subject: A Personal Reflection on the History of Radiology [print this page] A Personal Reflection on the History of Radiology
In the beginning, there was darknesswell at least there were darkrooms. But no x-rays. Yeah, we had the necessary ingredientselectricity, magnetism, and vacuum tubes. But as usual, they came with the proviso seen on my last Christmas presentSOME ASSEMBLY REQUIRED.("Honey, get me my hammerand get MacGyver on the phone.")
Fortunately, radiology has benefited from many MacGyvers. First and foremost was Conrad Roentgen, a German physicist and professor. Conrad Roentgen discovered X rays by accident on Friday November 8, 1895. He was conducting experiments with electricity and cathode ray tubes. He noticed a faint, flickering glow from barium platinocyanide screens used for other purposes and stored on a bench on the opposite side of the room. These screens were not part of his experiment and were distracting so he moved them as far away as possible but the glimmer persisted every time electricity was present. Fortunately, he possessed a supple intellect and the improvisational skills required to recognize and exploit this discovery. He reasoned that some type of ray or particle must be emanating from the evacuated cathode ray tubes to produce a glow on these screens. Roentgen realized that if these rays could penetrate a light proof container they could penetrate other things. Testing his hypothesis, he held various objects between the tube and the screen. When he placed his hand in the interval, he was amazed to see the ghostly shadow of the bones and soft tissues. The flesh was transparent, but the bones were opaque. Only lead and platinum obstructed the rays completely. The rays traveled in straight lines, were not distorted by magnetic fields (like cathode rays), and were not refracted by an air/water interface (like ultraviolet light). Roentgen dubbed his newly discovered form of light the "x-ray.
The potential of these x-rays was immediately recognized. On February 18, 1896, fluoroscopy was utilized to locate a bullet deeply embedded between the tibia and fibula of a Montreal man's leg facilitating its removal. The same year Harvey Cushing, a pioneer neurosurgeon, imaged a bullet lodged near a man's spinal cord. And this was just the beginning
Also, x-rays provide two-dimensional images of three-dimensional objects, thus the necessity for two views obtained perpendicular to each other. The adage "One view is no view" is repeated daily in radiology training programs around the world.
The ingenious solution to these two disparate problems was provided by one Godfrey Hounsfield, a British engineer, who reasoned that if many x-ray machines were placed in a ring, radiographs could be taken from all angles. Computers could then assimilate the information and display it in cross sections as if the patient had been passed through a guillotine at 1 centimeter intervals. This led to the birth of computerized tomography (CT scanning) in 1971.
CT easily demonstrated acute hemorrhage, infarcts, abscesses, inflammation and all other forms of pathology which had previously appeared as a single confluent shade of gray. Computerized tomography's incorporation of computers and coaxial imaging facilitated the next breakthrough in the field of radiology provided by Paul Lauterbur and Peter Mansfield whose clinical research with magnetic resonance imaging evolved throughout the 70's and 80's into today's MRI scanners. CT retains superiority in spatial resolution and speed. Although many of the advancements in radiology led to Nobel prizes and great fame, it is also necessary to mention those pioneers of radiology who advanced the field on a smaller but equally important level. CC Pate MD was born in Ennis, Texas in 1899. He attended TCU for his Bachelor's degree and later graduated from Vanderbuilt Medical School in the class of 1921. He moved to Paducah, TX in 1926 and established a medical practice that he would continue for 50 years. Dr. Pate made house calls in both automobile and on horseback. During emergencies, patients would hang a lantern on the windmill at night to aid him in locating their ranch houses. During one procedure at the hospital in Paducah, he utilized fluoroscopy to locate and remove metal fragments from the head, neck, and eye of a patient injured in an automobile accident. The fragments were deeply embedded in soft tissue and bone, and obscured by excessive bleeding, which often occurs in scalp and facial wounds. The procedure lasted more than an hour, and although the patient lived and his eye-sight was preserved, his hair fell out in the following weeks. Dr. Pate developed numerous non- healing ulcerations on his hands and left forearm. The risks of radiation exposure were poorly understood because radiation cannot be seen, heard or felt. It is odorless and tasteless. The complications are delayed. It's hard to believe that there once was a time when the value of x-ray, CT and MR in medicine was debatable.
However, due to the creative genius of past generations as well as the sacrifice and commitment to care of our predecessors, radiology has grown into the phenomenally beneficial field that it is today. Growing as always, changing constantly, and forever fascinating.
