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Knowledge of history once again proves vital to imaging practice

BY ROBERT GEORGE, FIR | July 1, 2009
Mr. George is president of the International Society of Radiographe rs and Radiological Technologists (www.isrrt.org). He qualified as a diagnostic radiographer and was formerly a manager in a large private radiology practice in Adelaide, Australia.

Discussion has always been lively on the value of reviewing history in the pursuit of new developments in technology. Sir Isaac Newton, for example, is credited with making the statement: "If I have seen further it is by standing on the shoulders of giants."1 Henry Ford, on the other hand, has been quoted as saying "History is more or less bunk." Ford also went on to say that "the only history that is worth a tinker's damn is the history that we make today."2

It is interesting to look at developments in medical imaging technology and radiological techniques and see how much they have relied on previous work, ideas, or concepts. I have always been fascinated by how future developments in imaging and therapy can be linked back to Roentgen's original and momentous discovery of x-rays.

One of my favorite historical clinical images is that of an amputated hand that had been injected with Teichmann's mixture in January 1896, and on which the digital and interosseous arteries and their anastomoses were clearly recognized.2 Teichmann's mixture was a curious combination of petroleum, cinnabar, and chalk. The contrast results from the calcium in the chalk—usually made up of compounds of calcium sulphate or calcium carbonate—and the mercury in cinnabar, which is mercury sulphide or painter's vermilion.

Inte restingly, as early as 1907, M.K. Kassabian of Philadelphia was drawing on his experience of angiocardiography to recommend that "the injection must be done carefully and slowly."2 Others took up the challenge of imaging the body's circulation on cadavers and in vivo. One of the most fascinating stories concerns the German physician Werner Forssmann, who catheterized his own heart using "a well-oiled urethral catheter."2 This experimental procedure, involving a 65-cm catheter fed from his left elbow, marked the beginning of cardiac catheterization. To check the cathe ter's positi on on the primitive fluoroscopy system, Forssmann asked a nurse to hold a mirror in front of the screen.

Forssmann's reward for his initiative and courage was the sack and subsequent restriction from further hospital positions. He served as a medical officer during World War II until he was imprisoned. Forssmann's paper describing the catheterization technique was read by André Frédéric Cournand and Dickinson W. Richards while he was being held as a prisoner of war. The pair then developed ways of applying his technique to the diagnosis of heart disease and research. This work was rewarded in 1956 when the Nobel Prize in Physiology or Medicine was awarded jointly to Cournand, Richards, and Forssmann. Cournand acknowledged Forssmann in his speech at the Nobel banquet as the man who "in a single brilliant experiment offered us the key to the solution of that riddle propounded by William Harvey more than three centuries ago—the measurement of the passage of blood into and out of the human heart."3

It is easy to see from these examples how history has played an important role in such a vital part of today's healthcare. We are all aware of the early work conducted by Marie and Pierre Curie4 and by Henri Becquerel, and their impact on radiation medicine. Another prime example of early research and subsequent medical imaging benefits concerns William Henry Bragg and his son Lawrence.

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