-busiest in the country and had treated more than 3,827 patients, qualifying it as one of the most experienced programs in the nation at that time.

In 2008, UAB also became the first site in the United States to treat a patient with RapidArc™ from Varian Medical Systems, under the direction of physicist Richard Popple, Ph.D. In all, three new Varian linear accelerators and one tomotherapy unit were commissioned into operation during the decade, in addition to many other state-of-the-art technologies.

Opened in 2010, the Hazelrig-Salter Radiation Oncology Center is the current home to the UAB Department of Radiation Oncology. The 50,000-square-foot radiation center is among the most technologically advanced radiation centers in the country, with a radiosurgery program that can handle every aspect of treatment planning and delivery. It offers the full spectrum of radiation oncology services through the O’Neal Comprehensive Cancer Center at UAB. The center was also among the first in the nation to begin using a TrueBeam, by Varian Medical Systems Inc., to deliver image-guided radiation therapy and radiosurgery with unmet speed and accuracy.

On the education front, the Medical Physics Residency Program began in 2011 and received full accreditation by the Commission on Accreditation of Medical Physics Educational Programs Inc. (CAMPEP) in 2012. In 2014, an educational partnership with Varian Medical Systems Inc. launched the “SRS & SBRT Delivery with Eclipse and TrueBeam” course, which is still taught today by Senior Vice Chair John Fiveash, M.D., and Assistant Vice Chair for Medical Physics Richard Popple, Ph.D. This training course, along with our Tours of Excellence, continue to increase our medical presence on a local, regional, and international scale. 

In this decade, UAB collaborated with Varian to bring HyperArc™ technology to fruition. In 2017, UAB treated brain cancer patients for the first time utilizing Varian HyperArc™ High-Definition Radiotherapy, becoming the first academic medical center in the United States to use this technology for complex radiosurgical procedures.

In 2019, UAB became the first program in the U.S. to use the Varian Edge radiosurgery system and virtual cone technology for functional SRS on movement disorder patients under the direction of Markus Bredel, M.D., Ph.D.

Today, the UAB Department of Radiation Oncology continues to be a trailblazer of technological advances in our field. Adaptive therapy and automated treatment planning are some of the early highlights of this decade. In 2021, we were among the first centers in the nation to install an Ethos system to begin our adaptive therapy program under the leadership of Richard Popple, Ph.D., and Dennis N. Stanley, Ph.D., DABR. With this progress, we became the first center in the world to treat a patient with adaptive therapy using the Varian Identify Surface imaging system in conjunction with the Ethos linear accelerator system.

In the same year, the department with our growing alumni base, founded the Robert Y. Kim Radiation Oncology Alumni Society. Our residency programs now typically graduate three physicians and one physicist annually, totaling 90 graduates in 2024. Our ACGME-accredited Radiation Oncology Residency Program emphasizes clinical trials training and offers support for the Holman Pathway, an alternative translational oncology training program.

In 2023, a TrueBeam linear accelerator was installed at The Kirklin Clinic at Acton Road, fully supporting an integrated department across our treatment locations. In October 2023, we proudly became the first radiation oncology practice in Alabama to attain accreditation from the American Society for Radiation Oncology APEx - Accreditation Program for Excellence® for both of our clinics, Hazelrig-Salter Radiation Oncology Center and The Kirklin Clinic at Acton Road, showing our commitment to providing the highest-quality patient care.

Artificial intelligence is transforming the landscape of radiation oncology and our department is pioneering AI-based solutions to improve cancer care delivery. Under the direction of Richard Popple, Ph.D., and Carlos Cardenas, Ph.D., we are on our way to increasing our automated planning footprint at UAB and partner sites with a vision to become an automated radiotherapy planning hub helping cancer patients on a local and global level gain access to high-quality radiotherapy treatment plans and physics services.

We look forward to expanding our practice through the new affiliation, announced in January 2024, between the O’Neal Comprehensive Cancer Center at UAB and Infirmary Cancer Care in Mobile, Alabama.