1950s diagnostic imaging

Risks of radiation and Lord Adrian

There were increasing concerns about the risks of radiation as the 1950s progressed. In May 1956 GM Ardran from Oxford wrote about risks to the operator and the patient in diagnostic X-ray procedures (Ardran BJR 1956; 29 (341):266-269) and Alma Howard from Mount Vernon Hospital tried to assess the genetic changes that might follow the irradiation of larger populations (Howard BJR 1956; 29(341):270-273). The issues were more severe for the early X-ray workers and a list of additional X-ray martyrs was published in May 1956 (BJR 1956; 29(341): 273). FW Spiers from Leeds spoke on environmental radioactivity for his Presidential Address of 1956 (Spiers BJR 1956; 29(344):409-417).

Tables showing radiation doses

Image source: Ardran BJR 1956; 29 (341):266-269

 

The United Nations was concerned about the responsibilities of the medical profession to limit the medical use of ionising radiation and issued a statement in June 1957 that is still relevant today and should be read by all (BJR 1957; 30(354):282-284). The government in 1956 under the chairmanship of Lord Adrian set up a committee on radiation hazards to patients and in June 1957 he was asking for the help and assistance of radiologists through the pages of the BJR (Adrian BJR 1957; 30(354): 285).

In August 1957 Sir Stanford Cade gave a useful review of radiation-induced cancer in humans (Cade BJR 1957; 30(356): 393-402) and GM Ardran looked at dose reduction in diagnostic radiology and how in might be achieved (Ardran BJR 1957; 30(356); 436-438).  GM Ardran and HE Crooks reviewed doses from dental radiography and the effect of radiographic techniques in September 1959 (Ardran and Crooks BJR 1959; 32(381): 572-583).  The Presidential Address by LF Lamerton for 1958 examined the clinical and experimental data for the risks to the individual of small doses of radiation (Lamerton BJR 1958; 31(365): 229-239). 

Pelvectory and table of comparison of radiation doses

Image sourcer: Lamerton BJR 1958; 31(365): 229-239

 

In April 1959 AGS Cooper and AW Steinbeck from Australia reported on leukaemia in a three-year-old following irradiation whilst in utero (Cooper and Steinbeck BJR 1959; 32(376): 265) and in an adult man following irradiation for ankylosing spondylitis (Cooper and Steinbeck BJR 1959; 32(376): 266-268). 

Many papers appeared on dose reduction techniques and an example is from A Appleby and others from Newcastle upon Tyne looked at how to achieve dose reduction in pelvimetry (Appleby, Hacking and Warrick BJR 1958; 31(365): 267-271).  
 
G Speigler and R Davis from the Royal Cancer Hospital described an improved method and film holder for personnel monitoring in July 1959 (Speigler and Davis BJR 1959; 32(379): 464-467).

 Personnel radiation monitoring filmholder

 Image source: Speigler and Davis BJR 1959; 32(379): 464-467

 

Neuroradiology

Neuroradiology was bases on the performance of invasive diagnostic tests (angiography and encephalography) or the scrutiny of the plain film.

Trevor Griffiths from the Brook Hospital wrote a detailed paper on the plain film findings in intracranial tumours in February 1957 (Griffiths BJR 1957, 30(350): 57-69). He felt that plain film examination was indispensable before any other investigations were performed. 
                                                    
David Sutton wrote on the assessment of the normal aqueduct and 4th ventricle in April 1950 (Sutton BJR 1950; 23(268): 208-218) using positive and negative contrast agents. Sutton emphasised that the pneumographic diagnosis often depended on the detection of slight variations from normal. In November 1951 with RD Hoare he described his technique for vertebral arteriography (Hoare BJR 1951; 24(287): 589-597).

Nuclear medicine developed and in May 1951 two papers appeared.  EH Belcher and HD Evans from the Royal Cancer Hospital used derivatives of fluorescein to locate cerebral tumours and made a theoretical evaluation confirmed with experimentation (Belcher and Evans BJR 1951; 24(281): 272-279). They were using a scintillation counter. Jan GT de Winter from Brighton and Lewes then made preliminary clinical observations (de Winter BJR 1951; 24(281): 280-284).

 

Radioactive Isotopes

Image source: de Winter BJR 1951; 24(281): 280-284

 

Skeletal radiology

A most significant publication was the Mackenzie Davidson Memorial Lecture of 1956 given by the American paediatric radiologist John Caffey (Caffey BJR 1957; 30(353): 225-238). He described the traumatic lesions of long bones seen in child abuse, what was called battered baby syndrome and more recently non-accidental injury. The problem sadly has not disappeared and is more than of academic interest.

James Brailsford from Birmingham reviewed sclerotic bone conditions in February 1950 (Brailsford BJR 1950; 23(266): 83-91).

 

Gastrointestinal tract

Ross Golden from New York gave the Mackenzie Davidson Memorial Lecture in 1950 (Golden BJR 1950; 23(271): 390-408) and discussed small bowel pathology. At that time the radiological investigation of the small bowel consisted on intermittent fluoroscopy and plain films following the barium down the alimentary tract. In May 1951 he reviewed recent advances in gastro-intestinal radiology (Golden BJR 1951; 24(281): 237-244) and concluded that most of the improvements have resulted from the development of old ideas during years of experience and from radiological-pathological correlation.  Sölve Welin from Malmö gave the Mackenzie Davidson Memorial Lecture in 1958 (Welin BJR 1958; 31(369):  453-464) and described his technique for double contrast barium enema examination. This became a standard.

The plain film was used frequently and J Frimann-Dahl from Norway described the features of acute abdominal pathology in November 1954 (Frimann-Dahl BJR 1955; 28(335): 581-586).

GM Ardran and FH Kemp from the Nuffield Institute for Medical Research published many cineradiography studies of swallowing that were published in the BJR. Their publication of April 1957, with C Wegelius from Stockholm, is of interest because it dealt with swallowing defects after polio-myelitis (Ardran, Kemp and Wegelius BJR 1957; 30(352): 169-189).

Table listing swallowing defects after polio-myelitis 

Image source: Ardran, Kemp and Wegelius BJR 1957; 30(352): 169-189

 

Breast disease

J Gershon-Cohen and H Ingleby from Philadelphia described their mammographic technique in 1953 (Gershon-Cohen and Ingleby BJR 1953; 26(302): 87-92) with radiological pathological correlation. Mammography was not new but at this time there was no agreement as to its diagnostic value.

 

Angiocardiography

The radiology of the heart developed gradually. In April 1953 an important study from Hammersmith Hospital and Sheffield Royal Infirmary was published by John Goodwin, Robert Steiner and others (Goodwin, Steiner et al BJR  1953; 26(304):161-184). They had examined 118 cases of congenital heart disease. The image quality is excellent.

 

Chest radiology

George Simon made many contributions to chest radiology and encouraged radiological-pathological correlation working with the pathologist Lynne Reid at the Brompton Hospital and their work on emphysema of May 1959 is classic (Rein and Simon BJR 1959; 32(377): 291-305).

 

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