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Perspective |
1 Department of Radiology, Charles University Hospital Plzen, Alej Svobody 80,
Plzen 30640, Czech Republic.
2 Deceased.
3 Department of Radiology, University Hospital Hradec Králové,
Hradec Králové, Czech Republic.
4 Department of Radiology, University Hospital Brno, Bohunice, Czech
Republic.
Received December 20, 2007; accepted after revision December 20, 2007.
In memory of Antonin Hlava (1931-2007), Herodotus of Czech radiology.
Keywords: Czech Republic • history of radiology
The first radiograph ever to be printed in the Czech press was an
X-ray of a finger wearing a ring, a rather popular theme at that time, in the
January 1896 issue of the Ziva; the image had been obtained by
Professor Karel Domalíp of the Czech University of Technology with an
instrument he had designed and built
[1]. The territorial units
preceding the establishment of the Czech Republic, the historical Lands of the
Czech Crown—the Bohemian Kingdom and the Moravian Margravate—were,
at the time of Roentgen's highly celebrated discovery, part of the Habsburg
Empire. Many Czech physicians of that time worked in long-term positions not
only at the Imperial-Royal Charles University in Prague, but also at the
University of Vienna. Czech academics also maintained active contacts with
academics at institutes in nearby Germany. It comes, therefore, as no surprise
that the first written record in the Czech specialized medical press, dated
February 8, 1896, is the announcement of a lecture to be held by Professor
en
k Strouhal on "Roentgen's
Experiments," printed in the Casopis lekaru ceskych—that
is, the Journal of Czech Physicians.
The Seeds
On February 17, 1896, Professor Strouhal (1850-1922) held his first lecture for the medical community in which he gave a practical demonstration of Roentgen's discovery; in front of an audience, he produced X-rays of various objects and animals (Fig. 1) and of a specimen of a hand in which needles had been stuck, and he demonstrated how an X-ray is obtained by imaging the right hand of a 21-year-old woman with posttraumatic pseudoarthrosis. The first experiments with X-rays were performed by this enthusiastic propagator of experimental physics, ac cording to the records of his assistant Vladimír Novák, after Christmas of 1895, although it was only on December 28, 1895 [1, 2], that Roentgen handed over the manuscript of his lecture "Ueber die neue Art von Strahlen"; the first press report was not published until January 5, 1896, in the Viennese daily Die Presse. Strouhal's interest in Roentgen's discovery was undoubtedly influenced by the years he had spent as a young scientist in Wuerzburg, Germany, where he earned his degree in 1878.
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Over the course of the year 1896, experiments with Roentgen rays were
handed to physicians from physicists and chemists. In 1897, experiments by
Jedli
ka and Chalupeck
were performed to locate foreign bodies
in the eyeballs of several patients. In a public lecture in January 1896,
Professor Domalíp demonstrated, among other things, an X-ray of an
enucleated eyeball with a foreign body, and the report published on this
experiment in the Bulletin is apparently the first-ever account in
the world of an intraocular foreign body imaged using X-rays
[1].
Starting in 1897, intensive experiments with the medical use of images
obtained with Roentgen rays aroused the interest of Professor Rudolf
Jedlika, dubbed "the father of Czech radiology," who, at
that time, was still working as an assistant to Maydl at the Department of
Surgery of the Charles University in Prague. It was Jedlika, with his
immense diligence and energy, who created radiology as a self-reliant
specialty. In addition to his many clinical successes obtained with the use of
radiologic diagnostics, one has to mention two circumstances: first,
Jedlika obtained one of the first X-ray films of calcified arteries
ever to be published; and, second, he had a rather tragic vision of the
negative effects of X-rays. Jedlika soon became the victim of his
untiring experiments and recognized as early as 1899 the nature of the
dermatitis affecting radiologic diagnosticians
[3].
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ka discussed the negative effects of X-rays with Zuppinger in
Zurich and with Contremoulin in Paris. In the same year, 1899, the then
30-year-old Jedlika published the first textbook about the use of
Roentgen rays titled On Skiagraphy and Skiascopy with Roentgen Rays and
Their Diagnostic Value in Surgery
(Fig. 2). Over the first 10
years since Roentgen's discovery, much like elsewhere in the world, imaging
with Roentgen rays spread to other medical specialties. Experiments concerned
with the therapeutic use of X-rays were published as well.
A turning year in the development of Czech radiology was 1918, related not
only to the fact that the Czech state had regained its sovereignty after 300
years, but also to a surge in activities aiming to emancipate radiology as a
specialty, which was not, unlike in Germany, an independent medical field in
the Austro-Hungarian Empire of that time. Professor Jedlika became the
founder of medical radiologic diagnostics in Bohemia, and when the independent
Czechoslovak Republic came into being, he was appointed the first professor of
radiology. He helped to establish the Radiological Society in 1924 and
organized the first Czechoslovak Radiological Congress in 1926 to mark the
30th anniversary of Roentgen's discovery.
The Czech community of radiologists came into being relatively slowly, and the excellent experts in radiologic diagnostics were first, most notably internists and surgeons. Interesting results were obtained by Prusík and Vorlicer, who performed arteriography in patients with acute lower extremity ischemia [4]. They injected their patients with iodized oil via per cutaneous punctures and established in 1928 that the diagnostic quality of the investigation was excellent, but they were surprised that none of their patients was ready to undergo the investigation again.
Over the period of the free First Czechoslovak Republic, a new generation
of physicians gradually started their professional careers as specialists in
radiology. Among these, Slavoj Vsín,
an untiring promoter of contrast-enhanced gastrointestinal radiologic
diagnostics, later became famous for several preeminent observations, such as
a case of carcinoma of the appendix in the 1930s. In 1939, the promising
development of Czech radiologic diagnostics was crushed by the tanks of Nazi
Germany.
Ripening
The freedom brought to us by the Allied armies in 1945 was followed, in addition to the establishment of new medical universities in Plzen, Hradec Králové, and Olomouc, by further expansion of the conception of central radiology departments. The academic institutes of universities remain places where radiologic diagnostics are cultivated with enthusiasm. The year 1946 saw the publication of the first issues of the Czech Radiological Society's specialist journal—Czechoslovak Radiology, which has been published continually to the present.
Czech radiology in the 1940s and 1950s was lucky to have enthusiastic
pioneers of invasive diagnostics. Two of the most interesting personalities
met in the Central Military Hospital in Prague and later became the most
important innovators in Czech radiology. In the 1950s, Josef Rösch and
Ji
í Bret worked in the field of angiography diagnostics of the
abdominal organs, where they achieved remarkable success
[5,
6]. The second occupation of
Czechoslovakia in 1968 divided these two colleagues for many years.
Rösch, who initiated the legendary visit of Charles Dotter to
Czechoslovakia in 1963 at the Czechoslovak Congress of Radiology in Karlovy
Vary, left for Portland, OR, in 1967. In Portland, he became a colleague of
Dotter, continued his work in interventional abdominal radiologic diagnostics,
and described an experimental percutaneous method of connecting the inferior
vena cava and the portal vein via the liver parenchyma—that is,
transjugular intrahepatic portosystemic shunt (TIPS)—in 1969. The impact
of the Congress in Karlovy Vary, organized by Rösch, on Czech radiology
was exceptional, and as early as the late 1960s, recanalization of the limb
arteries using the Dotter procedure was per formed in Prague, Pilsen, and
Hradec Králové.
Bret embarked on the path of interventional neuroradiology, applied himself to the treatment of arteriovenous malformations with embolization, and was the first to discover and perform an original method to treat hydrocephalus. The results of the treatment of hydrocephalus with catheterization of the aqueduct of Sylvius in more than 500 patients, published in 1981, bear witness to his untiring work.
For the second time and again with the force of tanks, this time from the Soviet Union, a gradual decline of the material equipment of Czech radiology started just as a new era of imaging methods was emerging. Despite this decline, the first CT unit was installed at the Department of Radiology of University Hospital Hradec Králové in 1978, but this was different from the installation of the first MRI unit; Czech radiology had to wait for it until the latter half of the 1980s.
The fact that Czech radiologists did not become completely disconnected from and fall behind their colleagues from the West in the 1980s is due to their considerable inventiveness with which they dealt with the most basic problems of material equipment. Personal involvement was the weapon used to compensate for the country's lagging behind due to the socialist system, most notably in the centers of interventional radiology in the Institute of Clinical and Experimental Medicine in Prague and the Department of Radiology University Hospital Hradec Králové. Many other workplaces, however, had to work on pieces of equipment from the 1960s: For, example in Pilsen—the largest Czech town freed by the U.S. Army—the Iron Curtain was tightened so closely that the first CT unit was not installed until 1985.
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í z Podbrad (George of
Podbrady). The great Czech King George was a
famous cult figure of Czech patriots for long centuries, but a shadow of doubt
persisted regarding the death of his predecessor.
The exhumed remains of King Ladislaus the Posthumous were reverently
studied by the Czech anthropologist Professor Emanuel Vlek. The
radiographs of the skeleton and CT scans of the neurocranium, obtained by
Professor Josef Br
na, showed multiple osteolytic defects that were
unequivocally interpreted as the aftereffects of acute hemoblastosis of a type
of acute lymphatic leukemia [7]
(Figs. 3A,
3B,
3C, and
3D). Signs of dissemination of
the leukemia were determined to have been the immediate cause of death, and
Czech King George was cleared of the suspicion of regicide after more than 500
years.
The Harvest
The Velvet Revolution of November 1989 opened a new chapter in Czech radiology. Gradually, it became possible for Czech radiologists to renew contacts with academics at centers abroad and to establish new contacts. The material equipment at workplaces began to improve as well, and the centers were equipped with state-of-the-art systems. After the "Velvet Divorce" of Czechoslovakia in 1994, Czech radiology developed independently of its sister society in Slovakia.
The acquisition of equipment that was already in most radiology workplaces made it possible for Czech radiologists to pursue current issues in the specialty. The most important centers in the Czech Republic are the following: in Prague, the Institute of Clinical and Experimental Medicine (IKEM), which concentrates on interventional radiology and experimental work with MRI; and Homolka Hospital and the Central Military Hospital, which focus on neuro radiology. Centers located outside Prague include a center in Hradec Králové, focusing on interventional radiology and prenatal MRI; and a center in Plzen, developing noninvasive cardiovascular diagnostics and new methods of gastro intestinal and oncologic diagnostics. In Moravia, the excellent center in Brno is active in diagnostics and treatment of conditions affecting the liver and biliary pathways, and a center in Olomouc pursues endovascular treatment of the aorta.
Important activities of Czech interventional radiology include the establishment of centers developing endovascular treatments of the aorta. The process of centralization has also been completed in the field of therapy of cerebral aneurysms, arteriovenous shunts, and stenoses of the carotid arteries. Workplaces that are active in oncologic centers, in addition, perform radiofrequency procedures not only in the liver, vertebral column, and skeleton, but also in pulmonary tumors. Similar to all European countries, the Czech Republic is paying attention to the diagnostics and monitoring of oncologic therapy. The fact that the Czech population belongs among the populations with the highest incidence of colorectal cancer, renal cell cancer, breast cancer, and head and neck tumors is matched by rather developed oncologic diagnostics. The mammographic screening that is currently in process has resulted in higher detection rates of curable stages of the disease. Radiology workplaces are paying considerable attention to whole-body imaging of malignant tumors, whether with hybrid PET/CT or with MRI. Centers equipped with PET/CT and with MRI are located in Prague, Plzen, and Olomouc.
A characteristic feature of the populations of Central and Eastern Europe is a high incidence of coronary artery disease and stroke. Non invasive diagnostics of cardiac conditions with CT angiography of the coronary arteries has been performed since 2002 in two institutes in Plzen and at IKEM in Prague. Since 2007, it has been possible to perform coronary CT angiography in 10 centers. Two workplaces, the University Hospital in Plzen and the University Hospital in Prague-Motol, have installed CT units with two radiation sources. In addition to the diagnostics of cardiac diseases, these work places conduct dual-energy radiation imaging.
A rather active subpopulation of Czech radiologists are those in the section of MRI; each year, two meetings are held for specialists from throughout the Czech Republic. The Czech Republic has now installed 18 MR scanners, two of which operate at 3-T intensity. Experimental work in the field of MRI is performed at IKEM in Prague, also using its equipment for animal studies. Czech radiologists participate in preclinical and clinical trials of new contrast media, organ- and molecule-specific, and test the possibilities of hybrid molecular imaging. Another area of interest that has developed especially in a center in Hradec Králové, but also in centers in Prague, Olomouc, Plzen, and Brno and at other centers, is prenatal imaging.
The activities of the Czech Radiological Society include the traditional biennial Czech Congress of Radiology and more specialized actions such as those dedicated to interventional radiology (e.g., Czech Society of Interventional Radiology [CSIR], per cutaneous transluminal angioplasty [PTA] courses), biennial Czech Neuroradiological Congress, MRI meeting sections, CT courses, abdominal radiologic diagnostics courses, and more. The year 2007, the 111th anniversary of Czech radiologic diagnostics, saw the rebirth of the journal Czech Radiology, which continues the tradition of Czechoslovak Radiology. Volume 61 has been published with a brand-new look (www.ceskaradiol.cz) and is published four times a year, 1,500 copies per run. The Czech Radiological Society currently has 1,300 members, and the academic community includes 13 professors and associated professors. Accredited workplaces offer, in addition to specialization in the basic specialty of radiology, specialization in neuro radiology, interventional radiology, and pediatric radiology.
References
átky rentgenologie v eském
lékaství (1896-1918). Hradec
Králové, Czech: Aurius 2002:640ch, konanch ve fysikálním
ústav eské university
K.F.I. ást obecná.
Vstník
eské akademie císae Frantiska Josefa.
Praha, Czech Kingdom: eské akademie, 1896:82
-89ka R. O skiagrafii a skiaskopii paprsky
Roentgenovmi a jejich diagnostické
cen v chirurgii. Praha, Czech
Kingdom: Edv. Grégr, 1899:65sledky
roentgenografie arterií po vstíknutí
jódového oleje. Cas Lek Ces1928; 67:14
-19
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