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HISTORY OF RADIOLOGY Resource faculties: Dr. Jyotsna Rimal Additional Professor, HOD Dr. Iccha Kumar Maharjan Associate Professor Presenter : Abhinaya Luitel JR- I Department of Oral Medicine and Radiology
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Nothing materializes as if by magic overnight. Even ROENTGEN’s discovery depended upon development and application of three converging thoughts; ELECTRICITY, VACCUM and MAGNETISM
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CONTENTS Prologue to discovery Discovery of X- Rays Post discovery Insight to oral radiology The other side of coin: radiation hazards Fundamentals in radiology Growth of dental radiology Panoramic Radiography
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Computed Tomography Magnetic resonance imaging Ultrasonography Nuclear imaging and medicine Bone scan Xeroradiography Radiovisiography Oral radiology journals. Radiology in Nepal Conclusion Who, when, what, how, which References.
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PROLOGUE TO DISCOVERY 600 BC Phoenician voyager Thales of Miletus “Delicate substance fair in color and beautiful in transparency” Baltic shores Electron or Amber
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Gilbert gave the term “Electricity” Stephen Gray discovered that current would flow over the conductor for great distances.
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Abbe Nollet “electric egg” became direct descendent of discharge tube. Charles DuFay (1730) – vitreous and resinous electricity.
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Otto Von Guericke (1648) – first air pump used in formation of vaccum Experiment on ‘Magdeburgh Hemispheres’ Evangelista Toricelli (1643) – Mercury Barometer; permanent vaccum
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Francis Hauksbee – electricity producing friction machine within a vaccum.
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DISCOVERY OF X- RAYS 1785 Sir William Morgan Obtained a vacuum so that there was no discharge. Glass cracked – display of colors Yellow, Green, Red, Violet, Blue Unknowingly he was first to produce X- Rays
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1821 Michael Faraday First experiment on electric discharges Fluorescence as “Radiant Matter ” : 4th state state
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1870 Wilhelm Hittorf Identified CATHODE rays
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Philip Lenard Cathode rays pass through aluminium window Cause fluorescent screen to glow 5 cms in air “Lenard’s Ray” Had he used barium platinocyanide instead of pentadecyl paratolylketon (discoverer of X- Rays) Proposed Inverse Square Law
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Humanity owes honor and gratitude for discovering the most striking and outstanding properties of cathode rays to Professor Wilhelm Conrad Roentgen Wurzberg Bavaria 1895
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November 8, 1895 Friday evening Research on electric discharge in diluted gas Crooke’s tube and Ruhmkorff induction coil Fluorescent screen with barium platinocyanide began to glow Rays produced when cathode rays encountered matter
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The rays could not be reflected or refracted They were unaffected by magnetic and electric fields Termed X- Rays (X = unknown) Roentgen Rays
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Property of fluorescence and penetration Shadows cast on screen
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FIRST MEDICAL RADIOGRAPH OF HUMAN BODY 15 minutes, Bertha Dec 22, 1895 First industrial radiograph: Roentgen’s Shotgun
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PUBLICATIONS A New Kind of Rays: A preliminary communication A New Kind of Rays: continued Further observations on A New Kind of Rays # Fact that X- Rays could be polarized and defracted
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NOBEL PRIZE 1901- First Nobel Prize in PHYSICS Honorary M.D Degree- Maximilan University, Wurzberg The Ruhmford Gold Medal of the Royal Society (British) The Iron Cross from Hindenberg
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POST DISCOVERY The year 1896- momentous Major discoveries and inventions in the field of radiodiagnostics and the emergence of radiotherapy Total of 49 books and brochures, and 1,044 scientific essays were written on the scientific aspects and possible applications of the newly discovered rays. A multitude of these publications dealt specifically with possible applications in medicine.
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In the eyes of USA
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Four years after his wife, Röntgen died at Munich on February 10, 1923, from carcinoma of the intestine.
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INSIGHT TO ORAL RADIOLOGY Who took the first dental radiograph ??? UNCERTAIN Honors shared between Dr. Friedrich Otto Walkhoff, Wilhelm Koenig Wilhem, Frank Harrison and C. Edmund Kells Crude but recognizable dental skiagrams 1896- Late winter and early spring
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Dr. Friedrich Otto Walkhoff Completed first dental radiograph 25 mins exposure Crown of maxillary and mandibular teeth, the first “Bitewing” 1896: first dental roentgenologic laboratory- Fritz Giesel
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Professor Wilhem Koenig Wilhem- Feb 2, 1896 Giesen- 14 dental radiographs of his own mouth 9 minute exposure per film Frank Harrison- Demonstration of “Pulp chamber” 10 minute exposure
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William J Morton, 1896 First recorded dental radiograph in US Revealed presence of impacted tooth which was otherwise invisible.
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FATHER OF DENTAL RADIOLOGY Dr. C Edmund Kells, First to use compressed air in dental office First to hire “lady assistance” or “ lady in attendance” First radiograph of root of teeth was made in 1896. First advocate of right angle or paralleling technique. First dentist to use radiograph in root canal therapy: may 10, 1899
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HISTORICAL PUBLICATIONS Dental Cosmos, 1899 : importance of keeping film and object at right angles to the source of X- Rays. Journal of Dental Service, “Lady in Attendance”: She would eventually be found in every dental office.
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THE OTHER SIDE OF COIN: RADIATION HAZARDS 1896, Frank Harrison: probably first to report occurrence of radiation hazard 1896, March 23 : Dr. John Daniel mentioned about hair loss from head of colleague that was photographed with radiography. 1896, July 22: W. Marcuse published first microscopic study of effect of radiation on tissues.
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Elihu Thomson: first X- Ray worker, Roentgen rays cause adverse effects. 1900, Kienbock: irradiation of rats 1901, William Rollins: irradiation of guinea pigs Direct relationship between X-Ray beams and biologic effects was established.
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IRONY: At age 40, Kells first began his work with x-rays Unaware of the unseen danger of cumulative doses of radiation. Often held the films in place with his own fingers.
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By age 50, he had developed cancer in his right hand. Over the next 20 years, Kells endured 42 operations eventually losing his hand, arm, and shoulder. On May 7, 1928, at age 72, he committed suicide - due to great suffering
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FUNDAMENTALS IN RADIOLOGY X- Ray Machine X-Ray tube Adjustable tube stand The Darkroom
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X- Ray Machine Induction coil Interrupter Rheostat Primary coil Mechanical Electrolytic Secondary coil Vibrating Mercury Ruhmkorff coil Jumbo coil, H.Clyde Snook (1904) Tesla Coil
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X-Ray Tube Gas Tubes Regulator Tubes, 1896, Queen and Company Vaccum Tubes, 1911, J.E. Lilienfeld
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GOLDEN AGE OF RADIOLOGY Clyde Snook, 1907 110 kvp, 200mA William David Coolidge, 1913
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SHOCKPROOF DENTAL X-RAY UNIT 1918- 1919, Coolidge and General Electric Company Victor CDX- shockproof dental X-Ray unit.
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Adjustable tube stand Dr. William Rollins, 1896 Protective screen and adjustable Diaphragm First to publish Harmful effects of X- Rays.
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X-Ray Films First dental radiograph- glass plate Kells and Rollins- Photographic film wrapped in black paper and rubber dam ( lack of emulsion sensitivity) First machine wrapped dental X- Ray film, 1919: Regular film KODAK 1920: cellulose nitrate base (inflammable)
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1924: non inflammable cellulose triacetate (expensive, wrinkled and tendency to break) Double emulsion film: Radiatized film (Kodak) 1940: the ultra speed (improved radia tized)
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1955: D speed Film 1960: polyester base 1980: Ekta speed Film (Kodak) 2000: F speed film
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Dark room Closet with or without running water (3.5 ft* 5ft) Developing time and solutions varied with operator Steps: Covering sensitive material with developing agent Adding a preservative Adding an accelerator Adding a bromide
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1896, Kells- 30-60 mins 1909: tank development, 5 min development at 65 F 1918: Eastman Kodak company, darkroom with tank processing 1920: film hangers 1910: Automatic processor 1981: Day light processor
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GROWTH OF DENTAL RADIOLOGY “Dentistry’s forgotten man” “Father of Radiation Protection” William Herbert Rollins (1852-1929) Intraoral cassette and oral fluoroscope. First dental X-Ray appatratus but never commercialized. First to suggest the use of radium for cancer.
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First to advise three precautions to X-Ray users (1901, guinea pigs) Wear lead glasses Enclose X-Ray tube in lead housing Irradiate only area of interest, rest cover with radio- opaque material. Introduced collimator to reduce beam size and recommended long target film distance for image quality and patient safety.
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Advocated draping of patient with non- radiable material. Pioneered sandwiching the film between two intensifying screens to reduce exposure. Suggested safe and harmless radiation dose to be determined. February 24, 1901, he published a resounding article entitled "X light kills”
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kn "Undoubtedly the greatest genius the dental profession has ever own...He gave more to the dental, medical radiologic scientific world than any other practitioner of our profession. Yet no dentist has received so little recognition for his contributions."
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Rollins, 1903: First to suggest selective filtration of X-Ray beam Kells, 1903: First X-Ray Laboratory, THE NEW ORLANDS X-RAY LAB
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Dr. Weston A Price, 1904: First proposed X-Ray production based on “Rule of Isometry” Developed flexible leaded rubber, first pair of leaded gloves for radiologists Established relationship between nutrition and dental health.
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Howard Riley Raper, 1909: A part time instructor at Indiana Dental College, Indianapolis Teaching of Dental Radiology in every school in United States 1901- 1910, first course of radiology initiated, professor of Radiology
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1911- 1913, series of papers in Dental items of interest 1916, Elementary and Dental Radiography, new disciple RADIODONTIA 1918, Angle meter and different vertical angles for different projections 1925, approached Eastman Kodak Company for Bite- wing Film
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Franklin W McCormack: Paralleling technique to practical use Hand wrapped dental films in black paper, added flat metal plate, wrapped both in wax paper Metal plate prevented back scatter radiation Mc Cormack long distance technique, lecture at Missouri Stale Dental Association- 55th annual meeting at Kansas, April 12 1920 Journal of Dental research, 1920, first layman to publish research in journal
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Dr. Gordon Fitzgerald, 1940 Designed long cone for dental X- Ray machine 1947-1950, Journal of American Dental Association, four articles, “Long Cone Paralleling Technique” 1949, American Academy of Oral Roentgenology, American Academy of Dental Radiology.
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PANORAMIC RADIOGRAPHY Dr. H Numata proposed (1933) and experimented (1934) with rotational panoramic radiography Y.V Paatero, Institute of Dentistry Finland proposed (1946) and experimented (1948) slit beam Panoramic radiography 1960, S.S White and Company marketed PANOREX 1968, International Association of Dental Maxillofacial Radiology was established
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COMPUTED TOMOGRAPHY 1969, Godfrey Hounsfield: Prototype scanner with Americium light source 1970: Computed tomography, announced in 1972, mathematics (1917), astrophysics (1956)
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1971: First scanner installed, 1972: commercially viable CT scanner (Thorn EMI central research laboratories), installed in Atkinson Morley’s Hospital in Wimbledon, England
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1974: First CT system from medical equipment manufacturer SIRETOM 1975: introduction of CT unit of 5000 series, 18 sec scanning time. 1976: Whole body CT imaging started, Fan beam and rotating anode used.
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1979: Godfrey Newbold Hounsfield, Dr. J Ambrose and Allan McLeod Cormack shared Nobel Prize in Medicine. 1980, Andrew Castagini: Electron beam CT
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1987, Dr. Michael Rhodes: First Dental CT reformatting package DENTASCAN designed. 1990, Wili Kalender and Kazuhiro Katada: The first spiral CT was Siemens SOMATOM Plus system 1992: Integrated CT angiography 1993: Interactive CT 1998: MDCT
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GENERATIONS OF CT
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MAGNETIC RESONANCE IMAGING 1946, Felix Bloch and Edward Purcell: Nobel Prize 1952, discovery of Magnetic Resonance 1971, Raymond Damadian: Nuclear Magnetic Relaxation time of tissue and tumors differs
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1973, Paul Lauterber: Demonstrated MRI on small test tube samples 1975, Richard Ernst: Proposed MRI using Phase and Frequency coding. Jul 3, 1977: First MRI performed on human, Dr. Raymond Damadian, Dr. Larry Minkoff, Dr. Michael Goldsmith INDOMITABLE
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1977, Peter Mansfield: Echo- Planar imaging 1ca9r8d7ia: cE cyocl-e.Planar performed real time movie imaging of single cardiac
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1987, Charles Dumoulin: perfecting Magnetic Resonance Angiography 1991, Richard Ernst: Nobel Prize in Chemistry
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1992: Functional MRI (fMRI) developed 2003, Paul C. Lauterbur, Sir Peter Mansfield: Nobel Prize in Medicine.
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ULTRASONOGRAPHY
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NUCLEAR IMAGING AND MEDICINE Invention of the cyclotron: Ernest Orlando Lawrence (1901-1958) 1930: first cyclotron which was only 4 inches in diameter. It involved 2 D-shaped magnets, which created a circular magnetic field, with a small gap between them.
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1935: John Lawrence, Injected radioactive phosphorus in mice with leukemia. 1939: Ernst Lawrence, Nobel prize in PHYSICS 1939: first successful radio isotopic treatment of polycythemia vera using phosphorus-32
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1946: Major achievement, iodine- 131 halted growth of thyroid cancer 1983, John Lawrence: Fermi Award “pioneering work and continuing leadership in nuclear medicine.“ 1980s: digitization of Nuclear Medicine
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RADIONUCLIDES: I-131, Ga- 67, Se- 74, Tc- 99m Scintillation Camera: ANGER cameras Capture photons Convert them to light and then to voltage signals Reconstruction to planar image- of radionuclide
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BONE SCAN 1961, Fleming et al: First radionucleide skeletal imaging using Sr- 85 F-18 and Ca- 45 (previously used) Development of Mo-99, Tc phosphate- 99m and Y-scintillation camera lead to phase out of previously used substances.
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XERORADIOGRAPHY Chester Carlson, 1937: imaging method discovered 1949: First known use 1963, Pogorzelska- stronczak B: attempted xeroradiography in stomatology.
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ORAL RADIOLOGY JOURNALS
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RADIOLOGY IN NEPAL
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Began in 2008 with few people from John Hopkins, grown to include >3500 contributors from 200 countries. Moves ahead to answer the need for radiology and imaging technology in resource limited regions and communities of world. Asian members: NEPAL, Bhutan, India, China, Jordan, Laos
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CONCLUSION Radiology is a medical specialty that uses imaging to diagnose and treat diseases seen within the body. A variety of imaging techniques such as X- ray radiography, ultrasound, computed tomography (CT), nuclear medicine including positron emission tomography (PET), and magnetic resonance imaging (MRI) are used to diagnose and/or treat diseases Pioneers of radiation, radiology and radio diagnosis have put upon their whole life into it just to come up with a spark of light that can form image or shadow that is castable and hence interpretable.
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Diagnosis of hard and soft tissue lesions of body including head and neck has become so easy and trustworthy that most of the radiodiagnosis tool have become routine investigations. History of radiology is not just about cramming of names of inventors, the dates and the inventions but an ODE to those great people who brought about magical change in medical fraternity, its about RESPECTING them and getting MOTIVATED from them
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Which was the vaccum tube used by Sir Wilhem Conrad Roentgen? Lenard’s tube b) Ruhmkorff’s tube c) Crooke’s tube d) Morgan’s tube c
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When was International Association of Dental and Maxillofacial Radiology Established? a) 1960 b) 1963 c) 1965 d) 1968 d
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Who revealed presence of impacted tooth for the first time in skiagram? Frank Harrison William J Morton Wilhem Koenig Wilhem d) C. Edmund Kells b
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Nepalese Journal of Radiology was launched in: a) 2010 b) 2011 c) 2012 d) 2013 c
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Who is known as Father of Radiation Protection? William Herbert Rollins Howard Riley Raper c) Gieson d) Gordon Fitzgerald a
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REFERENCES Karjodkar FR. Textbook of Dental and Maxillofacial Radiology. 2nd edition. New Delhi: Jaypee Brothers Medical Publishers (P) Limited; 2009 DiSantis DJ. Early American Radiology: The Pioneer Years. AJR. 1986, October; 147:850-853 Thomas A, Busch U. The Story of Radiology. Vienna: European Society of Radiology; 2012 (1)
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Thomas A, Busch U. The Story of Radiology. Vienna: European Society of Radiology; 2013 (2) Tsung J. History of Ultrasound and technological advances. New York: Mount Sinai School Of Medicine Carlson S. A Glance At The History Of Nuclear Medicine. Acta Oncologica. 1995; 34(8):1095-1102 BArJaRn. t WE, Budhathoki TB, Pradhan R. Radiology in Nepal. 1996;166:259-262
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Udoye CI, Zafarzadeh H. Xeroradiography: Stagnated after a Promising Beginning? A Historical Review. Eur J Dent. 2010 Jan; 4(1): 95–99 Stronczak P. ATTEMPTED APPLICATION OF XERORADIOGRAPHY IN STOMATOLOGY. Przeal Radiol Med Nukl. 1963 May-Jun;27:265-75 Curry TS, Dotwh dey JE, Murry Cr. Christensen’s Physics of Diagnostic Radiology. 4 eition. Philadelphia: Lippincott Williams and Wilkins; 1990
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UNANSWERED QUESTIONS History of radiology
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The name of scientist associated with Skiagram is Rowland. The two properties of X- Rays: a) Polarized: Vibration of light in a single plane. It can be brought about by transmission, reflection, refraction or scattering. b) Diffraction: it refers to slight bending of light as it passes around the edge of an object. MRI test tube: 4.2 mm diameter test tube contained capillary tube of 1mm diameter with water. Slit beam: a beam of X-Ray coming out from vertical slit aperture, a type of collimator.
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Different types of collimator: diaphragm (7cm diameter), tubular, rectangular and slit ( used only in OPG) collimator.
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What changes the speed of the film? 10 micrometer
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First commercially available intra-oral X-Ray films came in 1913 whereas the same for extra- oral came in 1918. Advantages of helical CT:
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Which gas is present in ionization gas detectors? Hydrogen and oxygen, Nitrogen-phosphorus, Argon, xenon Scientist associated with functional MRI(fMRI): 1890, Charles Sherrington linked brain function to blood flow. 1991, John Bellirean carried first fMRI.
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Multiplanar Imaging: Allows image to be created from original axial plane in either coronal saggital or oblique plane. It allows isotropic imaging in which image quality of reconstructed multiplanar iamge is same as original axial image. New MRI in Kathmandu: Grande International Hospital: 1.5 T digital broad band MRI, first of its kind in Nepal with outsanding image quality and scan.
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Nuclear imaging in Kathmandu: Gamma imaging and research center. Metro radiology and imaging center. National Academy and Medical Sciences (NAMS) Early radiation hazards that dentist can detect: Mucositis, Xerostomia, Superficial or Oppurtunistisc fungal infection, Soft tissue Necrosis.
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1896, Thomas Edison, Calcium Tungstate screen was a kind of first intensifying screen used in general radiology. Doppler Ultrasonography (Usg): Christian Andrews Doppler in 1842 formulated Doppler effect. Change in frequency of transmitted waves when relative motion exists between source of wave and observer. Doppler Usg: 1950 4D Usg: 3D picture in real time i.e, the 3D object moves.
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Usg cleft.
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HISTORY OF CBCT In 1988, cone beam computerized tomography (CBCT) was introduced to dentistry. This technology offered 3-dimensional visualization and more complex and more accurate imaging compared to analog and digital radiographs. Because CBCT exposure incorporates the entire FOV, only one rotational sequence of the gantry is necessary to acquire enough data for image reconstruction. Medical CT, which uses a fan-shaped x-ray beam in a helical progression to acquire individual image slices of the FOV and then stacks the slices to obtain a 3D representation. Each slice requires a separate scan and separate 2D reconstruction
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With larger FOVs, is a limitation in image quality related to noise and contrast resolution because of the detection of large amounts of scattered radiation Advantages in dentistry: Rapid scan time Beam limitation Interactive display modes applicable to maxillofacial imaging Multiplanar reformation