Conventional radiology had reached a remarkable degree of sophistication by the end of the 1960s with high resolution images. How could the low resolution ultrasound and nuclear medicine compare? Hugh Saxton from Guy’s hospital gave a very useful review of intravenous urography in May 1969 (Saxton BJR 1969; 42(497): 321-346) discussing the physiology of contrast media and the imaging techniques.
Image source: Saxton BJR 1969; 42(497): 321-346
So many papers on diagnostic radiology were published it is difficult to know what to select. Of interest is a paper by RO Murray in January on the bony changes in Cushing's syndrome and steroid therapy (Murray BJR 1960; 33(385): 1-19). The paper illustrated not only the careful radiological study but also the complications from exogenous steroid treatment. The numbers of pharmaceuticals available to clinicians markedly increased in the post-war years and many had complications which the radiologist needed to be aware of.
Another paper relating to the complications of medications was a paper by Ronald Grainger, AH Morris and P Ward from Sheffield (Grainger, Morris and Ward BJR 1962; 35(418): 687-691) describing the abnormalities associated with the use of thalidomide in pregnancy and the skeletal changes of “phocomelia” and as they sadly said “many maternity units in this and other countries have noticed in the past two years an increased incidence of an unusual foetal abnormality.”
Frank Doyle with others from the Hammersmith Hospital wrote an interesting study in April 1967 on the limitations of the plain film of the spine in the assessment of osteoporosis (Doyle, Gutteridge, Joplin and Fraser BJR 1967; 40(472): 241-250) that is still relevant and shows the need for bone densitometry and the inadequacy of subjective impressions.
Image source: Doyle, Gutteridge, Joplin and Fraser BJR 1967; 40(472): 241-250
The early apparatus needed for catheter angiography was clearly illustrated by John Laws and JCG Fox in February 1960 (Laws and Fox BJR 1960; 33(386): 119-123) . There is an interesting photograph of the gas powered injector and an illustration of catheters and the technique needed.
There was a symposium on thoracic aortography in the September 1960 BJR including papers by David Sutton from St. Mary’s Hospital (Sutton BJR 1960; 33(393): 545-558) in adults and by Robert Steiner from the Hammersmith Hospital (Steiner BJR 1960; 33(393): 559-567) on infants and children. The image quality was now excellent in these catheter studies. The August 1962 paper by Robert Steiner and Arthur Hollman (Steiner and Hollman BJR 1962; 35(416): 540-553) studied the left ventricle in a variety of conditions and in addition to the contrast studies they recorded arterial pressures in the heart and femoral artery using a polythene catheter. The pressures on either side of the aortic and mitral valves could be measured directly. The contrast media that could be used in the cardiovascular examinations were reviewed by Ronald Grainger in August 1964 (Grainger BJR 1964; 37(440): 568-580).
John Dow and DG Taylor from Guy’s Hospital described their experience of angiography in intra-cardiac shunts in April 1962 (Dow and Taylor BJR 1962; 35(412): 241-248).
Angiography could also be used to deliver therapy and this was reviewed by H Horwitz from Cambridge in November 1960 (Horwitz BJR 1960; 33(395): 659-678) and he described his infusion technique (Horwitz BJR 1960; 33(395): 679-683).
Angiographic techniques were becoming increasingly sophisticated and Eric Boijsen from Sweden described and reviewed his technique for selective pancreatic angiography in July 1966 (Boijsen BJR 1966; 39(463): 481-487). Pancreatic angiography was used to diagnose pancreatic tumours.
The history of neuroradiology was brilliantly recounted by James Bull in his Presidential Address of 1960 (Bull BJR 1961; 34(398): 69-84) and is a fascinating story. The story is well told and illustrated with an account of the work of the pioneer neuroradiologist Arthur Schüller who had died in 1957 (BJR 1959; 32(373): 49-50).
AM Hastin Bennett made an interesting presentation of stereotaxic apparatus to use in neurosurgery in June 1960 (Bennett BJR 1960; 33(390): 343-351) in this case using it to insert radioactive gold grains into the pituitary gland.
Image source: Bennett BJR 1960; 33(390): 343-351
The chest radiograph could with careful analysis give considerable information about physiology in health and in disease. Peter Lavender and others from Hammersmith Hospital reviewed pulmonary venous changes in mitral stenosis in May 1962 (Lavender, Doppman, Shawden and Steiner BJR 1962; 35(413): 293-302) and in the following paper with J Doppman looked at the hilum in pulmonary venous hypertension (Lavender and Doppman BJR 1962; 35(413): 303-313). The quality of the plain films and hilar tomograms is superb.
David Trapnell from Westminster Hospital published his study of the peripheral lymphatics of the lung in September 1963 (Trapnell BJR 1963; 36(429): 660-672) using lymphatic injections. The work is still relevant to our interpretation of chest radiography. That the careful analysis of the plain chest radiograph could provide information of considerable patho-physiological importance was further confirmed by papers by AR Crispin, John Goodwin and Robert Steiner on pulmonary hypertension in October 1963 (Crisdpin, Goodwin and Steiner BJR 1963; 36(430): 705-714) and by Eric Milne on mitral stenosis in December 1963 (Milne BJR 1963; 36(432): 902-913).
Conventional radiology was of high quality and resolution. David Trapnell looked at the principles needed in the interpretation of bronchography in February 1969 (Trapnell and Gregg BJR 1969; 42(494): 125-131) with beautiful high resolution vs. low resolution CT.
Image source: Trapnell and Gregg BJR 1969; 42(494): 125-131
A very important paper by Ian Donald and TG Brown from Glasgow appeared in September 1961 (Donald and Brown BJR 1961; 34(405): 539-546). The paper was based on a presentation at the Annual Congress of the BIR on the 26th April 1961. The paper on ultrasound was called “Demonstration of tissue Interfaces within the Body by Ultrasound Echo Sounding” and is a classic. Ultrasound had been used for several years to look at flaws in metals and Donald (the doctor) and Brown (from Messrs. Kelvin Hughes Ltd.) applied the principle to tissue boundaries in the body. They saw the technique as ancillary to radiology and speculated on what might be achieved in time in the hands of radiologists were they to embrace the technique. In August 1967 Ian Donald and Usama Abdulla reviewed the use of ultrasound in obstetrics and gynaecology (Donald and Abdulla BJR 1967; 40(476): 604-611).
In November 1969 there appeared an interesting paper by Peter Wells and colleagues from Bristol comparing A-scan images with compound B-scan images (Wells, McCarthy, Ross and Read BJR 1969; 42(503): 818-823). By 1969 ultrasound techniques were established but it took many years for radiologists to fully embrace the technique.
Image source: Wells, McCarthy, Ross and Read BJR 1969; 42(503): 818-823)
Another interesting paper on ultrasound was by James Ambrose from St. Georges Hospital in March 1964 (Ambrose BJR 1964; 37(435): 165-178). In this paper Ambrose was using ultrasound to determine the position of the midline of the brain and so detect pathology. The technique was uncertain and prone to artefact. Ambrose presented his work on cranial ultrasound in 1969 to the meeting of the British Medical Association in Leicester and although the paper was well received Ambrose would admit that the technique was not generally useful. In 1969 Ambrose, now at Atkinson Morley’s Hospital in Wimbledon, presented a paper at the Annual Congress of the BIR analysing the nuclear medicine brain scans performed in 1968. The hospital had performed 731 studies and although the numbers of nuclear scans were increasing Ambrose found that the number of contrast radiological studies had remained constant.
By 1948 Atkinson Morley’s Hospital had become the busiest neurosurgical unit in London. Neurosurgery had been developed by Wylie McKissock. McKissock had visited Stockholm and had been very impressed by the close collaboration between Herbert Olivecrona and the radiologist Eric Lysholm. McKissock disliked the current invasive neuroradiological techniques. James Ambrose shared his concerns and the department at Atkinson Morley’s Hospital actively investigated alternative imaging techniques including cranial ultrasound and nuclear medicine with the support of the physics department at St George’s Hospital. Ambrose was therefore well prepared to respond positively to Godfrey Hounsfield and to his novel ideas regarding cranial imaging and to his ideas in the early 1970s (Ambrose BJR 1973; 46(552): 1023-1047).
Image source: Ambrose BJR 1973; 46(552): 1023-1047