Hi PG,
If you look at the BT151 series data sheet, you will see that there are 3 devices in the BT 151 range; a 500 volt, 650 volt and 800 volt rated device. The type numbers are; BT151/500R, BT151/650R, and BT151/800R.
The R represents "Reverse polarity".
Traditionally, in Philips speak, a diode had the 'cathode' connected to the case. However, for these BT 151 types, the 'ANODE' is connected to the case (TAB)
If you consider a full wave rectifier, there are two 'cathodes' connected together at the +side, and two 'anodes' connected together at the - side. In order to get rid of the heat, as Mr AL says, it is good if the case can be directly mounted on to the heat sink WITHOUT an insulator. With the BT151/500R, the two anodes can be bolted directly to the heatsink; but for the other two diodes, they have to be insulated from the heats ink OR bolted directly to two independent heat sinks. HOWEVER, IF there was a device BT151/500, this would have the 'CATHODES' connected to the tab and then they could be bolted directly to a heatsink. I'm not sure I've seen 'normal polarity' SCR's but it was the case with diodes. See BYX52 series for example.
If you look at the data sheet for the BTW23, you will see the description says ;" ... reverse polarity types". Philips have been using this nomenclature for over 50 years.
With modern devices soldered directly into circuit, many of the previous mounting and heat dissipation problems have changed.
In the early days of high powered SCR's, the only available heat sink mounting insulator was mica, but today there are some excellent high thermal conductivity and high voltage, ceramic materials available.