AJR 2005; 184:363
© American Roentgen Ray Society
From the Editor's Notebook |
Radiological Advances: Putting Things in Perspective
James M. Provenzale, Associate Editor
prove001{at}mc.duke.edu
The number of emergency department patients who undergo CT of the cervical
spine has dramatically increased in my institution (like most other
institutions) in the last few years for various reasons. No doubt, this has
made life easier for residents. No longer, in the middle of the night, must
the resident obtain one "swimmer's view" film after another to
visualize the C7 vertebral body in a broad-shouldered emergency department
patient. It is all there on the PACS station, reformatted in enough planes to
answer almost all questions. I occasionally find myself saying to the resident
during read-out sessions "do you realize how much easier these CT scans
are to read than the plain films I had to deal with as a resident?" and
then explaining how much work went into clearing C-spine radiographs on many
patients in a busy emergency department. The typical response of the resident
is something along the lines of "I guess that was when giants walked the
earth." It is tempting to agree, but it is not true. The time when
giants walked the earth was long before me, when people like Russell Carman
(1875–1926) spent innumerable hours analyzing gastric fold patterns
during fluoroscopy and then followed patients to the operating room for
correlation with anatomical features
[1]. More recently, it was when
Juan Taveras (1919–2002) taught a generation of radiologists how to
diagnose brain pathology based on meticulous observation of subtle findings on
cerebral angiography.
Over time, diagnosis in radiology has become easier and the new generation
of radiologists (like my generation) may have lost a sense of how difficult
things once had been. This month's issue of the AJR shows a number of
instances our radiological forbearers would be amazed by the manner in which
their labor-intensive studies have been made much less costly in terms of time
and effort. For instance, Goehde et al. report upon the use of an MRI
examination that is tailored to provide detail of multiple organ systems
within a single patient [2].
The examination time is lengthy, being slightly longer than an hour.
Nonetheless, it is safe to assume that the late 19th and early 20th century
radiology pioneers would be quite impressed with the screening capabilities
offered by this technique. Consider the fact that the first dental
radiographs, obtained by Otto Walkhoff 2 weeks after Roentgen's discovery of
the X-ray, had an exposure time of 25 minutes
[3], about half the time needed
for the full-body screening MRI examination described by Goehde et al.
Other advances that would have caused the pioneers of radiology to stop and
take note are evident in the February issue. Two articles (one by Halliburton
and colleagues [4] and another
by Shim and colleagues [5]) can
be found on the use of MDCT for diagnosis of cardiac disease. One now can
diagnose various anatomic and physiologic cardiac abnormalities using a
noninvasive technique that takes just a few minutes to perform. What would
Werner Forssmann, who won the 1956 Nobel Prize in Medicine, have been able to
accomplish with such technology? In the absence of such technology in 1929,
Dr. Forssmann studied cardiac physiology by inserting a cannula in his own
antecubital vein followed by a 65-cm catheter. He then walked up a flight of
stairs to his radiography suite to show the tip of the catheter in his right
atrium [6].
We radiologists are fortunate to live in exciting times, but today's
researchers have big shoes to fill. Only time will tell if the present
exciting era ever will be regarded as "days of the giants." We can
only hope so.
References
- Eisenberg RL. Radiology. An illustrated
history. St. Louis, MO: Mosby Year Book, 1992:272
- Goehde SC, Hunold P, Vogt FM, et al. Full-body cardiovascular and
tumor MRI for early detection of disease: feasibility and initial experience
in 298 subjects. AJR2005; 184:598
–611[Abstract/Free Full Text]
- As mentioned on the Radiology historical Web site maintained by the
Section of Radiologic Computing and Imaging Science, Department of Radiology,
Penn State University
www.xray.hmc.psu.edu/rci/ss6/ss6_1.html.
Accessed December 27, 2004
- Halliburton SS, Stillman AE, Lieber M, Kasper JM, Kuzmiak SA, White
RD. Potential clinical impact of variability in the measurement of coronary
artery calcification with sequential MDCT. AJR2005; 184:643
–648[Abstract/Free Full Text]
- Shim SS, Kim Y, Lim SM. Improvement of image quality with
ß-blocker premedication on ECG-gated 16-MDCT coronary angiography.
AJR 2005;184:649
–654[Abstract/Free Full Text]
- Forssman W. Experiments on myself: memoirs of a surgeon
in Germany. New York: Saint Martin's Press, 1974:84
–85
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