The development of diagnostic imaging has been the result of a fruitful relationship between doctors, radiographers, physicists and equipment manufacturers. New apparatus has stimulated the introduction of new techniques and medical needs have in their turn stimulated new developments in equipment.
In 1895 Wilhelm Conrad Roentgen was the professor and head of the department of physics
at the Julius-
The apparatus used by Rontgen was readily available and the experiment could easily
be repeated. In the initial apparatus designed by Sir William Crookes (1832-
The apparatus was demonstrated in scientific and medical meetings and also in fun-
The apparatus gradually improved and hospitals started to acquire the equipment.
Many hospital X-
Many people were involved in what was called "The New Photography" including photographers
and general practitioners. At King’s College Hospital in London, two medical students
were sent to use the new apparatus. After some time, a Doctor Mayou was put in charge
of them since it was felt they were spending too much money on plates! Financial
considerations were important even then. He was warned by the students not to expose
his hands to the X-
At the Royal London Hospital experiments were undertaken by a physician, Dr Page
and a surgeon, Mr Harold Barnard. The initial interest was centred around a registrars
volunteered his services as a radiographer and the first radiograph of a needle in
a foot was made early in 1896. Peripheral radiography was not a problem where the
body part was thin. Radiography of the trunk was to prove technically more demanding
and the shadows produced were much more difficult to interpret. Harnack had three
assistants, Reginald Blackall, Ernest Wilson and Harold Suggars. Ernest Wilson joined
in 1898 to help with the X-
The absence of protection around the early X-
Ironside Bruce, Reginald Blackall and Ernest Wilson were among the 14 British names on the martyr’s memorial in the grounds of St George’s Hospital, Hamburg. The name of Ernest Harnack was added in the 1950s.
The radiographs were initially made onto glass photographic plates which had to be
placed into light tight cassettes or envelopes. The photographic plates were coated
with emulsion on one side only. The emulsion had a habit of slipping off during developing
and the job of a junior was to wax the edges of the plates to help to keep the emulsion
in place. Film was introduced by Eastman in 1918, however film only came into general
use from about 1923. It should be remembered that the image quality on glass was
excellent and it took some time for film to replace the older technique. Unlike the
glass plates, the film could be coated on two surfaces emulsion ("Dupli-
Most of the early X-
The gas tubes were difficult to use and the skill of the operator lay in proper seasoning
of the new tube and caring for it during use. It was only following the introduction
of the Coolidge tube in 1913 that predictable results were obtained. In the Coolidge
tube, the bulb could be completely evacuated and electrons were liberated from a
heated spiral cathode. The results were far more uniform and it was possible to vary
the current and voltage independently. In the early tubes, the high-
The initial apparatus was of low power and therefore fluoroscopy was superior to radiography. In 1896 a chest plate on a girl aged 10 years taken at St Thomas’s Hospital in London took 30 minutes to expose. The initial workers used fluoroscopy often with the hooded fluorescent screen. It was only with the development of higher powered apparatus with large induction coils and electrolytic interrupters that instantaneous radiograph could be developed. By 1905 better quality films could be obtained. A cultural change was also needed in physicians who initially found it hard to accept that an abnormality could exist when it was not clinically apparent and could only be demonstrated radiographically.
The first English book on Chest Radiography was published in 1905. The initial chest
films were of rather poor quality however they were of diagnostic quality and for
example enabled the drainage of a pneumothorax (collapsed lung) under X-
The techniques used reflected the pathology encountered, bronchiectasis (dilated
bronchi), tuberculosis, lung abscess and empyema (pleural abscess) being common in
the early years of this century. Fluoroscopy was extensively used in the treatment
of TB to assist in the diagnosis and in the performance of artificial pneumothorax
and dedicated chest fluoroscopic apparatus was used in many chest clinics. In a similar
way to the current use of screening mammography, the introduction of mobile miniature-
The introduction of agents that could safely be injected into the circulation allowed
the lung vessels to be demonstrated. More recently nuclear medicine, computed tomography
(CT) scanning and magnetic resonance imaging (MRI) have been introduced. These techniques
enable detailed anatomy to be demonstrated non-
The difficulty of visualising the abdominal organs is related to the thickness and density of the structures involved. As already indicated, radiography was difficult because of the low power of the apparatus used. Compression devices were used and because of the lack of contrast in the tissues contrast material had to be introduced. A major initial problem was the extent of new anatomical knowledge required and the identification of normal variants. The normal locations of abdominal organs in life is not obvious and earlier this century many operations to correct floating kidneys were performed. An early landmark was the publication by Kohler in 1910 of the first edition of his classic book on normal variants. To distinguish calcified lymph glands, gallstones, kidney and bladder stones and other shadows on an abdominal radiograph could be a major problem. In the renal tract Hurry Fenwick of the Royal London Hospital introduced ureteric catheters to identify the course of the ureters and retrograde studies with injected agents soon followed to demonstrate the kidneys. Intravascular (injectable) contrast agents were introduced in the 1930s and transformed the examination producing the intravenous urogram.
Liquid contrast was introduced into the stomach as the bismuth meal and later using the less toxic barium sulphate. The opaque meal to diagnose ulcers and cancers of the stomach and duodenum was developed in Vienna in 1904 by Reider and popularised in the UK by workers such as AE Barclay and Sebastian Gilbert Scott. Rectally administered the colon could be filled with bismuth or barium to assist in the diagnosis of large bowel disease such as cancer or diverticulosis.
The diagnosis of gallstones was difficult since most stones are not opaque to the
In the 1950s came the development of the image intensifier and X-
Many new techniques have been introduced in recent years. The principles of CT scanning
were first described by Godfrey Hounsfield and the first prototype EMI scanner was
installed in 1972 at Atkinson Morley’s Hospital. Work was progressing on Magnetic
Resonance Imaging (MRI) in the 1970s and the first human image was obtained at Aberdeen
in 1977. Nuclear Magnetic Resonance can be used to either to produce planar images
of anatomy or as Magnetic Resonance Spectroscopy can provide biochemical information.
Ultrasound started in the 1950s and gained popularity in the 1960s. "Real-
In modern radiological practice it is not possible to consider techniques in isolation. An integrated approach is needed with the various techniques used as appropriate. Often it is better for a complex procedure to be used early in an investigation since a diagnosis may be reached quickly with minimal inconvenience and risk to the patient. In recent years the widespread use of percutaneous biopsy techniques and ultrasound and CT scanning have considerably reduced the need for exploratory surgery. There have been many changes in medicine which influence radiological practice and for example, the increasing use of endoscopy has considerably reduced the need for barium meals. The recent developments in diagnostic imaging have considerably facilitated the recent trend to investigate and treat patients as day cases or as outpatients with considerably less disruption to the patients life.
Until the 1980s the techniques needed to store reports and films had changed little since the 1920s. Modern technology is transforming departments with the introduction of computer management systems and digital image storage. This last technique will dramatically alter the use of images with studies being transferred via links between different institutions and offices. The last 100 years have produced many changes and the next 100 will be even more dramatic.
To stimulate the study and conservation of British radiological history, the Radiology History Committee was founded in 1987. The committee became a charitable trust in 1992. The UK R0ntgen Centenary Conference took place in Birmingham in June 1995.
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Author Title Publisher
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