title: Radiation therapy

text: There are rigorous procedures in place to minimise the risk of accidental overexposure of radiation therapy to patients. However, mistakes do occasionally occur; for example, the radiation therapy machine Therac-25 was responsible for at least six accidents between 1985 and 1987, where patients were given up to one hundred times the intended dose; two people were killed directly by the radiation overdoses. From 2005 to 2010, a hospital in Missouri overexposed 76 patients (most with brain cancer) during a five-year period because new radiation equipment had been set up incorrectly.


title: Radiation therapy

text: Although medical errors are exceptionally rare, radiation oncologists, medical physicists and other members of the radiation therapy treatment team are working to eliminate them. ASTRO has launched a safety initiative called Target Safely that, among other things, aims to record errors nationwide so that doctors can learn from each and every mistake and prevent them from happening. ASTRO also publishes a list of questions for patients to ask their doctors about radiation safety to ensure every treatment is as safe as possible.


title: Radiation therapy

text: Radiation therapy is used to treat early stage Dupuytren's disease and Ledderhose disease. When Dupuytren's disease is at the nodules and cords stage or fingers are at a minimal deformation stage of less than 10 degrees, then radiation therapy is used to prevent further progress of the disease. Radiation therapy is also used post surgery in some cases to prevent the disease continuing to progress. Low doses of radiation are used typically three gray of radiation for five days, with a break of three months followed by another phase of three gray of radiation for five days.


title: Radiation therapy

text: Radiation therapy works by damaging the DNA of cancerous cells and can cause them to undergo mitotic catastrophe. This DNA damage is caused by one of two types of energy, photon or charged particle. This damage is either direct or indirect ionization of the atoms which make up the DNA chain. Indirect ionization happens as a result of the ionization of water, forming free radicals, notably hydroxyl radicals, which then damage the DNA.


title: Radiation therapy

text: In photon therapy, most of the radiation effect is through free radicals. Cells have mechanisms for repairing single-strand DNA damage and double-stranded DNA damage. However, double-stranded DNA breaks are much more difficult to repair, and can lead to dramatic chromosomal abnormalities and genetic deletions. Targeting double-stranded breaks increases the probability that cells will undergo cell death. Cancer cells are generally less differentiated and more stem cell-like; they reproduce more than most healthy differentiated cells, and have a diminished ability to repair sub-lethal damage. Single-strand DNA damage is then passed on through cell division; damage to the cancer cells' DNA accumulates, causing them to die or reproduce more slowly.


title: Radiation therapy

text: One of the major limitations of photon radiation therapy is that the cells of solid tumors become deficient in oxygen. Solid tumors can outgrow their blood supply, causing a low-oxygen state known as hypoxia. Oxygen is a potent radiosensitizer, increasing the effectiveness of a given dose of radiation by forming DNA-damaging free radicals. Tumor cells in a hypoxic environment may be as much as 2 to 3 times more resistant to radiation damage than those in a normal oxygen environment.


title: Radiation therapy

text: Much research has been devoted to overcoming hypoxia including the use of high pressure oxygen tanks, hyperthermia therapy (heat therapy which dilates blood vessels to the tumor site), blood substitutes that carry increased oxygen, hypoxic cell radiosensitizer drugs such as misonidazole and metronidazole, and hypoxic cytotoxins (tissue poisons), such as tirapazamine. Newer research approaches are currently being studied, including preclinical and clinical investigations into the use of an oxygen diffusion-enhancing compound such as trans sodium crocetinate (TSC) as a radiosensitizer.


title: Radiation therapy

text: Charged particles such as protons and boron, carbon, and neon ions can cause direct damage to cancer cell DNA through high-LET (linear energy transfer) and have an antitumor effect independent of tumor oxygen supply because these particles act mostly via direct energy transfer usually causing double-stranded DNA breaks. Due to their relatively large mass, protons and other charged particles have little lateral side scatter in the tissue – the beam does not broaden much, stays focused on the tumor shape, and delivers small dose side-effects to surrounding tissue. They also more precisely target the tumor using the Bragg peak effect. See proton therapy for a good example of the different effects of intensity-modulated radiation therapy (IMRT) vs. charged particle therapy. This procedure reduces damage to healthy tissue between the charged particle radiation source and the tumor and sets a finite range for tissue damage after the tumor has been reached. In contrast, IMRT's use of uncharged particles causes its energy to damage healthy cells when it exits the body. This exiting damage is not therapeutic, can increase treatment side effects, and increases the probability of secondary cancer induction. This difference is very important in cases where the close proximity of other organs makes any stray ionization very damaging (example: head and neck cancers). This X-ray exposure is especially bad for children, due to their growing bodies, and while depending on a multitude of factors, they are around 10 times more sensitive to developing secondary malignancies after radiotherapy as compared to adults.


title: Radiation therapy

text: The amount of radiation used in photon radiation therapy is measured in grays (Gy), and varies depending on the type and stage of cancer being treated. For curative cases, the typical dose for a solid epithelial tumor ranges from 60 to 80 Gy, while lymphomas are treated with 20 to 40 Gy.


title: Radiation therapy

text: Preventive (adjuvant) doses are typically around 45–60 Gy in 1.8–2 Gy fractions (for breast, head, and neck cancers.) Many other factors are considered by radiation oncologists when selecting a dose, including whether the patient is receiving chemotherapy, patient comorbidities, whether radiation therapy is being administered before or after surgery, and the degree of success of surgery.


title: Radiation therapy

text: Delivery parameters of a prescribed dose are determined during treatment planning (part of dosimetry). Treatment planning is generally performed on dedicated computers using specialized treatment planning software. Depending on the radiation delivery method, several angles or sources may be used to sum to the total necessary dose. The planner will try to design a plan that delivers a uniform prescription dose to the tumor and minimizes dose to surrounding healthy tissues.


title: Radiation therapy

text: In radiation therapy, three-dimensional dose distributions may be evaluated using the dosimetry technique known as gel dosimetry.


title: Radiation therapy

text: The total dose is fractionated (spread out over time) for several important reasons. Fractionation allows normal cells time to recover, while tumor cells are generally less efficient in repair between fractions. Fractionation also allows tumor cells that were in a relatively radio-resistant phase of the cell cycle during one treatment to cycle into a sensitive phase of the cycle before the next fraction is given. Similarly, tumor cells that were chronically or acutely hypoxic (and therefore more radioresistant) may reoxygenate between fractions, improving the tumor cell kill.


title: Radiation therapy

text: Fractionation regimens are individualised between different radiation therapy centers and even between individual doctors. In North America, Australia, and Europe, the typical fractionation schedule for adults is 1.8 to 2 Gy per day, five days a week. In some cancer types, prolongation of the fraction schedule over too long can allow for the tumor to begin repopulating, and for these tumor types, including head-and-neck and cervical squamous cell cancers, radiation treatment is preferably completed within a certain amount of time. For children, a typical fraction size may be 1.5 to 1.8 Gy per day, as smaller fraction sizes are associated with reduced incidence and severity of late-onset side effects in normal tissues.


title: Radiation therapy

text: In some cases, two fractions per day are used near the end of a course of treatment. This schedule, known as a concomitant boost regimen or hyperfractionation, is used on tumors that regenerate more quickly when they are smaller. In particular, tumors in the head-and-neck demonstrate this behavior.


title: Radiation therapy

text: Patients receiving palliative radiation to treat uncomplicated painful bone metastasis should not receive more than a single fraction of radiation. A single treatment gives comparable pain relief and morbidity outcomes to multiple-fraction treatments, and for patients with limited life expectancy, a single treatment is best to improve patient comfort.


title: Radiation therapy

text: One fractionation schedule that is increasingly being used and continues to be studied is hypofractionation. This is a radiation treatment in which the total dose of radiation is divided into large doses. Typical doses vary significantly by cancer type, from 2.2 Gy/fraction to 20 Gy/fraction, the latter being typical of stereotactic treatments (stereotactic ablative body radiotherapy, or SABR – also known as SBRT, or stereotactic body radiotherapy) for subcranial lesions, or SRS (stereotactic radiosurgery) for intracranial lesions. The rationale of hypofractionation is to reduce the probability of local recurrence by denying clonogenic cells the time they require to reproduce and also to exploit the radiosensitivity of some tumors. In particular, stereotactic treatments are intended to destroy clonogenic cells by a process of ablation – "i.e." the delivery of a dose intended to destroy clonogenic cells directly, rather than to interrupt the process of clonogenic cell division repeatedly (apoptosis), as in routine radiotherapy.


title: Radiation therapy

text: Different cancer types have different radiation sensitivity. While predicting the sensitivity based on genomic or proteomic analyses of biopsy samples has proven challenging, the predictions of radiation effect on individual patients from genomic signatures of intrinsic cellular radiosensitivity have been shown to associate with clinical outcome. An alternative approach to genomics and proteomics was offered by the discovery that radiation protection in microbes is offered by non-enzymatic complexes of manganese and small organic metabolites. The content and variation of manganese (measurable by electron paramagnetic resonance) were found to be good predictors of radiosensitivity, and this finding extends also to human cells. An association was confirmed between total cellular manganese contents and their variation, and clinically inferred radioresponsiveness in different tumor cells, a finding that may be useful for more precise radiodosages and improved treatment of cancer patients.


title: Radiation therapy

text: The differences relate to the position of the radiation source; external is outside the body, brachytherapy uses sealed radioactive sources placed precisely in the area under treatment, and systemic radioisotopes are given by infusion or oral ingestion. Brachytherapy can use temporary or permanent placement of radioactive sources. The temporary sources are usually placed by a technique called afterloading. In afterloading a hollow tube or applicator is placed surgically in the organ to be treated, and the sources are loaded into the applicator after the applicator is implanted. This minimizes radiation exposure to health care personnel.


title: Radiation therapy

text: Particle therapy is a special case of external beam radiation therapy where the particles are protons or heavier ions.


title: Radiation therapy

text: A review of radiation therapy randomised clinical trials from 2018 to 2021 found many practice-changing data and new concepts that emerge from RCTs, identifying techniques that improve the therapeutic ratio, techniques that lead to more tailored treatments, stressing the importance of patient satisfaction, and identifying areas that require further study.


title: Radiation therapy

text: Historically conventional external beam radiation therapy (2DXRT) was delivered via two-dimensional beams using kilovoltage therapy X-ray units, medical linear accelerators that generate high-energy X-rays, or with machines that were similar to a linear accelerator in appearance, but used a sealed radioactive source like the one shown above. 2DXRT mainly consists of a single beam of radiation delivered to the patient from several directions: often front or back, and both sides.


title: Radiation therapy

text: "Conventional" refers to the way the treatment is "planned" or "simulated" on a specially calibrated diagnostic X-ray machine known as a simulator because it recreates the linear accelerator actions (or sometimes by eye), and to the usually well-established arrangements of the radiation beams to achieve a desired "plan". The aim of simulation is to accurately target or localize the volume which is to be treated. This technique is well established and is generally quick and reliable. The worry is that some high-dose treatments may be limited by the radiation toxicity capacity of healthy tissues which lie close to the target tumor volume.


title: Radiation therapy

text: An example of this problem is seen in radiation of the prostate gland, where the sensitivity of the adjacent rectum limited the dose which could be safely prescribed using 2DXRT planning to such an extent that tumor control may not be easily achievable. Prior to the invention of the CT, physicians and physicists had limited knowledge about the true radiation dosage delivered to both cancerous and healthy tissue. For this reason, 3-dimensional conformal radiation therapy has become the standard treatment for almost all tumor sites. More recently other forms of imaging are used including MRI, PET, SPECT and Ultrasound.


title: Radiation therapy

text: Stereotactic radiation is a specialized type of external beam radiation therapy. It uses focused radiation beams targeting a well-defined tumor using extremely detailed imaging scans. Radiation oncologists perform stereotactic treatments, often with the help of a neurosurgeon for tumors in the brain or spine.


title: Radiation therapy

text: There are two types of stereotactic radiation. Stereotactic radiosurgery (SRS) is when doctors use a single or several stereotactic radiation treatments of the brain or spine. Stereotactic body radiation therapy (SBRT) refers to one or several stereotactic radiation treatments with the body, such as the lungs.


title: Radiation therapy

text: Some doctors say an advantage to stereotactic treatments is that they deliver the right amount of radiation to the cancer in a shorter amount of time than traditional treatments, which can often take 6 to 11 weeks. Plus treatments are given with extreme accuracy, which should limit the effect of the radiation on healthy tissues. One problem with stereotactic treatments is that they are only suitable for certain small tumors.


title: Radiation therapy

text: Stereotactic treatments can be confusing because many hospitals call the treatments by the name of the manufacturer rather than calling it SRS or SBRT. Brand names for these treatments include Axesse, Cyberknife, Gamma Knife, Novalis, Primatom, Synergy, X-Knife, TomoTherapy, Trilogy and Truebeam. This list changes as equipment manufacturers continue to develop new, specialized technologies to treat cancers.


title: Radiation therapy

text: The planning of radiation therapy treatment has been revolutionized by the ability to delineate tumors and adjacent normal structures in three dimensions using specialized CT and/or MRI scanners and planning software.


title: Radiation therapy

text: Virtual simulation, the most basic form of planning, allows more accurate placement of radiation beams than is possible using conventional X-rays, where soft-tissue structures are often difficult to assess and normal tissues difficult to protect.


title: Radiation therapy

text: An enhancement of virtual simulation is 3-dimensional conformal radiation therapy (3DCRT), in which the profile of each radiation beam is shaped to fit the profile of the target from a beam's eye view (BEV) using a multileaf collimator (MLC) and a variable number of beams. When the treatment volume conforms to the shape of the tumor, the relative toxicity of radiation to the surrounding normal tissues is reduced, allowing a higher dose of radiation to be delivered to the tumor than conventional techniques would allow.


title: Radiation therapy

text: Intensity-modulated radiation therapy (IMRT) is an advanced type of high-precision radiation that is the next generation of 3DCRT. IMRT also improves the ability to conform the treatment volume to concave tumor shapes, for example when the tumor is wrapped around a vulnerable structure such as the spinal cord or a major organ or blood vessel. Computer-controlled X-ray accelerators distribute precise radiation doses to malignant tumors or specific areas within the tumor. The pattern of radiation delivery is determined using highly tailored computing applications to perform optimization and treatment simulation (Treatment Planning). The radiation dose is consistent with the 3-D shape of the tumor by controlling, or modulating, the radiation beam's intensity. The radiation dose intensity is elevated near the gross tumor volume while radiation among the neighboring normal tissues is decreased or avoided completely. This results in better tumor targeting, lessened side effects, and improved treatment outcomes than even 3DCRT.


title: Radiation therapy

text: 3DCRT is still used extensively for many body sites but the use of IMRT is growing in more complicated body sites such as CNS, head and neck, prostate, breast, and lung. Unfortunately, IMRT is limited by its need for additional time from experienced medical personnel. This is because physicians must manually delineate the tumors one CT image at a time through the entire disease site which can take much longer than 3DCRT preparation. Then, medical physicists and dosimetrists must be engaged to create a viable treatment plan. Also, the IMRT technology has only been used commercially since the late 1990s even at the most advanced cancer centers, so radiation oncologists who did not learn it as part of their residency programs must find additional sources of education before implementing IMRT.


title: Radiation therapy

text: Proof of improved survival benefit from either of these two techniques over conventional radiation therapy (2DXRT) is growing for many tumor sites, but the ability to reduce toxicity is generally accepted. This is particularly the case for head and neck cancers in a series of pivotal trials performed by Professor Christopher Nutting of the Royal Marsden Hospital. Both techniques enable dose escalation, potentially increasing usefulness. There has been some concern, particularly with IMRT, about increased exposure of normal tissue to radiation and the consequent potential for secondary malignancy. Overconfidence in the accuracy of imaging may increase the chance of missing lesions that are invisible on the planning scans (and therefore not included in the treatment plan) or that move between or during a treatment (for example, due to respiration or inadequate patient immobilization). New techniques are being developed to better control this uncertainty – for example, real-time imaging combined with real-time adjustment of the therapeutic beams. This new technology is called image-guided radiation therapy (IGRT) or four-dimensional radiation therapy.


title: Radiation therapy

text: Another technique is the real-time tracking and localization of one or more small implantable electric devices implanted inside or close to the tumor. There are various types of medical implantable devices that are used for this purpose. It can be a magnetic transponder which senses the magnetic field generated by several transmitting coils, and then transmits the measurements back to the positioning system to determine the location. The implantable device can also be a small wireless transmitter sending out an RF signal which then will be received by a sensor array and used for localization and real-time tracking of the tumor position.


title: Radiation therapy

text: A well-studied issue with IMRT is the "tongue and groove effect" which results in unwanted underdosing, due to irradiating through extended tongues and grooves of overlapping MLC (multileaf collimator) leaves. While solutions to this issue have been developed, which either reduce the TG effect to negligible amounts or remove it completely, they depend upon the method of IMRT being used and some of them carry costs of their own. Some texts distinguish "tongue and groove error" from "tongue or groove error", according as both or one side of the aperture is occluded.


title: Radiation therapy

text: Volumetric modulated arc therapy (VMAT) is a radiation technique introduced in 2007 which can achieve highly conformal dose distributions on target volume coverage and sparing of normal tissues. The specificity of this technique is to modify three parameters during the treatment. VMAT delivers radiation by rotating gantry (usually 360° rotating fields with one or more arcs), changing speed and shape of the beam with a multileaf collimator (MLC) ("sliding window" system of moving) and fluence output rate (dose rate) of the medical linear accelerator. VMAT has an advantage in patient treatment, compared with conventional static field intensity modulated radiotherapy (IMRT), of reduced radiation delivery times. Comparisons between VMAT and conventional IMRT for their sparing of healthy tissues and Organs at Risk (OAR) depends upon the cancer type. In the treatment of nasopharyngeal, oropharyngeal and hypopharyngeal carcinomas VMAT provides equivalent or better protection of the organ at risk (OAR). In the treatment of prostate cancer the OAR protection result is mixed with some studies favoring VMAT, others favoring IMRT.


title: Radiation therapy

text: Temporally feathered radiation therapy (TFRT) is a radiation technique introduced in 2018 which aims to use the inherent non-linearities in normal tissue repair to allow for sparing of these tissues without affecting the dose delivered to the tumor. The application of this technique, which has yet to be automated, has been described carefully to enhance the ability of departments to perform it, and in 2021 it was reported as feasible in a small clinical trial, though its efficacy has yet to be formally studied.


title: Radiation therapy

text: Automated treatment planning has become an integrated part of radiotherapy treatment planning. There are in general two approaches of automated planning. 1) Knowledge based planning where the treatment planning system has a library of high quality plans, from which it can predict the target and dose-volume histogram of the organ at risk. 2) The other approach is commonly called protocol based planning, where the treatment planning system tried to mimic an experienced treatment planner and through an iterative process evaluates the plan quality from on the basis of the protocol.


title: Radiation therapy

text: In particle therapy (proton therapy being one example), energetic ionizing particles (protons or carbon ions) are directed at the target tumor. The dose increases while the particle penetrates the tissue, up to a maximum (the Bragg peak) that occurs near the end of the particle's range, and it then drops to (almost) zero. The advantage of this energy deposition profile is that less energy is deposited into the healthy tissue surrounding the target tissue.


title: Radiation therapy

text: Auger therapy (AT) makes use of a very high dose of ionizing radiation in situ that provides molecular modifications at an atomic scale. AT differs from conventional radiation therapy in several aspects; it neither relies upon radioactive nuclei to cause cellular radiation damage at a cellular dimension, nor engages multiple external pencil-beams from different directions to zero-in to deliver a dose to the targeted area with reduced dose outside the targeted tissue/organ locations. Instead, the in situ delivery of a very high dose at the molecular level using AT aims for in situ molecular modifications involving molecular breakages and molecular re-arrangements such as a change of stacking structures as well as cellular metabolic functions related to the said molecule structures.


title: Radiation therapy

text: In many types of external beam radiotherapy, motion can negatively impact the treatment delivery by moving target tissue out of, or other healthy tissue into, the intended beam path. Some form of patient immobilisation is common, to prevent the large movements of the body during treatment, however this cannot prevent all motion, for example as a result of breathing. Several techniques have been developed to account for motion like this. Deep inspiration breath-hold (DIBH) is commonly used for breast treatments where it is important to avoid irradiating the heart. In DIBH the patient holds their breath after breathing in to provide a stable position for the treatment beam to be turned on. This can be done automatically using an external monitoring system such as a spirometer or a camera and markers. The same monitoring techniques, as well as 4DCT imaging, can also be for respiratory gated treatment, where the patient breathes freely and the beam is only engaged at certain points in the breathing cycle. Other techniques include using 4DCT imaging to plan treatments with margins that account for motion, and active movement of the treatment couch, or beam, to follow motion.


title: Radiation therapy

text: Contact X-ray brachytherapy (also called "CXB", "electronic brachytherapy" or the "Papillon Technique") is a type of radiation therapy using kilovoltage X-rays applied close to the tumour to treat rectal cancer. The process involves inserting the X-ray tube through the anus into the rectum and placing it against the cancerous tissue, then high doses of X-rays are emitted directly into the tumor at two weekly intervals. It is typically used for treating early rectal cancer in patients who may not be candidates for surgery. A 2015 NICE review found the main side effect to be bleeding that occurred in about 38% of cases, and radiation-induced ulcer which occurred in 27% of cases.


title: Radiation therapy

text: Brachytherapy is delivered by placing radiation source(s) inside or next to the area requiring treatment. Brachytherapy is commonly used as an effective treatment for cervical, prostate, breast, and skin cancer and can also be used to treat tumours in many other body sites.


title: Radiation therapy

text: In brachytherapy, radiation sources are precisely placed directly at the site of the cancerous tumour. This means that the irradiation only affects a very localized area – exposure to radiation of healthy tissues further away from the sources is reduced. These characteristics of brachytherapy provide advantages over external beam radiation therapy – the tumour can be treated with very high doses of localized radiation, whilst reducing the probability of unnecessary damage to surrounding healthy tissues. A course of brachytherapy can often be completed in less time than other radiation therapy techniques. This can help reduce the chance of surviving cancer cells dividing and growing in the intervals between each radiation therapy dose.


title: Radiation therapy

text: As one example of the localized nature of breast brachytherapy, the SAVI device delivers the radiation dose through multiple catheters, each of which can be individually controlled. This approach decreases the exposure of healthy tissue and resulting side effects, compared both to external beam radiation therapy and older methods of breast brachytherapy.


title: Radiation therapy

text: Radionuclide therapy (also known as systemic radioisotope therapy, radiopharmaceutical therapy, or molecular radiotherapy), is a form of targeted therapy. Targeting can be due to the chemical properties of the isotope such as radioiodine which is specifically absorbed by the thyroid gland a thousandfold better than other bodily organs. Targeting can also be achieved by attaching the radioisotope to another molecule or antibody to guide it to the target tissue. The radioisotopes are delivered through infusion (into the bloodstream) or ingestion. Examples are the infusion of metaiodobenzylguanidine (MIBG) to treat neuroblastoma, of oral iodine-131 to treat thyroid cancer or thyrotoxicosis, and of hormone-bound lutetium-177 and yttrium-90 to treat neuroendocrine tumors (peptide receptor radionuclide therapy).


title: Radiation therapy

text: Another example is the injection of radioactive yttrium-90 or holmium-166 microspheres into the hepatic artery to radioembolize liver tumors or liver metastases. These microspheres are used for the treatment approach known as selective internal radiation therapy. The microspheres are approximately 30 µm in diameter (about one-third of a human hair) and are delivered directly into the artery supplying blood to the tumors. These treatments begin by guiding a catheter up through the femoral artery in the leg, navigating to the desired target site and administering treatment. The blood feeding the tumor will carry the microspheres directly to the tumor enabling a more selective approach than traditional systemic chemotherapy. There are currently three different kinds of microspheres: SIR-Spheres, TheraSphere and QuiremSpheres.


title: Radiation therapy

text: A major use of systemic radioisotope therapy is in the treatment of bone metastasis from cancer. The radioisotopes travel selectively to areas of damaged bone, and spare normal undamaged bone. Isotopes commonly used in the treatment of bone metastasis are radium-223, strontium-89 and samarium (Sm) lexidronam.


title: Radiation therapy

text: In 2002, the United States Food and Drug Administration (FDA) approved ibritumomab tiuxetan (Zevalin), which is an anti-CD20 monoclonal antibody conjugated to yttrium-90.


title: Radiation therapy

text: In 2003, the FDA approved the tositumomab/iodine (I) tositumomab regimen (Bexxar), which is a combination of an iodine-131 labelled and an unlabelled anti-CD20 monoclonal antibody.


title: Radiation therapy

text: These medications were the first agents of what is known as radioimmunotherapy, and they were approved for the treatment of refractory non-Hodgkin's lymphoma.


title: Radiation therapy

text: Intraoperative radiation therapy (IORT) is applying therapeutic levels of radiation to a target area, such as a cancer tumor, while the area is exposed during surgery.


title: Radiation therapy

text: The rationale for IORT is to deliver a high dose of radiation precisely to the targeted area with minimal exposure of surrounding tissues which are displaced or shielded during the IORT. Conventional radiation techniques such as external beam radiotherapy (EBRT) following surgical removal of the tumor have several drawbacks: The tumor bed where the highest dose should be applied is frequently missed due to the complex localization of the wound cavity even when modern radiotherapy planning is used. Additionally, the usual delay between the surgical removal of the tumor and EBRT may allow a repopulation of the tumor cells. These potentially harmful effects can be avoided by delivering the radiation more precisely to the targeted tissues leading to immediate sterilization of residual tumor cells. Another aspect is that wound fluid has a stimulating effect on tumor cells. IORT was found to inhibit the stimulating effects of wound fluid.


title: Radiation therapy

text: Medicine has used radiation therapy as a treatment for cancer for more than 100 years, with its earliest roots traced from the discovery of X-rays in 1895 by Wilhelm Röntgen. Emil Grubbe of Chicago was possibly the first American physician to use X-rays to treat cancer, beginning in 1896.


title: Radiation therapy

text: The field of radiation therapy began to grow in the early 1900s largely due to the groundbreaking work of Nobel Prize–winning scientist Marie Curie (1867–1934), who discovered the radioactive elements polonium and radium in 1898. This began a new era in medical treatment and research. Through the 1920s the hazards of radiation exposure were not understood, and little protection was used. Radium was believed to have wide curative powers and radiotherapy was applied to many diseases.


title: Radiation therapy

text: Prior to World War 2, the only practical sources of radiation for radiotherapy were radium, its "emanation", radon gas, and the X-ray tube. External beam radiotherapy (teletherapy) began at the turn of the century with relatively low voltage (<150 kV) X-ray machines. It was found that while superficial tumors could be treated with low voltage X-rays, more penetrating, higher energy beams were required to reach tumors inside the body, requiring higher voltages. Orthovoltage X-rays, which used tube voltages of 200-500 kV, began to be used during the 1920s. To reach the most deeply buried tumors without exposing intervening skin and tissue to dangerous radiation doses required rays with energies of 1 MV or above, called "megavolt" radiation. Producing megavolt X-rays required voltages on the X-ray tube of 3 to 5 million volts, which required huge expensive installations. Megavoltage X-ray units were first built in the late 1930s but because of cost were limited to a few institutions. One of the first, installed at St. Bartholomew's hospital, London in 1937 and used until 1960, used a 30 foot long X-ray tube and weighed 10 tons. Radium produced megavolt gamma rays, but was extremely rare and expensive due to its low occurrence in ores. In 1937 the entire world supply of radium for radiotherapy was 50 grams, valued at £800,000, or $50 million in 2005 dollars.


title: Radiation therapy

text: The invention of the nuclear reactor in the Manhattan Project during World War 2 made possible the production of artificial radioisotopes for radiotherapy. Cobalt therapy, teletherapy machines using megavolt gamma rays emitted by cobalt-60, a radioisotope produced by irradiating ordinary cobalt metal in a reactor, revolutionized the field between the 1950s and the early 1980s. Cobalt machines were relatively cheap, robust and simple to use, although due to its 5.27 year half-life the cobalt had to be replaced about every 5 years.


title: Radiation therapy

text: Medical linear particle accelerators, developed since the 1940s, began replacing X-ray and cobalt units in the 1980s and these older therapies are now declining. The first medical linear accelerator was used at the Hammersmith Hospital in London in 1953. Linear accelerators can produce higher energies, have more collimated beams, and do not produce radioactive waste with its attendant disposal problems like radioisotope therapies.


title: Radiation therapy

text: With Godfrey Hounsfield's invention of computed tomography (CT) in 1971, three-dimensional planning became a possibility and created a shift from 2-D to 3-D radiation delivery. CT-based planning allows physicians to more accurately determine the dose distribution using axial tomographic images of the patient's anatomy. The advent of new imaging technologies, including magnetic resonance imaging (MRI) in the 1970s and positron emission tomography (PET) in the 1980s, has moved radiation therapy from 3-D conformal to intensity-modulated radiation therapy (IMRT) and to image-guided radiation therapy (IGRT) tomotherapy. These advances allowed radiation oncologists to better see and target tumors, which have resulted in better treatment outcomes, more organ preservation and fewer side effects.


title: Radiation therapy

text: While access to radiotherapy is improving globally, more than half of patients in low and middle income countries still do not have available access to the therapy as of 2017.


title: Dragon's Dogma

text: Dragon's Dogma is an action role-playing hack and slash video game developed and published by Capcom for PlayStation 3 and Xbox 360 in 2012. An enhanced version titled Dragon's Dogma: Dark Arisen was released for the game's original consoles in 2013, then later ported to Microsoft Windows in 2016, PlayStation 4 and Xbox One in 2017, and Nintendo Switch in 2019. Set in the high fantasy world of Gransys, the player takes on the role of a human protagonist dubbed the Arisen on a quest to defeat the dragon Grigori, a being said to herald the world's end, while uncovering a deeper conspiracy along the way.


title: Dragon's Dogma

text: The gameplay focuses on the Arisen—a customizable avatar—exploring Gransys completing quests and fighting monsters in real-time combat. The protagonist is accompanied by Pawns, characters who provide combat support and advice; the protagonist has one customized Pawn, and two additional Pawns either pre-set within the game or other customized Pawns shared by other players through an online lobby. Both standard combat and boss battles involve grappling with or climbing on enemies.


title: Dragon's Dogma

text: The design document for "Dragon's Dogma" was created by director Hideaki Itsuno in 2000 prior to working on "Devil May Cry 2". Itsuno successfully pitched the project and production began in 2008. The 150-strong staff, who had previously worked on Capcom franchises such as "Street Fighter", "Breath of Fire", and "Devil May Cry", took inspiration from Western RPGs including "" and "Fable II". The music, led by Tadayoshi Makino and including contributions from Israeli-American composer Inon Zur, used a full orchestra and focused on ambiance. "Dark Arisen" was designed to incorporate fan feedback and offer a complete experience for both old and new players.


title: Dragon's Dogma

text: The original version of "Dragon's Dogma" was praised by critics. Praise was given to the gameplay and the Pawn system, while the narrative was generally criticized as lacking. The "Dark Arisen" version was praised for its technical improvements and additional content. The original "Dragon's Dogma" sold over one million copies worldwide, and the different versions of "Dark Arisen" also met with positive sales. A Japan-exclusive massively multiplayer online role-playing game titled "Dragon's Dogma Online" released in 2015. An original net animation adaptation was globally released on Netflix in 2020. A sequel, "Dragon's Dogma II", is in development.


title: Dragon's Dogma

text: "Dragon's Dogma" is an action role-playing game set in an open world environment and played from a third-person perspective. The player is able to select between various vocations: Fighter, Strider, Mage, Warrior, Mystic Knight, Ranger, Assassin, Sorcerer and Magic Archer. Gender choice and appearance settings are also available. The vocation, or class system, changes gameplay and tactical options available to the player. For example, the Fighter has abilities that focus on hack and slash combat and the Strider is skilled at climbing large enemies. The game was designed to be playable even by those who are not skilled at action games.


title: Dragon's Dogma

text: One of the game's main innovations is the "pawn" system. While the player's party is exploring the world, the three party members who accompany the main character are controlled by artificial intelligence, but the player can issue orders to them, including "Go," "Help" and "Come." One of the party members is a non-playable character (NPC) and belongs to the main character's world, while the other two party members are NPCs borrowed from other players by connecting online or are locally generated by the game. The party members, referred to as pawns, can talk, seek the main character's help, and provide information about enemies. The player must work on strengthening the main character and the party members. The pawns are vocal, yelling out useful hints and strategies, which are often vitally important to surviving tough boss encounters and dungeons. The pawn system also features social networking features.


title: Dragon's Dogma

text: The game features a "grab" action, where the main character can grab or cling to enemies, objects, or NPCs. The player can use this feature for more advanced attacks. For example, the main character can either grab on to a griffin's legs and attack it directly, or climb up to reach its head for a more lethal blow. "In a lot of action games, with big enemies the tendency is just to have you hacking away at the shins. You don't get the full effect of fighting a giant boss," Hideaki Itsuno, the director of "Dragon's Dogma", said. "With this game you can climb all over it. If it has a body part, you can attack it."


title: Dragon's Dogma

text: The game's large open world environments have drawn comparisons to "". In addition to the large open world, "Dragon's Dogma" features a large city environment with over 200 non-player characters (NPCs) who move about according to their own schedules. The player is able to communicate with the residents in full voice. The game also features a persistent world with a dynamic weather system and day-night cycle.


title: Dragon's Dogma

text: The game's hack and slash combat elements have been compared to their own "Devil May Cry" series and "Dark Souls". Some of the fantasy elements are reminiscent of "Breath of Fire", and the combat and party systems have been compared to "Monster Hunter".


title: Dragon's Dogma

text: Although "Dragon's Dogma" does not feature a direct multiplayer mode, the developers have revealed that players can compete online with asynchronous encounters called "Events" via Xbox Live or the PlayStation Network. One such event includes the 'Ur-Dragon' in which the effect of each party's attacks will be combined until the Ur-Dragon finally falls. Players that deal the fatal blow will receive the maximum reward, but all players can still obtain both common and rare items dropped by the Ur-Dragon when they inflict damage.


title: Dragon's Dogma

text: The game opens with a group led by a knight named Savan nearing the end of a quest to defeat the Dragon, a being that signals the end of days. An unknown time later in the present day Duchy of Gransys, the protagonist's village of Cassardis is attacked by the newly-arrived Dragon. When the protagonist attacks the Dragon, the Dragon takes their heart. The protagonist remains alive after this, marking them as the "Arisen", a figure destined to face the Dragon and stop the coming apocalypse; the Arisen is served by Pawns, human-like beings who live to fight the Dragon, and the Arisen creates a new Pawn shortly after beginning their quest. Heading to a nearby encampment, the protagonist defends an encampment of soldiers from a Hydra attack, taking one of its heads before driving it back; this is witnessed by Mercedes Marten, a soldier sent from a neighbouring nation to support Gransys's Duke Edmun Dragonsbane against the Dragon.


title: Dragon's Dogma

text: Mercedes helps the Arisen escort the Hydra head to the Duke's capital of Gran Soren; upon completing quests for the local Wyrm Hunter guild, the Arisen is granted an audience with the Duke, who has held the position for over a century without ageing after claiming victory against the Dragon. During their quest, the Arisen finds aid from a former Arisen dubbed the Dragonforged; investigates an underground tower dubbed the Everfall by the local Pawn guild; confronts Salvation, a nihilistic cult led by a man named Elysion which seeks the Dragon's victory; and learns of Mercedes's role as a token ally as other nations have come to fear Gransys becoming too powerful should the Duke defeat a second Dragon. The Arisen eventually confronts Elysion, who turns his followers into undead to kill the Arisen. The Arisen defeats them, but the Dragon arrives and kills Elysion. The Dragon challenges the Arisen to find him and stop the apocalypse. Confronting the Dragon, the Dragon offers the Arisen a choice; fight and kill it, or sacrifice their beloved—a character the Arisen has grown close to during the game—in exchange for replacing the Duke as ruler of Gransys, the same bargain the Duke took when he faced the Dragon.


title: Dragon's Dogma

text: Upon defeating the Dragon, the Arisen and all those connected to the Dragon—including the Duke and the Dragonforged—lose their immortality, and the Everfall becomes a bottomless pit which swallows part of Gran Soren. Returning to Gran Soren, the Arisen is attacked by the aged Duke and flees upon being accused of cursing him. While fleeing, the Arisen and their Pawns are swallowed by the Everfall. Passing into a higher plane after opening a portal within the Everfall, the Arisen faces the Seneschal, the being which sustains the world and the current form of the knight Savan. The Arisen is offered a choice; fight the Seneschal or return to Gransys and live a quiet life. Should the Arisen lose the fight with the Seneschal, they are reborn as the next Dragon. Besting the Seneschal results in the Arisen taking their place, unable to interact with the world below. The Arisen then kills themselves to break the cycle, falling back towards Gransys with their Pawn. The game ends with the Pawn awakening within the Arisen's body in their village to be met by their beloved.


title: Dragon's Dogma

text: The concept for "Dragon's Dogma" was created by Hideaki Itsuno. He created the initial concepts of an RPG title and the Pawn system in 2000, before he was brought on board the staff of "Devil May Cry 2". Itsuno had a chance to pitch the project in 2008 following the completion of "Devil May Cry 4". With internal discussions going on about Capcom's next large-scale project, the company had asked for a concept which could potentially sell one million copies. "Dragon's Dogma" was one of seven pitches given by Itsuno. The main concept was an RPG based primarily about single-player but with casual multiplayer elements similar to watching a bulletin board system. The Pawn system and its Western RPG-styled formed part of the pitch. Itsuno's decision to pitch the project was due to the advances in gaming hardware, which had become powerful enough to properly realize the game.


title: Dragon's Dogma

text: At the time "Dragon's Dogma" was pitched, social mobile games with features similar to the Pawn system had yet to take off in Japan, and it was before the popularity of hardcore action RPGs such as "Demon's Souls" and "Dark Souls". It was also the first time an open world had been proposed for a Capcom title. Due to these factors, there was initial resistance and scepticism from Capcom executives. Capcom eventually approved the project after Itsuni scaled down his initial proposal to fit within projected budget and development resources. Development of the game lasted three years including early concept development, with the 150-strong staff being mostly carried over from "Devil May Cry 4". Including external staff, the development team was over 200 people. As with other large-scale Capcom projects, the development team was divided into units with specific tasks, allowing production to be streamlined without compromising the project as a whole.


title: Dragon's Dogma

text: The public reveal of "Dragon's Dogma" was planned for the 2010 Tokyo Game Show alongside "", but the visual quality of the title at the time was thought lacking and so the announcement was delayed. The game was eventually revealed in April 2011 at a special event by Capcom. Initially scheduled for "early 2012", Capcom delayed the release date by several months. A game demo was released on April 24, 2012 in Japan and North America, and April 25 in Europe. The demo offered access to the character creation system and two classes to use in two boss encounters from the main game. Characters created in the demo could be imported into the full game. "Dragon's Dogma" was released on May 22 in North America, May 24 in Japan and Australia, and May 25 in Europe. All versions came with a one-time download code to access a demo of "Resident Evil 6". Following the game's release, multiple downloadable content (DLC) packs were released, ranging from cosmetic items to new quests.


title: Dragon's Dogma

text: The scenario and script were written by Haruo Murata. Brought on board the project during development, he was favorably impressed by an early demo of a Cyclops battle. He was in charge of writing the main scenario and dialogue interactions, with his main aim being to create a setting which would react to playing actions in a "natural" way. The world design and basic scenario were created by Makoto Ikehara, a veteran of the "Breath of Fire" series. He was not involved in the later parts of production, but he was able to bring knowledge of both fantasy settings and role-playing mechanics to the team. Another contributor to the scenario was Bingo Morihashi, who had previously worked on the scripts on the "Devil May Cry" series since "Devil May Cry 2" and "". Itsuno cited multiple inspirations for the world of "Dragon's Dogma", including "The Lord of the Rings", "Dungeons & Dragons" and "The Neverending Story". To research the setting, the team made several trips to Europe to research its scenery and architecture. The game's title evoked both the Dragon's key role and how the Dragon taught the protagonist—and by extension the player—about the world.


title: Dragon's Dogma

text: The art directors were Daigo Ikeno and Makoto Tanaka. Ikeno was an established Capcom artist noted for his work on the "Street Fighter" series, "Devil May Cry 3" and the first two "Onimusha" titles. Ikeno designed the Dragon himself, aiming for a classic high fantasy look and "cool" aesthetic. The final design emulated the "simple yet powerful" dragons of folklore, but with the main aim being to make the fantastical creature as realistic as possible. The characters were designed by Toru Kanaseki; monster designs were handled by Yoshinori Matsushita and Yumei Nagaki; weapon and armor designs were created by Kaoru Araki and Tomihiko Osumi; and background and concept art was designed by Kenichi Suzuki and Western artist Craig Mullins. During the initial design phases, several concepts were created but had to be discarded due to either design changes or a lack of development time and resources to include them. Tanaka described the world as "an orthodox sort of high fantasy open world" similar to those used in Hollywood movies so players would immediately understand it.


title: Dragon's Dogma

text: The characters' clothing was inspired by the clothing used in Medieval society. The clothing designs of Cassardis and Gran Soren were designed to contrast each other; the people of Cassardis had a lot of exposed skin and a blue color theme, while those in Gran Soren covered up more and used orange. While much of the final game used Medieval clothing designs, many of Kanaseki's early designs drew from Ancient Greek and Roman designs. As the key colour of the game was red, Kanaseki designed the default Arisen character designs to look good with flaming red hair. He also gave the Arisen a simple hairstyle. Mercedes was designed to appear capable of defending herself while maintaining her femininity. The monastic design of Elysion was designed to both serve as the model for Salvation cultist clothing and remain modest so as not to overshadow the character himself. The Duke was designed to show his growing mental strain, and his cloak—which incorporated dragon designs symbolizing his reputation—took a long time to complete. The monsters were created based on their representations in folklore and fairytales. Rather than making the original designs more fantastical, they were made more realistic. The art team tried not to stray too far from traditional imagery grounded in ancient legends and iconography; this approach was influenced by Mike Mignola's Hellboy comics and the manga "Berserk" by Kentaro Miura.


title: Dragon's Dogma

text: The aim for the developers was, rather than using Japanese role-playing traditions, to emulate Western RPGs including "Fallout 3", "" and "Fable II". Itsuno's original version of the game was substantially larger than the final game, including the whole of Gransys, a dungeon related to the game's lore, and the game world's moon. While utilising RPG elements, "Dragon's Dogma" was primarily focused on action gameplay as Capcom's staff were experienced with action games. Itsune described the game as their attempt to create a defining RPG experience similar to "". The control layout was carried over from Capcom's other action titles such as "Devil May Cry". Many of the action elements were carried over and how characters fought with enemies was also drawn from that series. The game's open world was the largest world ever created for a Capcom title.


title: Dragon's Dogma

text: The world's design was intended to promote both realism and fantasy; game designer Makoto Tanaka compared the wished-for atmosphere to someone walking through the African savana and encountering its wildlife, but with fantasy beasts replacing real-world animals. The team gradually worked through the rules of the game world, which were all based on the real world as far as possible. According to Kobayashi, the game's scale and style—which were like nothing produced by Capcom up to that point—caused multiple problems for the development team. There were several times when Kobayashi felt like giving up due to the problems that came up. Due to the world's scale, the development team had to get used to multiple new sound management techniques, creating a new audio program to manage sound over in-game distances. A difficult sound to create were bell chimes, which were included due to their importance to Medieval European life when sounding for events. The sounds were recorded using a real bell at a Hollywood studio. Recording the bell chimes was troublesome, as the structure the bells were suspended in nearly collapsed. To help create monster noises, the sound team used the sounds of trained animals from Hollywood which were trained for roles in production.


title: Dragon's Dogma

text: The game used the 2.x version of Capcom's proprietary MT Framework game engine, which had previously been used in several Capcom games including "" and "Devil May Cry 4". According to the programmer Taro Yahagi, who was in charge of work for the engine, "Dragon's Dogma" was the most difficult project as MT Framework required a large number of adjustments. Previous MT Framework titles had been stage-based action titles, so transitioning to an open world was a drastic change and required the creation of a dedicated "World Offset" function which shifted the world based on player position so environmental data could be updated. The team could not increase the number of data points to solve the issue of rendering environments as this would have been beyond the available hardware. Another new addition was "deferred lighting", an advanced lighting engine which could maintain realistic lighting during the game's day-night cycle in the open world, in addition to environmental effects such as characters getting wet. The retail version of the game also incorporated an advanced anti-aliasing filter. Character actions, including combat actions such as grappling, where created using a combination of motion capture and inverse kinematics. Physics was controlled using a specially-created in-house physics engine. The physical interaction between large monsters and characters climbing on them using a combination of physics and motion-based algorithms similar to early water animation techniques. These designs were intended to work on the contrasting hardware of the PS3 and 360.


title: Dragon's Dogma

text: The game was developed for the PlayStation 3 (PS3) and Xbox 360 (360) consoles. The choice of PS3 and 360 was chosen due to both the team's experience with the platforms and their large international install base. According to producer Hiroyuki Kobayashi, the team's previous experience creating "Devil May Cry 4" helped with development as they both carried over technology and had familiarity with the planned platforms. The online functionality for the PS3 and 360 were respectively co-developed and supported by Sony Computer Entertainment and the Japanese branch of Microsoft. Their cooperation enabled Capcom to reduce running costs for the online functions to nearly nothing. The limited scope of online elements was a compromise which both fulfilled with gameplay goals of the team while avoiding many of the problems of full multiplayer.


title: Dragon's Dogma

text: The localization was led by Erin Ellis. When creating the dialogue, Ellis's team wanted to create a similar feeling to the writing of George R. R. Martin and J. R. R. Tolkien due to the dramatic style of the game's narrative. The team decided to use semi-archaic English words in dialogue such as "thou" and "aught", resulting in the team needing to keep themselves from going too far or adding in incongruous words that clashed with the archaic style. Rather than using conventional spell names such as "Fire" and "Ice", the team found old English words such as "Halidom" and "Ingle". In contrast to many Japanese games—which were translated from Japanese to English and then into other languages—"Dragon's Dogma" was localized in six languages at once due to the development team still working on the game during the localization process. This meant that the team were able to minimize trimming the dialogue down and eliminating improbably abbreviations. According to Makino, the team hired 82 voice actors; the recording took place in North America between two studios over fifteen weeks, with two audio directors supervising the process. The team used different accents to indicate people being from different regions of the world, promoting a sense of realism. The Pawn voices were difficult due to the variety of physical customization. The team ultimately chose twelve voice actors to record lines at different pitches. The game ultimately featured 20 hours of voiced dialogue, coming to 42,000 lines of dialogue for all characters. As English was the primary language for all versions, lip syncing was not an issue. Needing to handle the different pieces of the localization within the strict time limit was a new experience for both Ellis and the Capcom staff.


title: Dragon's Dogma

text: An expanded version of the game titled "Dragon's Dogma: Dark Arisen" began development in 2012 for the game's original platforms. The game included additional content including an extra dungeon dubbed Bitterblack Isle, with additional weapons and armor exclusive to that area, and full Japanese voice acting. Producer Minae Matsukawa and director Kento Kinoshita had both worked on the original "Dragon's Dogma". Kobayashi acted as executive producer. "Dark Arisen" was Kinoshita's debut as a director. The game came about due to community feedback about the original game, with Bitterblack Isle being designed as a lore-based end-game dungeon with powerful enemies. There was also a wish to create a "complete" version of the game. "Dark Arisen" released in Japan on April 25, 2013 as both standard and limited editions. In Western territories, the game released on April 23 in North America and Australia, and April 26 in Europe. Save data from "Dragon's Dogma" can be transferred into "Dark Arisen".


title: Dragon's Dogma

text: A Microsoft Windows version of "Dark Arisen" was planned from an early stage, with the main aim being to take advantage of the Windows platform's greater technical specifications compared to the PS3 and 360, in addition to expanding the game's player base. The port was developed with QLOC. The team's main aim was to optimise the game for the Windows platform, rather than improving or expanding on current assets. The Windows version of "Dark Arisen" was released worldwide on January 15, 2016. It eventually released in Japan on October 5, 2017. "Dark Arisen" was later released for PlayStation 4 and Xbox One on October 3 in the West and October 5 in Japan. "Dark Arisen" was later released for the Nintendo Switch on April 23, 2019 in Europe and North America, and April 25, 2019 in Japan.


title: Dragon's Dogma

text: The music director for "Dragon's Dogma" was Tadayoshi Makino, who had previously worked on "Monster Hunter Tri". Maniko initially began planning the musical elements of the game in 2009, when the game world's design was still in a state of flux. Makino was initially pulled in two different directions by Itsuno and Kobayashi; while both wanted to make an impression outside standard fantasy music expectations, Itsuno wanted to use jazz while Kobayashi wanted to use hard rock similar to Queen and Kiss. By contrast, Makino wanted to use a full orchestra and ethnic elements, which resulted in the score having far more variety than anyone expected. Makino's team created samples, matched them against prototype promotional videos, then consulted sound staff at Capcom to blend the ethnic, orchestral and rock elements. The first completed track, the game's main theme, was favorably received by Kobayashi and Makino used the fusion of elements for the entire score. When creating his plan for the music, Makino decided to move away from the typical harsh-sounding action soundtracks Capcom games were known for, which used many high and low-pitched notes. Instead, Makino chose a softer sound for "Dragon's Dogma". His aim was to not make the music too assertive, allowing it to blend in with the natural world of the game.


title: Dragon's Dogma

text: Makino brought on three other composers to work on the soundtrack. They were Rei Kondoh, a composer who had worked on "Ōkami" and the "Sengoku Basara"; Inon Zur, an Israeli-American composer noted for his work on the "Dragon Age" series who was brought on board to make the soundtrack an international collaboration; and Masayoshi Ishi, whose work included the "Sengoku Basara" series and "The Excitement of Haruhi Suzumiya". Ishi was involved from an early stage, when the musical direction of the project was still being decided upon. Kondoh was brought in due to her work on previous Capcom titles. Zur's methods of working were entirely new to the otherwise-Japanese composers, something which the team thought would benefit the production. Makino acted as general supervisor due to his knowledge of the game's story. During the composing stage, Kondoh and Zur were described by Makino as bouncing opinions off each other when creating the soundtrack when creating tracks for individual situations. The composition went smoothly for the team, with each member stimulating the other. Vocals for the main theme "Eternal Return" were provided by Aubrey Ashburn, a frequent collaborator with Zur. Ashburn was brought on board after the theme was written and recorded using a substitute vocal track. During recording, she had instructions via a livestream from the production team.


title: Dragon's Dogma

text: The music was recorded in Bulgaria by the Sofia Philharmonic Orchestra; the recording, which took place at the Bulgarian National Radio Studio, included roughly 130 musicians and choir. A European orchestra was chosen as Makino wanted a distinctive sound different from the typical Hollywood-styled orchestral sound. The recording was supervised by Thomas Böcker and his company Merregnon Studios, who were brought aboard the project by Harmonics International based on their previous collaborations on Symphonic Fantasies concerts. Rock elements included in some tracks were recorded in Japan by guitarist Tenyu Nakamura and drummer Tatsuya Suzuki. As much music as possible was recorded live rather than using synthesized instruments. The game's theme song was "Into Free -Dangan-", written and performed by Japanese rock duo B'z. The song was an English cover version of B'z's 1998 single "Samayoeru Aoi Dangan". The lyrics were written by Koshi Inaba and Shane Gaalaas, while the music was created by Tak Matsumoto.


title: Dragon's Dogma

text: For "Dark Arisen", Makino returned to compose new tracks for the game's new dungeon alongside Kondoh and Zur; the new work, mainly focused on the new dungeon, covered 24 tracks. In contrast to "Dragon's Dogma", the added music for "Dark Arisen" made heavy use of synthesized music. Despite moving away from the style of the main game, Makino wanted to ensure the new music remained thematically in tune with the rest of the soundtrack. The new vocal theme for "Dark Arisen", "Coils of Light", was composed by Makino and performed by Japanese singer Raychell. When first contacted about the project, Raychell was already familiar with "Dragon's Dogma" and daunted by the prospect of providing a new theme song. The lyrics were written by Raychell to convey the game's world, in addition to the dark atmosphere of the new dungeon. Makino created "Coils of Light" using the core melody of "Eternal Return", tying into the original soundtrack. The English version of "Coils of Light" was sung by William Montgomery.


title: Dragon's Dogma

text: The official soundtrack album for "Dragon's Dogma" was released on May 23, 2012. Featuring 66 tracks across two CDs, the album was published by the music label of Square Enix. A shorter album was released by Sumthing Else Music Works as a physical and digital release on November 11. "Into Free -Dangan-" was released as a digital single on iTunes on April 4, 2012. The two-CD album for "Dark Arisen" released on April 24, 2013. The first disc contained the new music, while the second included a selection from the main soundtrack and tracks that could not be released on the original album. The Japanese version of "Coils of Light" was not included on the album. At Kobayashi's suggestion, Makino collaborated with Square Enix's Tsuyoshi Sekito, who had composed music for multiple Square Enix titles and performed as part of The Black Mages; Sekito performed guitar for some of the album's arranged tracks. "Coils of Light" was released as part of Raychell's album "L ▶ R" on April 24. A compilation album titled "Dragom's Dogma 5th Anniversary Best", featuring tracks from across the "Dragon's Dogma" series up to that point, was released on December 20, 2017 through Capcom's music label.


title: Dragon's Dogma

text: The game has been well received in Japan, where gaming magazine "Famitsu" gave the game an overall score of 34 out of 40, based on four reviewer scores of 8, 9, 8, and 9. "Famitsu" gave it a "Hall of Fame: Gold" award, praising "the game’s variety in combat, the effectiveness of working together with Pawns, the exceptionally fun sidequests, and the uniqueness of each vocation."


title: Dragon's Dogma

text: In the Western world, "Dragon's Dogma" received generally positive reviews. Review aggregator website Metacritic gave the PlayStation 3 version 78/100, and the Xbox 360 version 75/100.


title: Dragon's Dogma

text: "Game Informer" gave the game an 8.5 out of 10 and stated that "I left the game feeling that I made my mark on Gransys the way I chose to, instead of being escorted from plot point to plot point. When you're talking about an open-world game, I can't think of higher praise." "Eurogamer" Italy said that "Dragon's Dogma is a great fantasy game, where the lack of a multiplayer experience is compensated from an impressive single player." UK magazine "PSM3" wrote, "Big, challenging and imaginative, but its hardcore nature won't appeal to everyone." "GameSpot" gave the game a score of 8 out of 10. The review praised the "fantastic combat encounters," one of "the best boss fights in any role-playing game," atmospheric touches, and "striking choices" that lead to "an unforgettable ending." The review notes that the game "takes chances, and it's that riskiness that makes this role-playing game so unique among its peers," concluding that, "Engrossing and frustrating, "Dragon's Dogma" is a flawed and unique gem." The review also notes that while the boss battles are "epic", in the sense they allow players to climb up enemy monsters, the game itself lacks an adequate fast-travel system.


title: Dragon's Dogma

text: "Play" UK criticized it for low framerates on the Xbox 360 version. "IGN" scored it 7.5/10, stating ""Dragon's Dogma" has the scale and challenge of a great action RPG, but not the character or polish. Nevertheless, there's a lot to love here, like some great ideas that make you want to give it a chance." The Gaming mafia user Evan Daggett calls the game "a true underrated gem" and demands a sequel of the game. "GameTrailers" praised the challenging combat and the gameplay mechanics, though they criticized the story as "flat." Their rating for the game was an 8.7.


title: Dragon's Dogma

text: "Dragon's Dogma: Dark Arisen" received positive reviews. On Metacritic, the PC version scored 81/100, the Xbox 360 version scored 77/100, and the PlayStation 3 version scored 80/100. "IGN" scored the PC version 8.9/10, calling it a "thoroughly great action RPG" and stating "it has near perfect fluidity and all the epic feel of the Xbox 360/PS3 edition" and is a "valid alternative to "The Witcher 3" or "Dark Souls", if one can withstand graphics that are not really on par with today's standards."


title: Dragon's Dogma

text: "Dragon's Dogma: Dark Arisen" received a nomination for "Role-Playing/Massively Multiplayer Game of the Year" at the 17th Annual D.I.C.E. Awards.


title: Dragon's Dogma

text: In April 2020, "IGN" listed "Dragon's Dogma: Dark Arisen" as one of the best modern role-playing games, placing at number 9. IGN Staff cited, "It may be built off the massive open world RPG foundation of games like "The Elder Scrolls" and "The Witcher", but there’s still nothing quite like "Dragon’s Dogma: Dark Arisen"."


title: Dragon's Dogma

text: Upon its debut in Japan, the PS3 version of "Dragon's Dogma" topped gaming charts with sales of over 302,000 units. The 360 version came in at fourth place with over 29,000 units sold. These strong sales broke the previous record holder for the fastest-selling new intellectual property of the seventh console generation. In the United States, the game sold 92,000 copies within five days. The game reached ninth place in the regions's retail charts for May. In the UK, the game debuted in third place in game charts behind "Max Payne 3" and ahead of "". By the following month, the game had sold 1.5 million copies worldwide, being considered a major success by Capcom. According to the report, sales in Japan "exceeded expectations", while the game struggled in Western markets. Alongside sales of "Resident Evil 6", the game was credited by Capcom for their record-breaking earnings during 2012.


title: Dragon's Dogma

text: "Dark Arisen" for PS3 debuted in Japan at second place in gaming charts with sales of over 125,300 units. The 360 version reached thirteenth place with over 9,000 units sold. In the United Kingdom, "Dark Arisen" debuted in third place behind "" and "". In July 2013, Capcom described sales of the "Dark Arisen" version had met with solid sales without outselling the original version from the previous year. The PC version, while suffering from lower sales due to less marketing, became both Capcom's fastest-selling and one of the three best-selling titles for PC in the company's history.


title: Dragon's Dogma

text: On January 27, 2015, Capcom announced a sequel with a new story titled "Dragon's Dogma Online" as a free-to-play game for PlayStation 3, PlayStation 4 and PC. The game was launched in Japan on August 31, 2015. Cross-platform play among all platforms will be supported upon release.


title: Dragon's Dogma

text: "Dragon's Dogma Online" reached more than two million downloads within its first ten days of release. As of December 2019, "Dragons Dogma Online" servers have been shutdown due to low player count as it was only accessible natively in Japan.


title: Dragon's Dogma

text: Director Hideaki Itsuno had expressed interest in making a direct sequel as early as 2013. The sequel, "Dragon's Dogma II", was announced in June 2022. It is being developed on the RE Engine, with Itsuno returning as director.


title: Dragon's Dogma

text: In March 2019, production of an original net animation anime series adaptation based on the game was announced by Netflix. Produced by Sublimation and directed by Shin'ya Sugai, the series was released worldwide on September 17, 2020.


title: Canaanite religion

text: The Canaanite religion was the group of ancient Semitic religions practiced by the Canaanites living in the ancient Levant from at least the early Bronze Age through the first centuries AD. Canaanite religion was polytheistic and, in some cases, monolatristic.


title: Canaanite religion

text: Canaanites believed that following physical death, the "npš" (usually translated as "soul") departed from the body to the land of Mot (Death). Bodies were buried with grave goods, and offerings of food and drink were made to the dead to ensure that they would not trouble the living. Dead relatives were venerated and sometimes asked for help.


title: Canaanite religion

text: None of the inscribed tablets found in 1929 in the Canaanite city of Ugarit (destroyed c. 1200 BC) has revealed a cosmology. Any idea of one is often reconstructed from the much later Phoenician text by Philo of Byblos (c. 64–141 AD), after much Greek and Roman influence in the region.


title: Canaanite religion

text: According to the pantheon, known in Ugarit as 'ilhm (Elohim) or the children of El, supposedly obtained by Philo of Byblos from Sanchuniathon of Berythus (Beirut) the creator was known as Elion, who was the father of the divinities, and in the Greek sources he was married to Beruth (Beirut = the city). This marriage of the divinity with the city would seem to have Biblical parallels too with the stories of the link between Melqart and Tyre; Chemosh and Moab; Tanit and Baal Hammon in Carthage, Yah and Jerusalem.


title: Canaanite religion

text: The union of El Elyon and his consort Asherah would be representation of primordial Cronos and Rhea in Greek mythology or Roman Saturnus and Ops.


title: Canaanite religion

text: In Canaanite mythology there were twin mountains Targhizizi and Tharumagi which hold the firmament up above the earth-circling ocean, thereby bounding the earth. W. F. Albright, for example, says that El Shaddai is a derivation of a Semitic stem that appears in the Akkadian "shadû" ("mountain") and "shaddā'û" or "shaddû'a" ("mountain-dweller"), one of the names of Amurru. Philo of Byblos states that Atlas was one of the Elohim, which would clearly fit into the story of El Shaddai as "God of the Mountain(s)". Harriet Lutzky has presented evidence that Shaddai was an attribute of a Semitic goddess, linking the epithet with Hebrew "šad" "breast" as "the one of the Breast". The idea of two mountains being associated here as the breasts of the Earth, fits into the Canaanite mythology quite well. The ideas of pairs of mountains seem to be quite common in Canaanite mythology (similar to Horeb and Sinai in the Bible). The late period of this cosmology makes it difficult to tell what influences (Roman, Greek, or Hebrew) may have informed Philo's writings.


title: Canaanite religion

text: In the Baal Cycle, Ba'al Hadad is challenged by and defeats Yam, using two magical weapons (called "Driver" and "Chaser") made for him by Kothar-wa-Khasis. Afterward, with the help of Athirat and Anat, Ba'al persuades El to allow him a palace. El approves, and the palace is built by Kothar-wa-Khasis. After the palace is constructed, Ba'al gives forth a thunderous roar out of the palace window and challenges Mot. Mot enters through the window and swallows Ba'al, sending him to the Underworld. With no one to give rain, there is a terrible drought in Ba'al's absence. The other deities, especially El and Anat, are distraught that Ba'al has been taken to the Underworld. Anat goes to the Underworld, attacks Mot with a knife, grinds him up into pieces, and scatters him far and wide. With Mot defeated, Ba'al is able to return and refresh the Earth with rain.


title: Canaanite religion

text: Archaeological investigations at the site of Tell es-Safi have found the remains of donkeys, as well as some sheep and goats in Early Bronze Age layers, dating to 4,900 years ago which were imported from Egypt in order to be sacrificed. One of the sacrificial animals, a complete donkey, was found beneath the foundations of a building, leading to speculation this was a 'foundation deposit' placed before the building of a residential house.


title: Canaanite religion

text: It is considered virtually impossible to reconstruct a clear picture of Canaanite religious practices. Although child sacrifice was known to surrounding peoples, there is no reference to it in ancient Phoenician or Classical texts. The biblical representation of Canaanite religion is always negative.


title: Canaanite religion

text: Canaanite religious practice had a high regard for the duty of children to care for their parents, with sons being held responsible for burying them, and arranging for the maintenance of their tombs.


title: Canaanite religion

text: Canaanite deities such as Baal were represented by figures which were placed in shrines, often on hilltops, or 'high places' surrounded by groves of trees, such as is condemned in the Hebrew Bible, in Hosea (v 13a) which would probably hold the Asherah pole, and standing stones or pillars.


title: Canaanite religion

text: The Levant region was inhabited by people who themselves referred to the land as 'ca-na-na-um' as early as the mid-second millennium BC. There are a number of possible etymologies for the word referred.


title: Canaanite religion

text: The Akkadian word ""kinahhu"" referred to the purple-colored wool, dyed from the "Murex" molluscs of the coast, which was throughout history a key export of the region. When the Greeks later traded with the Canaanites, this meaning of the word seems to have predominated as they called the Canaanites the Phoenikes or "Phoenicians", which may derive from the Greek word ""Phoenix"" meaning crimson or purple, and again described the cloth for which the Greeks also traded. The Romans transcribed ""phoenix"" to ""poenus"", thus calling the descendants of the Canaanite settlers in Carthage ""Punic"".


title: Canaanite religion

text: Thus while ""Phoenician"" and ""Canaanite"" refer to the same culture, archaeologists and historians commonly refer to the Bronze Age, pre-1200 BC Levantines as Canaanites; and their Iron Age descendants, particularly those living on the coast, as Phoenicians. More recently, the term Canaanite has been used for the secondary Iron Age states of the interior (including the Philistines and the states of Israel and Judah)


title: Canaanite religion

text: that were not ruled by Arameans — a separate and closely related ethnic group. The DNA of the modern Arab and Jewish people matches the DNA of the ancient Canaanites.


title: Canaanite religion

text: Canaanite religion was strongly influenced by their more powerful and populous neighbors, and shows clear influence of Mesopotamian and Egyptian religious practices. Like other people of the Ancient Near East Canaanite religious beliefs were polytheistic, with families typically focusing on veneration of the dead in the form of household gods and goddesses, the Elohim, while acknowledging the existence of other deities such as Baal and El, Mot, Qos, Asherah and Astarte. Kings also played an important religious role and in certain ceremonies, such as the "hieros gamos" of the New Year, may have been revered as gods. "At the center of Canaanite religion was royal concern for religious and political legitimacy and the imposition of a divinely ordained legal structure, as well as peasant emphasis on fertility of the crops, flocks, and humans."


title: Canaanite religion

text: Canaanite religion was influenced by its peripheral position, intermediary between Egypt and Mesopotamia, whose religions had a growing impact upon Canaanite religion. For example, during the Hyksos period, when chariot-mounted "maryannu" ruled in Egypt, at their capital city of Avaris, Baal became associated with the Egyptian god Set, and was considered identical – particularly with Set in his form as Sutekh. Iconographically henceforth, Baal was shown wearing the crown of Lower Egypt and shown in the Egyptian-like stance, one foot set before the other. Similarly Athirat (known by her later Hebrew name Asherah), Athtart (known by her later Greek name Astarte), and Anat henceforth were portrayed wearing Hathor-like Egyptian wigs.


title: Canaanite religion

text: From the other direction, Jean Bottéro has suggested that "Ya" of Ebla (a possible precursor of Yam) was equated with the Mesopotamian god Ea during the Akkadian Empire. In the Middle and Late Bronze Age, there are also strong Hurrian and Mitannite influences upon the Canaanite religion. The Hurrian goddess Hebat was worshiped in Jerusalem, and Baal was closely considered equivalent to the Hurrian storm god Teshub and the Hittite storm god, Tarhunt. Canaanite divinities seem to have been almost identical in form and function to the neighboring Arameans to the east, and Baal Hadad and El can be distinguished amongst earlier Amorites, who at the end of the Early Bronze Age invaded Mesopotamia.


title: Canaanite religion

text: Carried west by Phoenician sailors, Canaanite religious influences can be seen in Greek mythology, particularly in the tripartite division between the Olympians Zeus, Poseidon and Hades, mirroring the division between Baal, Yam and Mot, and in the story of the Labours of Hercules, mirroring the stories of the Tyrian Melqart, who was often equated with Heracles.


title: Canaanite religion

text: Until Claude F. A. Schaefer began excavating in 1929 at Ras Shamra in Northern Syria (the site historically known as Ugarit), and the discovery of its Bronze Age archive of clay tablets written in an alphabetical cuneiform, modern scholars knew little about Canaanite religion, as few records have survived. Papyrus seems to have been the preferred writing medium, but whereas in Egypt papyrus may survive centuries in the extremely dry climate, Canaanite records have simply decayed in the humid Mediterranean climate. As a result, the accounts contained within the Bible represented almost the only sources of information on ancient Canaanite religion. This record was supplemented by a few secondary and tertiary Greek sources: (Lucian's "De Dea Syria" (The Syrian Goddess), fragments of the "Phoenician History" of Philo of Byblos (died 141 AD), and the writings of Damascius). More recently, detailed study of the Ugaritic material, of other inscriptions from the Levant and also of the Ebla archive from Tel Mardikh, excavated in 1960 by a joint Italo-Syrian team, have cast more light on the early Canaanite religion.


title: Canaanite religion

text: According to "The Encyclopedia of Religion", the Ugarit texts represent one part of a larger religion that was based on the religious teachings of Babylon. The Canaanite scribes who produced the "Baal" texts were also trained to write in Babylonian cuneiform, including Sumerian and Akkadian texts of every genre.


title: Canaanite religion

text: Archaeological excavations in the last few decades have unearthed more about the religion of the ancient Canaanites. The excavation of the city of Ras Shamra (1928 onwards) and the discovery of its Bronze Age archive of clay-tablet alphabetic cuneiform texts provided a wealth of new information. Detailed study of the Ugaritic material, of other inscriptions from the Levant and also of the Ebla archive from Tel Mardikh, excavated in 1960 by a joint Italo-Syrian team, have cast more light on the early Canaanite religion.


title: Foo Fighters (album)

text: Foo Fighters is the debut studio album by American rock band Foo Fighters, released on July 4, 1995, through Roswell and Capitol Records. Dave Grohl wrote and recorded the entire album himself, with the assistance of producer Barrett Jones at Robert Lang Studios in Seattle, Washington, in 1994. He said that he recorded the album just for fun, describing it as a cathartic experience to recover from the suicide of Nirvana bandmate Kurt Cobain.


title: Foo Fighters (album)

text: After Grohl completed the recordings, he chose the name "Foo Fighters" for the project to hide his identity, and passed cassette copies of the sessions to personal friends. When the tapes attracted record label interest, Grohl signed with Capitol and recruited a full band to perform the songs live. The album was promoted through extensive tours and six singles, two of which were accompanied by music videos.


title: Foo Fighters (album)

text: Upon its release, "Foo Fighters" earned positive reviews, praising its songwriting and performances, and was also a commercial success, becoming the band's second-best-selling album in the United States. It also peaked within the top five of charts of the United Kingdom, Canada, Australia, and New Zealand.


title: Foo Fighters (album)

text: In 1990, Dave Grohl joined the grunge band Nirvana as drummer. During tours, he took a guitar with him and wrote songs, but was too intimidated to share them with the band; he was "in awe" of the songs written by frontman Kurt Cobain. Grohl occasionally booked studio time to record demos and covers, issuing an album of demos, "Pocketwatch", under the pseudonym Late! in 1992.


title: Foo Fighters (album)

text: Following Cobain's suicide in April 1994, Grohl entered a state of depression, and found it difficult to both listen to music and play instruments. He was uncertain of what to do next, even considering abandoning his musical career despite a few invitations by bands such as Danzig or Tom Petty and the Heartbreakers to become their drummer, because "it would just remind me of being in Nirvana; every time I sat down at a drum set, I would think of that."


title: Foo Fighters (album)

text: Grohl's first musical performance following the demise of Nirvana was performing with The Backbeat Band at the 1994 MTV Movie Awards in June, during which he was invited by Mike Watt to take part in his album "Ball-Hog or Tugboat?". After enjoying the performance, Grohl figured he could do his own musical project, which could work as "some sort of cathartic therapy, to go out and record these songs that I'd written by myself." Grohl afterwards booked six days at Seattle's Robert Lang Studios, which were located near his house, where he would record "my favorite songs I had written in the past four, five years that no one had heard" with the assistance of "Pocketwatch" producer Barrett Jones. The idea was to have Grohl playing all instruments and release it under a name that would make people believe it was a band, similar to Stewart Copeland's "Klark Kent".


title: Foo Fighters (album)

text: Grohl and Jones produced the record across a period of one week in October 1994, with Grohl on vocals and all instruments. Both would arrive in the morning at Robert Lang Studios, start production by noon and do four songs a day. According to Grohl, during the recording process he would run from room to room, "still sweating and shaking from playing drums and [then] pick up the guitar and put down a track, do the bass, maybe another guitar part, have a sip of coffee and then go in and do the next song". The only performance by an outsider was a guitar part on "X-Static" provided by Greg Dulli of the Afghan Whigs, who was watching Grohl record the songs. Grohl eventually asked him if he wanted to play and handed him a guitar. Each song took about 45 minutes to be completed, and the compositions were recorded in the same order that became the album's track listing. The only song that required two run-throughs before completion was "I'll Stick Around". Grohl was insecure about his singing, and added effects to his voice in "Floaty", and tried to enhance the performance through double track – "You know how people double their vocals to make them stronger? That album the vocals are quadrupled."


title: Foo Fighters (album)

text: In an attempt to keep his anonymity, Grohl planned to release the songs under the name Foo Fighters. It would be a very low-key release, with only 100 LP records being pressed after the sessions were finished. Grohl also went to a cassette duplication lab in Seattle and created 100 cassette copies of the session and started handing them to friends for feedback and "I'd give tapes to everybody. Kids would come up to me and say 'Nirvana was my favourite band' and I'd say 'well here, have this'". Eddie Vedder premiered two songs from the recording on January 8, 1995 during his "Self-Pollution" radio broadcast. The recordings quickly circulated amongst the music industry, which in turn created record label interest. A deal was eventually signed to Capitol Records, as president Gary Gersh was a personal friend of Grohl ever since he worked on Nirvana's label Geffen Records.


title: Foo Fighters (album)

text: The mixing sessions of the album began in Robert Lang Studios (which were used on the 100 tapes Grohl gave away) but eventually those mixes were discarded and the sessions moved to Rob Schnapf and Tom Rothrock's "The Shop" studio in Arcata, California. Mixes were done on a 32 channel API DeMedio console, custom built by Frank DeMedio in 1972 for Wally Heider Recording's 'Studio 4'. A Stephen's 24 track 2" tape machine was used for playback. Processors used in the mixes included an Eventide Omnipressor compressor for vocals and guitar solos, an Alan Smart stereo compressor for "squashing" the drums and mixing them back in as well as being used over the entire mix. Other processors included UREI 1176 and LA3A compressors as well as an Echoplex for delays and a "crappy digital reverb". Mixes were "nothing that crazy" Rob described, adding that he "mixed 'Big Me' in 20 minutes".


title: Foo Fighters (album)

text: During the sessions, Grohl was invited by Tom Petty to perform with The Heartbreakers on "Saturday Night Live" one month later. The performance was followed by an invitation to be a full-time member of the Heartbreakers, but once Petty heard about the Foo Fighters, he instead encouraged Grohl to move on with this solo project. Grohl soon recruited a full band, which included bassist Nate Mendel and drummer William Goldsmith of the recently disbanded Sunny Day Real Estate, as well as Nirvana touring guitarist, and former Germs member, Pat Smear.


title: Foo Fighters (album)

text: Nine of the songs in the album were composed before or during Grohl's tenure with Nirvana, and existed in demos created by Grohl on his home 8-track tape recorder. The only compositions done after Cobain's death were "This Is a Call", "I'll Stick Around", "X-Static" and "Wattershed". The album's sound has been primarily described as alternative rock, post-grunge, grunge, and punk rock. Stephen Thomas Erlewine of AllMusic stated that the album was a "handful of punk-pop gems that show, given the right musicians and songwriters, the genre had not entirely become a cliché by the middle of the '90s." The music mostly followed a hard rock sound with the soft-loud dynamics seen in Nirvana tracks such as "Smells Like Teen Spirit" and "Heart-Shaped Box". Variants include the melancholic "Exhausted", which Grohl defined as a song that's "sad but makes you feel good".


title: Foo Fighters (album)

text: Most of the lyrics on "Foo Fighters" are nonsensical lines written by Grohl in the 20 minutes before recording began. As Grohl later explained, "I had seven days to record fifteen songs. I was just concentrating on everything being as together as possible, having everything be tight and in sync. There wasn't too much time spent sitting in a chair thinking." Grohl would add that the gibberish was deliberate, given that "there was too much to say" following Cobain's death and "a lot of emphasis [was] placed on the meaning of the first Foo Fighters album." Grohl still considered that "the things you write down spur of the moment are most revealing. Now I look at them and some of them seem to actually have meaning", and revealed that a few songs have lyrics inspired by "personal experiences of the last four or five years", with the standout being "Big Me", an "out-and-out love song" to Grohl's then-wife Jennifer Youngblood that he described as his favorite track on the album. Contrasting with the aggressive and rebellious themes of Nirvana, Grohl had positive and cheery tunes such as "This Is a Call", defined as "a 'hello' and a 'thank you'" to everyone that had played a key role in Grohl's life; the playful "For All the Cows"; and "Wattershed", with a title referencing Mike Watt and lyrics that described Grohl's "love of hardcore and old school punk rock".


title: Foo Fighters (album)

text: The name "Foo Fighters" was taken from the description World War II aircraft pilots would use to describe various UFOs. This science fiction theme is further continued with the name of Grohl's Capitol Records imprint, Roswell Records, a reference to the city of Roswell, New Mexico, known for the Roswell UFO incident of 1947; and the album cover done by Grohl's then-wife, photographer Jennifer Youngblood, featuring a Buck Rogers XZ-38 Disintegrator Pistol.<ref name="/story714">Apter, 2006. pp. 271-4</ref> Some reviewers considered the gun on the cover as insensitive, given Kurt Cobain died by shooting himself, but Grohl dutifully disregarded it as just a coincidence. Goldsmith later explained, "It was all pretty much based on the whole Foo Fighters thing—Roswell, the space stuff, an antique Buck Rogers raygun. It's really a completely separate thing. Dave wasn't even conscious of that." Despite Grohl being the album's only contributor, at Capitol's insistence the liner notes included a picture of the full band that Grohl had recruited.


title: Foo Fighters (album)

text: In spring 1995, Foo Fighters embarked on their first ever United States tour, supporting Mike Watt on his Ring Spiel Tour along with fellow tour newbies Hovercraft, whose line-up included Vedder at the time. As well as performing with their own bands, Grohl and Vedder each picked up a role as a member of Watt's backing band throughout the tour, supplying drums and guitar respectively. In May 1995, radio stations KROQ-FM and KNDD started playing some tracks of the then-unreleased album before receiving a cease-and-desist from Capitol. That June, "Exhausted" and "This Is a Call" were sent to college and modern rock radio stations. One week later, "This Is a Call" became the band's first commercial single.


title: Foo Fighters (album)

text: "Foo Fighters" was released July 4, 1995 on Roswell Records, distributed by Capitol Records. The band promoted the release that summer by completing another US tour with Wool and Shudder to Think, with 25 concerts in little over a month. Foo Fighters also made their network television debut on the "Late Show with David Letterman" on August 14, performing "This Is a Call". Afterwards, the band played several of their largest shows up to that point, making their debut on the European festival circuit with performances at Pukkelpop, Reading and Lowlands.


title: Foo Fighters (album)

text: "I'll Stick Around" was issued as the second single on September 4, 1995 and would also mark Foo Fighters' music video debut, directed by Gerald Casale. That fall, the band continued to tour extensively, with a European tour with Built to Spill, and visits to Japan, Australia and New Zealand. The tour was wrapped with a performance at the Phoenix Festival on July 20, 1996. The Foo Fighters performed nearly 100 concerts throughout 1995, and over 70 dates the following year.


title: Foo Fighters (album)

text: Three more songs of the album were issued as singles: "For All the Cows" in 1995, and both "Big Me" and "Alone + Easy Target" in 1996. "Big Me" was the first commercial single made available in the US, and the second song from the album to see release as a music video, a parody of the Mentos television commercials directed by Jesse Peretz.


title: Foo Fighters (album)

text: "Foo Fighters" earned mostly positive reviews upon release. Many critics compared the album to Nirvana. Reviewer David Browne of "Entertainment Weekly" considered that "[Grohl's] songs pack the riffy wallop of unpolished Nirvana demos, and his voice has Kurt Cobain's lunging, over-the-top passion." Writing for "Spin", Terri Sutton stylistically compared the album to Nirvana's second album, "Nevermind", saying that "the album's first half [...] owes much to "Nevermind", and it's tempting to hear it in the way "Nevermind" taught us to hear." Paul Rees of "Kerrang!" admitted that ""Foo Fighters" cannot fail to evoke Kurt Cobain's memory, whether if through Grohl's ragged howl of a voice or the way a number of its songs go soft-soft-loud", but ultimately considered the record "more than strong enough to stand or fall in its own merits". "Billboard" complimented the "inspired songwriting and passionate performances", adding the album could please grunge fans and "also remind fans of other rock and punk taste makers, from Green Day and the Offspring to Better than Ezra."


title: Foo Fighters (album)

text: The album received minor criticism for its lack of intensity, which many proposed was due to the fact that Grohl played all the instruments himself. AllMusic reviewer Stephen Thomas Erlewine wrote, "Since he recorded the album by himself, they aren't as powerful as most band's primal sonic workouts, but the results are damn impressive for a solo musician." "Rolling Stone"s Alex Foege described the record as a "remarkable yet coolly understated solo debut" and felt that "the album's only disappointment is that despite its home-studio feel, it ultimately reveals little about its creator." "New York" described both the overall melodies and Grohl's singing as derivative of the grunge sound, but praised the "tight Beatlesesque harmonies" and lyrics that "key into the more poetic moments of dudespeak." Robert Christgau wrote in "The Village Voice" that the band shows "spirit" but lacks an "identity" and cited the songs "Big Me" and "This Is a Call" as highlights. He later rated the album a three-star honorable mention in his "Consumer Guide" book, indicating "an enjoyable effort consumers attuned to its overriding aesthetic or individual vision may well treasure".