Methods of imaging
The 1970s can be seen as a golden decade for radiology with the development of many techniques that are now standard. JE Johns from Toronto in an insightful Silvanus Thompson Memorial Lecture half way through the decade in 1975 reviewed the new methods of imaging (Johns BJR 1976; 49(585): 745 - 764). There is an excellent review of CT scanning and other techniques such as xeroradiography and ionography are described.
Image source: Johns BJR 1976; 49(585): 745 - 764
The development of better contrast media resulted in fewer side effects. In the 1970s and continuing ever since was the replacement of invasive diagnosis and treatment by non-invasive diagnosis and minimally invasive treatment.
In 1977 Louis Kreel from Northwick Park Hospital wrote a very important paper on the EMI general purpose scanner (Kreel BJR 1977; 50(589): 2-14). The paper gives an account on the images obtained on the first body scanner and investigative medicine was transformed. Also from Northwick Park Hospital HB Meire reviewed the current state of ultrasound in July 1977 (Meire BJR 1977; 50(594): 379-380). The two techniques are then compared in an interesting paper from Northwick Park Hospital by Janet Husband, HB Meire and Louis Kreel (Husband, Meire and Kreel BJR 1977; 50(600): 855-862).
Image source: Husband, Meire and Kreel BJR 1977; 50(600): 855-862
Whilst the new scanner was obviously effective it was also very expensive. EMI had various problems which Melvyn Marcus outlined in the Sunday Telegraph of July 30th, 1978 in an article entitled ‘It’s crisis time for scanners.’ The difficulties that EMI experienced were from two directions. Firstly there was competition from other companies. There were several court cases for patent infringements including a suit filed by EMI against Ohio-Nuclear in 1976 and Pfizer in 1977. However more significantly was the clamp down on hospital expenditure in the United States under the administration of president Jimmy Carter. America was the largest market for the EMI Scanner and hospitals had to meet very rigorous conditions to be able to undertake any major capital expenditure. The issues of the legal actions on EMI patents were discussed in two interesting letters in March 1994 by AB Strong and RAA Hurst (Strong and Hurst BJR 1994; 67(795): 315-316) and then by AM Cormack (Cormack BJR 1994; 67(795): 316-317). The development of the EMI scanner is briefly reviewed and the implications of the patent litigation are discussed.
However in spite of the problems experienced by EMI and the EMI scanner, CT has continued to develop.
The award of the Nobel Prize for Medicine and Physiology to Godfrey Hounsfield and Alan Cormack in 1979 emphasised the arrival of the new technique. Alan Cormack had developed the mathematical basis of CT scanning but he had worked independently from Godfrey Hounsfield. Cormack had developed a mathematical approach to looking at the problems of variations in body tissues that are important in radiotherapy. At the time there was no commercial interest and the subject was not pursued. There were a number of workers looking at the same area for example Oldendorf and David Kuhl. Cormack became aware of the pioneering work of Radon only in the late 1970s. Radon had stated that if the line integrals of a particular property of an object, such as its density, could be known for all lines intersecting a slice of any object and coplanar with the slice then the density can be reconstructed exactly. Cormack then considered how many measurements need be made since only a finite number of measurements can be made with beams of a finite width. It is very salutary to observe the number of disconnected workers considering the same problem but coming from quite different directions.
The 75th anniversary of the BIR
1972 marked the 75th Anniversary of the BIR (BJR 1972; 45(540): 875) and a special symposium was held at the Royal Society on the 23rd and 24th November 1972 (BJR 1972; 45(540): 876-877). The president was Robert Steiner from the Hammersmith Hospital and in his address at the Anniversary Banquet he reflected on the Institute (Steiner BJR 1972; 45(540): 878-880).
The BJR issued a special issue in October 1973 edited by Nigel Trott and Hugh Saxton (Trott and Saxton BJR 1973; 46(550): 739-740) to celebrate the 75th Anniversary and all of the papers are of interest. The papers presented at the Anniversary Meeting were Looking Back and Looking Forward with appended invited reviews in the journal.
Image source: BJR 1972; 45(540): 876-877
WV Mayneord started with a personal review of medical physics (Mayneord BJR 1973; 46(550): 754-756) and showed how medical physics had made scientific history of first rate importance. 1947 was the 50th anniversary year of the BIR and WV Mayneord gave a series of 6 lectures to the BIR in the February. These appeared as the second supplement to the BJR in 1950. The supplement was called “Some Applications of Nuclear Physics to Medicine” and the title “Nuclear Medicine” is a contraction of Mayneord’s title. Mayneord wrote: “It is now commonplace to remark that recent developments in nuclear physics are revolutionising medicine, but only rarely are such statements followed by detailed information as to how this revolution is being brought about by examples of the applications of the new knowledge in the medical field.” Mayneord was a master of providing detailed information and practical examples of the applications of physics to medicine through his long career.
HW Grover wrote a well illustrated account of the development of radiological equipment (Grover BJR 1973; 46(550): 757-761).
Experimental radiology and radiation biology
FG Spear wrote a personal account of biological research in radiology (Spear BJR 1973; 46(550): 762-765). The years 1895 to 1940 were formative for radiation biology.
S Cochrane Shanks reviewed radiology in the 1920s (Cochrane Shanks BJR 1973; 46(550): 766-767).
Ralston Paterson reviewed the state of radiotherapy from 1925-1959 (Paterson BJR 1973; 46(550): 768-770). The paper is a fascination account by one of the great names in radiotherapy.
The papers on the future are interesting since in 1973 CT was still in its infancy and MRI was yet to be born. JR Greening looked at the future of medical physics (Greening BJR 1973; 46(550): 771-775) and RE Ellis reviewed trends in population radiation exposure (Ellis BJR 1973; 46(550): 776-782). George du Boulay cried ‘Help!’ and looked at recent computer applications to radiodiagnosis (du Boulay BJR 1973; 46(550):783-792). His figure 3 shows himself with James Bull from the Lysholm Department at the National Hospital in Queen Square. There is an interesting discussion of early CT scanning. Keith Hainan reviewed the future of cancer prevention, diagnosis and treatment (Halnan BJR 1973; 46(550): 793-798) and Patricia Lindop considered what help radiobiology might offer (Lindop BJR 1973; 46(550): 799-802). Howard Middlemiss from Bristol made major contributions to radiology education in the UK, in Europe and worldwide and reflected on the future (Middlemiss BJR 1973; 46(550): 803-807). The future of nuclear medicine was reviewed by ES Williams from the Middlesex Hospital (Williams BJR 1973; 46(550): 808-810). Peter NT Wells made major contributions to ultrasound and gave an interesting personal assessment (Wells BJR 19783; 46(550): 811-818). Peter Wells pointed out that the 75th Anniversary of the BIR coincided with the centenary of the birth of Paul Langevin who pioneered the generation and detection of ultrasonic waves. B Combée from Philips Medical Systems reviewed the technical prospects in radiology (Combée BJR 1973; 46(550): 819-823) and of all of these papers he probably had the hardest task writing in 1972. Combée extrapolated from his present day into the future and little could he anticipate the explosion in medical imaging in the subsequent 20 years which completely revolutionised clinical practice. He wished to avoid ‘future shock’ and did not succeed! The future of technical developments in nuclear medicine were reviewed by DH Pringle from Nuclear Enterprises (Pringle BJR 1973; 46(550): 824-829) and there are nice illustrations of an old gamma Anger camera, a dual headed rectilinear scanner and a renography couch. The series finishes with GS Innes reviewing radiotherapy equipment (Innes BJR 1973; 46(550): 830-832).
Image source: Pringle BJR 1973; 46(550): 824-829
These invited reviews in this 75th BIR Anniversary BJR are a wonderful resource for anyone interested in the history and development of UK radiology.
Montague Cohen from the London Hospital masterfully surveyed the contribution of physics to radiology (Cohen BJR 1973; 46(550): 841-853).
R Oliver from the Hammersmith Hospital reviewed this important topic (Oliver BJR 1973; 46(550): 854-860). The BIR had a central role in developing radiation protection and awareness of the need for safe practice. The BIR recommendations for protection are reproduced.
EJ Tunnicliffe reviewed the British X-ray industry (Tunnicliffe BJR 1973; 46(550): 861-871). The BIR has always been multidisciplinary and industrial members contributed to the Institute from the earliest days.
Hugh Saxton beautifully reviews conventional radiology (Saxton BJR 1973; 46(550): 872-884) and the role of the BJR. The paper is a good account of radiology at the point just before modern imaging emerged.
GM Ardran from the Nuffield Institute for Medical Research in Oxford reviewed the applications of cinematography to medical imaging (Ardran BJR 1973; 46(550): 885-888). The cinema was born at about the same time as radiology emerged.
Joan McAlister from St. Bartholomew’s Hospital reviewed nuclear medicine and the major contributions that members of the BIR made to the emerging discipline in the post-war period. (McAllister BJR 1973; 46(550): 739-740)
CR Hill from the Royal Marsden Hospital gave an interesting historical review at this time when the images are still primitive but promising much in the future (Hill BJR 1973; 46(550): 899-905).
Image source: Hill BJR 1973; 46(550): 899-905
Radiotherapy and oncology
TJ Deeley from the Velindre Hospital and T Hale from Bristol General Hospital reviewed radiotherapy (Deeley and Hale BJR 1973; 46(550): 906-910) and many of these developments are recorded in the papers published in the BJR and in supplements and reports. The early years of radiotherapy were hampered by a lack of dosimetry and radiotherapy was put onto a scientific footing in the the1930s. The advances in cancer treatment cannot be illustrated better than by observing the changes to the management of Hodgkin’s disease and these were detailed by David Smithers from the Marsden Hospital (Smithers BJR 1973; 46(550): 911-916). Smithers had started work at the Cancer Hospital in 1935 and saw dramatic changes during his professional lifetime. Harold Hewitt from the Gray Laboratory at Mount Vernon Hospital then reviewed how the applications of clinical research and radiobiology increased our knowledge of cancer and enabled improved clinical treatments (Hewitt BJR 1973; 46(550): 917-926). It has already been stated that WV Mayneord was a master of providing detailed information and practical examples of the applications of physics to medicine and the series of invited reviews ended with his review of mathematics “See Mystery to Mathematics Fly!” (Mayneord BJR 1973; 46(550): 927-931).
Professor J. Rotblat (1908-2005)
Joseph Rotblat KCMG, CBE, FRS was President of the BIR in 1971-72 and was a strong supporter of our Institute until his death in 2005.
Joseph Rotblat was born in Poland and became a British citizen. He went to Liverpool University in 1939 to work with James Chadwick who had discovered the neutron. He then went with Chadwick's group to the USA in 1944 to work on the Manhattan Project to build the atomic bomb. Joseph Rotblat was appointed professor of physics at St. Bartholomew’s Hospital in 1950, retiring in 1978. After the war his work on nuclear fallout made a major contribution to the partial test ban treaty. He was a signatory of the Russell-Einstein manifesto and was the general secretary of the Pugwash Conferences on Science and World Affairs (www.pugwash.org ) from its origin until 1973, becoming its president in 1988. In 1995, with the Pugwash Conferences, he received the Nobel Peace Prize for his efforts towards nuclear disarmament. His Presidential Address of 1972 should be read by everyone at all interested by the ethical and moral implications of science (Rotblat BJR 1972; 45,(534): 397-404). As he said: “Both individually and collectively as members of this institute we can contribute to this effort (to save our civilisation) and help in creating conditions in which man will live not only in better health, but also in peace and security.”
Various deaths are recorded in the pages of the BJR.
William David Coolidge (1873-1975)
William David Coolidge (1873-1975) died on February 3rd 1975 in Schenectady, NY (Trout BJR 1975; 48,(576): 1050). William Coolidge was a major figure in radiology and the Coolidge tube which is the basis for all modern X-ray tubes.
Gordon Hamilton Fairley (1930-1975)
Tragically Gordon Hamilton Fairley who was Professor of Medical Oncology at St Bartholomew’s Hospital was killed when walking his dog when a bomb was exploded in London (AKT BJR 1976; 49(577): 100). He was killed by a Provisional Irish Republican Army car bomb in London on 22 October 1975. The bomb was intended for Sir Hugh Fraser, his wife Lady Antonia Fraser and their guest Caroline Kennedy, who lived nearby.
George Simon died in 1977 and his obituary written by George du Boulay described the life of this remarkable man (du Boulay BJR 1978; 51(602): 159). His book “Principles of Chest X-ray Diagnosis” is a classic (Rackow BJR 1957; 30(353): 273). George Simon made many contributions to chest radiology and encouraged radiological-pathological correlation working with the pathologist Lynne Reid at the Brompton Hospital (Simon and Reid BJR 1959; 32(377): 291-305) and their work on emphysema is classic. George Simon gave the Mackenzie Davidson Memorial lecture in 1968 (Simon BJR 1968; 41(489): 642-647) and considered the future of radiology. He considered the new techniques of ultrasound and nuclear medicine that were competing with radiology. He would have been fascinated by modern CT scanning and MRI of the chest.
Image source: du Boulay BJR 1978; 51(602): 159
Cuthbert Andrews (1882-1972)
Cuthbert Andrews died in 1972 and was a manufacturer on radiological equipment. He was a strong supporter of the BIR and was president. He was also a strong supporter of radiography. He prepared the 1953 BIR Handbook and the 1962 edition included the Charter which he worked so hard for the BIR to achieve. Cuthbert Andrews read a delightful paper to the Society of Radiographers in January 1934 (Andrews BJR 1934; 7(76): 246-252). The section “The Little Old lady in Black” is a radiographic classic and has been reprinted many times. Do read this little piece and remember the final words of the little old lady in black “’ow kind they was to me when I was in the X ray.” He considered the future of the radiographer in July 1932 (Andrews BJR 1932, 5(55):570-580) and this is worth reading if only for his amusing and informal style. In his Presidential Address of 1953 (Andrews BJR 1954; 27(314): 81-85) he spoke on the X-ray Industry and the Institute and described the close links between the two.
Peter Kerley (1900-1979)
The chest radiologist Peter Kerley died in 1979 (Starer BJR 1979;, 52(619); 604). “PK” was one of the world’s leading cardiothoracic radiologists and made many contributions other than his well known “B” line.