1970s diagnostic imaging

Central nervous system

BJR in January 1970 opened with a masterly account of the radiological investigation of proptosis by Glyn Lloyd from Moorfields Eye Hospital (Lloyd BJR 1970; 43(505): 1-18). The techniques include many of historical interest including plain films, conventional tomography, subtraction macro-angiography, contrast orbitography, orbital pneumography and orbital venography. Orbital pneumography showed the optic nerve elegantly by radiography following retro bulbar injection of air. The subtraction angiography was made using a photographic technique. So many of these traditional techniques that required a high degree of radiological and radiographic skill for performing and interpreting the results have been replaced by cross-sectional imaging.

In 1972 Sir Thomas Lodge gave his Mackenzie Davidson Memorial Lecture on the developmental defects that are the skull vault (Lodge BJR 1975; 48(570): 421-434) and he beautifully illustrated those using plain films and air encephalogram studies. In a similar manner there is a paper by Mario Savoiardo and Marjorie LeMay in May 1970 (Savoiardo and LeMay BJR 1970; 43(509): 291-202) describing the diagnosis of posterior fossa lesions by angiography and pneumography. In June 1972 there is a beautifully illustrated paler by Glyn Lloyd on the use of frontal venography to demonstrate lesions of the orbital apex and cavernous sinus (Lloyd BJR 1972; 45(534):405-44)  http://dx.doi.org/10.1259/0007-1285-45-534-405. There are very elegant subtraction angiograms.

Images of lateral subtraction angiogram showing proptosis 

Image source: Lloyd BJR 1970; 43(505): 1-18

In May 1970 Johs. Praestholm and Jack Lester (Praestholm and Lester BJR 1970; 43(509): 303-308)  described water-soluble contrast lumbar myelography with meglumine iothalamate (Conray). Conray was not ideal and caused irritation and spasm and there was an incidence of arachnoiditis (Johnson and Burrows BJR 1978; 51(603):196-202). By December 1975 IG Wylie and others from London (Wylie, Afshar and Koeze BJR 1975; 48(576): 1007-1012) were using the new water soluble contrast agent metrizamide (Amipaque) in the posterior fossa an experimental study.  In January 1976 EB Hansen and others from Copenhagen (Hansen, Praestholm, Fahrenkrug and Bjerrum BJR 1976; 49(577): 34-38)  described lumbar myelography using Amipaque (a non-ionic contrast agent). A further paper on metrizamide myelography by Ronald Grainger and others from the UK appeared in December 1976 (Grainger, Kendall and Wylie BJR 1976; 49(588): 996-1003). This was an elegant technique and lasted late into the 1980s before being replaced by CT and then by MRI.

Many papers on the use of the new EMI scanner / CT scanner appeared. Examples include papers from the National Hospital for Nervous Diseases in London on sub-arachnoid haemorrhage (Kendall, Lee and Claveria BJR 1976;  49(582): 483-501) and on a computerised subtraction technique to assess regional cerebral blood volume (Zilkha, Ladurner, Linnette et al BJR 1976; 49(580): 330-334). In August 1978 Brian Kendall and EW Radue from the National Hospital (Kendall and Radue BJR 1978; 51(608): 563-573) described the CT findings of cerebral haemorrhage. CT scanning was pioneered by Sir Godfrey Hounsfield which transformed investigative medicine.  

 computed tomography of cerebral heamatoma

Image source: Kendall and Radue BJR 1978; 51(608): 563-573

 

Ultrasound

In February 1970 there is an interesting paper from Bristol by C F McCarthy and others (McCarthy, Rhys Davies, Wells, Ross, Follett, Read BJR 1970;  43(506): 100-109) comparing ultrasound and nuclear medicine in liver disease. Whilst the ultrasound images now appear primitive to us they are exciting and prefigure future developments. At that time neither technique could distinguish between obstructive and intra-hepatic causes of jaundice.

The Danish ultrasound pioneer Hans Holm wrote on abdominal ultrasound in January 1971 (Holm BJR 1971; 44(517): 24-36). There is an interesting illustration of his apparatus and technique. In November 1972 with others he then looked at errors and pitfalls in abdominal ultrasound (Holm, Rasmussen and Kristensen BJR 1972; 45(539): 835-840). By November 1972 he and his group had scanned more than 4000 abdomens.  Ellis Barnett and Patricia Morley from the Western Infirmary in Glasgow demonstrated urinary tract space occupying lesions in October 1971 using a prototype version of the Nuclear Enterprises Diasonograph (Barnett and Morley BJR 1971; 44(526): 733-742). The compound B scan images are illustrated before the development of grey scale.

The early images were being replaced by grey-scale images and KJW Taylor and VR McCready from the Royal Marsden Hospital elegantly demonstrated these improvements in March 1976 (Taylor and McCready BJR 1976;  49(579): 244-252). They found that the grey-scale technique made placental location considerably easier.  The old conventional bistable ultrasound images are shown in a paper by JG Duncan and others from Glasgow in October 1976 (Duncan, Imrie and Blumgart BJR; 49(586): 858-862). By the end of the decade ultrasound had improved with the diagnosis of jaundice (Dewbury, Joseph, Hayes and Murray BJR 1979; 52(616): 276-280) and pancreatic disease (Meire and Farrant BJR 1979; 52(619): 562-567).

Ian Donald gave the Mackenzie Davidson Memorial Lecture in February 1975 (Donald BJR 1976; 49(580): 306-315) taking as his subject “New diagnostic horizons with sonar.” Ian Donald was from the Queen Mother’s Hospital in Glasgow and was a major pioneer in the clinical use of ultrasound. His account of his work with ultrasound should be read by all who work with ultrasound. In the lecture he mainly concentrated on his newer work with ultrasound.

In March 1979 RA Lersky, Ellis Barnett and Patricia Morley from the Western Infirmary in Glasgow elegantly demonstrated trans-rectal ultrasound of the prostate (Lersky, Barnett and Morley, BJR 1979; 52(52): 225-226). The radial scanner was incorporated into a special chair.

The scope of ultrasound increased gradually and Hylton Meire from Northwick Park Hospital reviewed the current literature at the end of the decade (Meire BJR 1979; 52(621): 685-703). Ultrasound was having profound effects on clinical practice and in particular its use in the complications of early pregnancy revolutionised the care of pregnancy.

Diagnostic imaging - fetal abdoment at 18 weeks 

Image source: Meire BJR 1979; 52(621): 685-703

 

Teaching

There is much talk about the use of models and simulators for the teaching of invasive procedures before the technique is used on a patient and Morris Simon and Keith Rabinov described an elegant model of the aorta for teaching selective catheterisation (Simon and Rabinov BJR 1970; 43(508): 273-274).

 

Chest

George Simon wrote on the long line shadow across a lower zone of the lung in May 1970 (Simon BJR 1970; 43(509): 327-332) illustrated by plain films, bronchography and conventional angiography. In October 1971 with Ian Kerr and GC Sutton from the Brompton Hospital he reviewed the plain film findings in pulmonary embolism (Kerr, Simon and Sutton BJR 1971; 44(526): 751-757).

 

The foetus

It’s important historically to judge any era by its own standards, and techniques that are now unacceptable may have been all that was available at the time. In the early 1970s there was increasing awareness of the dangers of foetal irradiation. In October 1970 Edward Daw describes a radiographic technique for foetal visualisation in cases of polyhydramnios (Daw BJR 1970; 43(514): 710-712). This involved injecting Myodil (an oily contrast material) into the amniotic sac followed by radiography 8 to 24 hours after injection. The technique could assess foetal abnormalities, maturity and gender. AH Ang and others from Malaysia (Ang, Chan and Ng BJR 1975;  48(576): 979-981) demonstrated a hydatidiform mole by amniography in December 1975.

 

Cardiovascular radiology

Radiology made many contributions to cardiology and these were reviewed by Robert Steiner, professor of radiology at Hammersmith Hospital in his BIR presidential address of 1972 (Steiner BJR 1973; 46(550): 741-753). Steiner beautifully reviews the development of radiology of the heart including fascinating images of early angiocardiography at Sheffield in 1948.

David Sutton from St Mary’s Hospital wrote a masterly account of the imaging of adrenal tumours in April 1975 (Sutton BJR 1975; 48(568): 237-258). It is apparent how difficult adrenal tumours were to diagnose before the advent of CT, MRI and ultrasound. The diagnostic techniques were quite invasive as the illustration of a retroperitoneal air insufflation study attests. The images are very elegant and required considerable technical skills both radiological and radiographic to obtain. MSF McLachlan and EE Roberts descried the normal adrenal gland in September 1971 using venography and retro-peritoneal gas insufflation. (McLachlan and Roberts BJR 1971; 44(522): 664-671). Adrenal venography was also illustrated by JK Davidson and others from Glasgow in June 1975 (Davidson, Morley, Hurley and Holford BJR 1975; 48(570): 435-450) with elegant venograms and primitive bistable ultrasound images.

The potential for angiographic interventional techniques was gradually developed. In July 1976 AR Goldin from South Africa demonstrated three patients with severe duodenal haemorrhage treated with trans-catheter embolization with cyanoacrylate glue (Goldin BJR 1976; 49(583): 583-588). In April 1977 Bob Dick from the Royal Free Hospital gave a thoughtful account of the current state of therapeutic embolisation (Dick BJR 1977; 50(592): 241-242) and in July 1979 DP MacErlean and others from Dublin described their experience of bronchial artery embolization for massive haemoptysis (MacErlean, Gray and Fitzgerald  BJR 1979; 52(619): 558-561).

Bronchial embolisation 

Image source: MacErlean, Gray and Fitzgerald  BJR 1979; 52(619): 558-561

 

Gastrointestinal tract

Pharmacological agents have been of great use in assisting with examination of the gastrointestinal tract with barium and their use was reviewed by Louis Kreel in September 1975 (Kreel BJR 1975; 48(573): 691-703). The indications, contraindications and side effects of the drugs were reviewed. WG Scott-Harden from Cumberland was an expert in barium radiology of the GI tract and reviewed upper digestive tract radiology in August 1976 (Scott-Harden BJR 1976; 49(584): 658-659).  In spite of his views that double-contrast radiology and endoscopy are complementary as endoscopy improved the use of barium gradually diminished. The patients were prepared for barium enema with oral laxatives and colonic washouts. E Bersnihan and others from Leeds reviewed two techniques for colonic lavage in July 1978 (Bersnihan, de Dombal, Parkin, Smith, Fake and Horrocks BJR 1978; 51(607): 528-529). By the end of the 1970s the double contrast techniques had reached a remarkable degree of accuracy and sophistication as is shown by AM Htoo and Clive Bartram (Htoo and Bartram BJR 1979; 52(616): 263-267).

Interventional diagnostic and therapeutic techniques are recorded. In March 1977 a paper from the Royal Free Hospital by S Jain and others including Sheila Sherlock described their experience with percutaneous transhepatic cholangiography using a fine (”Chiba”) needle (Jain, Long, Scott, Dick and Sherlock BJR 1977; 50(591): 175-180).  They found it a good way of opacifying the biliary system. In November 1977 DG Garrow from Vancouver wrote up a large serried of percutaneous removal of retained biliary calculi (Garrow BJR 1977; 50(599): 777-782)  using a steerable catheter and wire basket.

L Dalla Palma and others from Italy described their experience with plain tomography of the biliary tree following intravenous cholangiography (Dalla Palma, Bazzochi and Pietrantonio BJR 1978; 51(607): 484-493). The difficulties of investigating the biliary tree at that time are apparent. The pancreas was also difficult to examine. 

An early CT body scanner went to the University of Manchester and in January 1978 RA Fawcitt and others including Ian Isherwood published their experience of its use in pancreatic disease (Fawcitt, Forbes, Isherwood, Braganza and Howat  BJR 1978; 51(601): 1-4). They used the EMI 5000 whole body scanner. The investigation of pancreatic diseases was transformed at a stroke.

Computed tomography of pancreas with cysts

Image source: Fawcitt, Forbes, Isherwood, Braganza and Howat  BJR 1978; 51(601): 1-4

 

Nuclear medicine

Bone scintigraphy advances in the 1970s were significantly helped by the introduction of technetium labelled phosphate compounds described by Parvathi Hosain in September 1973 (Hosain BJR 1973; 46(549): 724-728) and created “considerable interest and optimism in bone scanning.” . Malcolm Merrick from the Royal Postgraduate Medical School reviewed bone scintigraphy in May 1975 (Merrick BJR 1975; 48(569): 327-351). The images are mainly obtained from the rectilinear scanner and a few gamma camera images are reproduced.

The nuclear medicine brain scan was of considerable importance to neuroradiology. The 1972 Mackenzie Davidson Memorial Lecture was given by James WD Bull from the National Hospital in Queen Square (Bull BJR 1972; 45(540): 881-890) on the subject of neurology’s debt to Becquerel. Reliable results were obtained from the isotope brain scan and its introduction had revolutionised the field of neuroradiology. The isotope brain scan had been introduced in 1963 at the National Hospital and there had been a dramatic increase in the numbers performed with a concomitant reduction in the number of ventriculograms. Edward (Ted) Burrows from Southampton was recommending radionuclide brain scanning for acoustic neuromas in December 1975 (Burrows BJR 1975; 48(576): 1000-1006) and was getting excellent results.

Tumour imaging radiopharmaceuticals were reviewed by AHG Paterson and VR McCready in July 1975 (Paterson and McCready BJR 1975; 48(571): 520-531). The development of effective agents to image tumours would be a great advance in the management of malignant disease. AGH Paterson and others from the Royal Marsden Hospital (Paterson, Taylor and McCready BJR 1975; 48(): 832-842) then compared tumour-imaging radiopharmaceuticals in October 1975. They were interested in whole body scanning for suspected tumours and to improve the tumour: background ratio.

John Bingham and Michael Maisey from Guy’s Hospital described their experience of using DMSA (dimercaptosuccinic acid) in 366 patients in August 1978 (Bingham and Maisey BJR 1978; 51(608):599-607). This replaced other more invasive methods to determine divided renal function. It is interesting to read early studies of techniques that are now standard techniques in all departments.

 Renal imaging using DMSA agent

Image source: Bingham and Maisey BJR 1978; 51(608):599-607

 

Breast imaging

Thermography

The technique of thermography and the clinical results were described by CH Jones and others from the Royal Marsden Hospital in July 1975 (Jones, Greening, Davey McKinna and Greeves BJR 1975; 48(571): 532-538). The Breast Unit had examined more than 12000 women using thermography.

 

Mammography

A number of techniques were used to perform mammography. Jack Boag and others from the Royal Marsden Hospital reviewed the history and current application of xeroradiography to mammography in September 1972 (Boag, Stacey and Davis BJR 1972; 45(537): 633-640).

The use of mammography was stimulated by the possibility of mass screening using mammography for early cancer detection. DL Asbury and PG Barker from South Manchester investigated doses to the breast in well-women clinics (Asbury and Barker BJR 1975; 48(576): 963-967) and concluded that mammography could be performed at safe radiation levels.  The South Manchester Breast Unit was one of three chosen by the DHSS to investigate the feasibility of screening mammography. In January 1976 RR Mills and others from the Royal Marsden Hospital wrote an interesting paper on the detection and significance of calcifications in the breast on mammography (Mills  Davis and Stacey BJR 1976; 49(577): 12-26). Calcifications were described and correlated with histological studies.

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