When MRI created excitement in the air

NHS

Dr Adrian Thomas shares his experience of working as a radiologist and how excited he was to see the EMI/CT scanner for the first time. 

 

adrian thomas

Dr Adrian Thomas

In my time as a radiologist I have seen the amazing growth and flowering of radiology. I entered medical school in 1972, which was the year that the CT/EMI scanner was announced by Godfrey Hounsfield and James Ambrose at the BIR Annual Congress; and I started radiology at Hammersmith Hospital in 1981, which coincided with the opening of their MRI scanner. I don’t think that either of these events were connected!

 

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X-ray Television at Farnborough Hospital in 1970

When I started medical school everything looked so advanced and exciting to my young eyes. As I look back now it all seems rather primitive. Computers were in their infancy, and imaging was almost all traditional. However, I liked the X-ray departments that I saw, and was taught by Peter Bretland at the Whittington Hospital, and by the great George Simon who was a pioneer chest radiologist. Both were inspirational teachers.

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Old X-ray cassette, pre-digital

The juniors today will find it difficult to understand how very different things were. As a junior doctor, practising emergency medicine or surgery with only minimal imaging was not easy. Many assumptions were made. So for example, an older person with left iliac fossa pain and fever was assumed to have acute diverticulitis. They were treated with intravenous fluids, antibiotics and a nasogastric tube; a barium enema was then arranged as an outpatient. Many exploratory laparotomies were performed for undiagnosed acute symptoms, and the surgeon had only a limited idea as to what would be found. We had plain films, contrast studies and nuclear medicine, but no CT and only limited access to ultrasound. I can remember patients who would have been managed entirely differently today with modern imaging. In particular, an accurate diagnosis made by CT or ultrasound may preclude the need for invasive surgery.

5 Store for conventional film packets

Store for conventional film packets. Large storage rooms were needed for storing X-ray film packets, with many filing clerks

I was a surgical houseman in 1978-9, and I recollect one particular patient that had done something that you should never do, that is to polish the floor  underneath a carpet. He had come downstairs, and had stepped onto the carpet. The carpet had slid forwards, and he fell backwards hitting himself hard on the occiput. He presented with a severe headache, but no neurological signs. His skull plain film X-ray showed no fracture, and I admitted him for neurological observations. After 24 hours he remained well, but still had his severe headache. The surgical team decided to keep him in  hospital for further observation. We kept him for well over a week, and he remained well although with a persistent headache. We then finally sent him home. I had a phone call some days later from another hospital. My patient had unfortunately died, and the other team wanted to know what we had been doing. I explained what had happened, and the voice on the ‘phone said that this was all very reasonable and we could not be criticised. Today the patient would have been scanned, a potentially treatable lesion could have been found, and this young man could be alive today.

3 Traditional cassette opened to show intensifying screens and film

Traditional cassette opened to show intensifying screens and film

I had first seen the EMI/CT scanner when my consultant took his firm of neurology students to see the new scanner at the National Hospital in Queen Square, where he had clinical sessions. I was fascinated by the images we saw, and the radiologist Ivan Moseley showed us the capability of the scanner. I could feel the excitement in the air, and a knowledge as to how much we could learn about the natural history of various diseases. I was also aware of the excitement in the air when I was at Hammersmith Hospital as a registrar  in Radiology. We were being taught tradition imaging – plain films, barium meals and enemas, and IVPs. I became quite good at TLAs (trans-lumbar aortograms), when a long needle was passed into the prone anaesthetised patient, and contrast injected to show the peripheral vessels. However, whilst I was learning the traditional techniques, Graeme Bydder, from the MRI Unit, used to join us for our lunchtime meetings and show us the recent scans hot off the printer. This was long before the days of digital transfer of images and PACS. I remember being excited by the images of NMR as it was called then, and realising how the neurosciences would be revolutionised.

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Bags of films for reporting. Once a common scene in reporting rooms

Imaging has utterly transformed both the practice of medicine, and also how we look at ourselves. It is all too easy to be cynical about the modern world and whist things may always improve major advances have been made. However, all of these changes were quite unpredictable when the NHS was set up, and it is a major achievement that these new imaging techniques have been introduced. Modern imaging is readily available for our patients, and has transformed untold numbers of lives. Godfrey Hounsfield was always very humbled by the many letters that he received from patients and relatives thanking him for his invention.


About Dr Adrian Thomas

Adrian Thomas is a radiologist, and visiting professor at Canterbury Christ Church University. He has been President of the Radiology Section of the Royal Society of Medicine, and of the British Society for the History of Medicine. He is the Honorary Historian to the British Institute of Radiology. Adrian has written extensively on the history of radiology writing many papers, books and articles. He is currently, with a colleague, writing a biography of the first woman radiologist and woman hospital physicist.  He has had a long-term interest in role development in radiography, and teaches postgraduate radiographers.

 

A revolution in imaging: radiology memories for #NHS70

NHS

Professor Adrian K Dixon was born in the same year that the NHS began. Here he reflects on what the NHS has given him and the revolution he has experienced in the world of radiology.

 

Adrian Dixon

Professor Adrian K Dixon

I was born in 1948 and, 70 years on, I remain one of the most passionate supporters of the NHS. Like many of my generation, I have received huge personal benefit from the NHS over the years; both my elbow fractures were brilliantly treated in Accident and Emergency Units; joint replacements for osteoarthritis have provided renewed mobility latterly; audiology services have looked after my long-term inherited deafness and allowed me to function reasonably well so far.

Training in medicine in Cambridge (1966–9) and London (St Bartholomew’s Hospital, 1969–72) was very different from nowadays. On hour one, day one, as a young houseman, sister said to me: “There are three patients for myelography today –  there are three trays set up for lumbar puncture – all you have to do is to send some cerebrospinal (CSF) fluid off to the lab and instil the Myodil before they go down to radiology where Professor du Boulay will be waiting….!” I had not even seen a lumbar puncture at that stage but I learnt quickly at the hands of an excellent registrar. Then I went off for training in General Medicine at Nottingham General Hospital in the excellent Professorial Unit led by Professor Mitchell and Dr (later Professor) Hampton. Any patient over 65 then was ‘geriatric’. I well remember one elderly lady recovering from a cardiac event who was not quite well enough to go home where she lived alone – I said: “I think you need a few days in our convalescent home in Cleethorpes (yes, the NHS provided such things in those days!)”. Her reply: “Oh lovely; I have never seen the sea”. No package holidays or low-cost flights back then!

I was extremely lucky to train in radiology during the 1970s and to be involved with the beginning of the revolution in imaging, namely the introduction of ultrasound, CT and MRI. These advances were truly miraculous compared with the fluoroscopic techniques of old. Indeed image intensification was only just becoming sophisticated while I was training and I did my fair share of barium work using direct fluoroscopy following dark adaptation with red goggles! This even persisted after my move to Cambridge when I was given responsibility for imaging services at the local geriatric hospital where the ageing equipment was nearly as old as some of the patients!

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After a brief spell in paediatric radiology, I became fascinated by Computed Tomography and I was lucky to be appointed as a Research Fellow at St Bartholomew’s Hospital. There, Dr Ian Kelsey Fry had the foresight to install one cranial and one whole body CT systeminto 2 standard X-ray rooms (an excellent strategy – replacing old technology rather than merely adding on the new). This gave me the experience to be appointed as a young lecturer/Honorary Consultant at the newly emerging Clinical School in Cambridge (thanks to the risk taken by my lifelong friend Professor Tom Sherwood).

In partnership with NHS radiological stars in Cambridge (Desmond Hawkins and Chris Flower, to name but two), Tom Sherwood forged a highly successful combined University/NHS Radiology Department which continues to this day. I was fortunate to be given free rein to develop Body CT and the townspeople generously raised the money for a machine which was opened by HRH the Prince of Wales in 1981. But the NHS was not quite ready for CT! Not only did the town-based charity have to pay for the building, it also had to provide running costs for the first five years; we only received subsequent NHS funding in 1986 after a thorough Department of Health Audit of our work. Even then the local NHS was sceptical; the local oncologists saved the day by suggesting that they could manage more of their patients as outpatients if CT was available. The outstanding local fundraisers were so successful that the charity was able to fund top-of-the range MRI systems in Cambridge for some decades thereafter. Although there was one generous distribution of NHS funding for CT systems on the back of Sir Mike Richards’ cancer initiatives, NHS funding for high-end equipment has never really been properly addressed.


About Professor Adrian K Dixon

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Professor Adrian K Dixon

Professor Dixon is Emeritus Professor of Radiology at the University of Cambridge and a retired Consultant Radiologist. He has published extensively on Computed Tomography and Magnetic Resonance Imaging and has edited several textbooks. He was Warden of the Royal College of Radiologists (Clinical Radiology, 2002–2006) and MR Clinical Guardian to the UK Department of Health (2004–2007). He has been awarded honorary Fellowship/Membership of Radiological Societies in Austria, Australia & New Zealand, France, Hungary, Ireland, Sweden, Switzerland and the USA. He was Editor-in-Chief of European Radiology 2007–12 and was awarded the Gold Medal of the European Society of Radiology in 2014. He has been awarded Honorary Degrees by Munich and Cork. He was Master of Peterhouse, University of Cambridge 2008–2016.