Having a scan with your head in a rubber hat

NHS

Dr Jim Stevenson, reflects on life as a radiologist in the 1970s.

 

Jim StevensonI started my radiological life in the mid seventies at St George’s Hospital. Part of the rotation programme involved some time at the Atkinson Morley Hospital where I came across the first generation scanner. There was an old dental chair on which a patient laid back with his head in a rubber hat in the scanner porthole. It took 8 slices. Each slice took 5 minutes using an old fashioned tomogram X-ray tube. The image details were processed by a very large computer. The resultant image was printed on a photograph. The image matrix was 80 by 80, an advance since the original 40 by 40. How Jamie Ambrose invented the reports I do not know but his detailed knowledge of brain anatomy was quite outstanding.

Once when walking past the scanner I saw a porter in a brown overall walking round the machine. Being concerned about security, I spoke to Jamie Ambrose. “Don’t worry about him,” he said, ‘”That’s only Godfrey“ (Hounsfield from EMI).

Significant advances in CT occurred about every 5 years. When the first body images appeared we all had to learn cross-sectional anatomy. Since 1945 all anatomy was taught in longitudinal section – sagittal and coronal. I showed an image to my father-in-law. He had no problem with it but he had qualified in 1940. Before the war, all medics had to learn cross-section anatomy! The very best cross-section anatomy book I found was Eycleshymer and Schoemaker published in America in 1911. Still much better than the modern ones of recent times. The only difficulty is that all the labels are in Latin which can make interpretation difficult!

Over the past fifty years medical technology advances have been and will continue to be outstanding. The need to make proper use of them hasn’t changed. Wet films, fluorescent imaging, U/S, MRI and digital are all contributing to our future.


About Dr Jim Stevenson

Dr James Duncan Stevenson BSc. MB.BS, FRCR trained at St.Thomas’ Hospital Medical School, London and four years later turned to radiology at St.George’s Hospital, London. In November 1980 he became a Consultant Radiologist at Royal Victoria Hospital, Bournemouth and Poole Hospital. He retired in August 2007.

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A pregnant goat in the machine: memories of working in radiology

NHS

From dark art to a pregnant goat in the machine, Dr Richard Keal reflects on his NHS career in radiology. 

 

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When I started training in medicine in 1971, radiology was literally a dark art. The Middlesex Hospital X-ray department was in the basement of the hospital, a gloomy place populated by pale individuals, some wearing red goggles, who were rarely seen outside and certainly never communicated with medical students. We heard rumours of strange investigations performed there, such as air-encephalograms, which sounded more like medieval torture than anything diagnostic. Radiology had very little impact on my life as a medical student apart from my elective in Hamilton, Ontario in 1975. Here I heard a lecture by an eminent neuro-radiologist from England lamenting that he had had to come to Canada to see images from the new “EMI Scanner” – the start of the revolution in imaging.

After qualifying, I tried several specialities before ending up as a cardiology registrar. Here I was responsible for all the emergency pacing and assisting at cardiac catheterisations. I had no radiation protection training other than being told that we had to wear lead coats and radiation monitoring badges. The portable image intensifier kept cutting out and it was only when I was training in radiology that I learnt that this was due to the permitted time limit being exceeded. I often wonder whether this was the reason I developed cataracts later on.

A further career change found me training in radiology in Aberdeen. This was an exciting time: Aberdeen had two CT scanners, new real time ultrasound machines and a completely new department no longer hidden in the basement. However the real star was the NMR (as it was called then) scanner. When I arrived to train in 1983, The Mark 1 (the world’s first whole-body MRI scanner) had been relegated to research use and was available for the radiology trainees to use. I had my head scanned on it. The 64 x 64 pixel image at least proved I had a brain! I was unfortunate to have been scanned just after a pregnant goat had been in it and the smell was indescribable. We were the first trainees in the world to be taught and examined on MRI imaging for our part 1 exam. Looking at the scanner, now in the museum in Aberdeen, it is impossible to believe that a machine built of copper plumbing components with a chicken wire and aluminium foil Faraday cage and a ZX81 processor could have ever produced images.

Coming to Leicester in 1986 was like a step back in time! No MRI, a B-mode ultrasound system and a CT scanner that no registrars were allowed access to. It was here that I did my first (and last) trans-lumber aortagram and saw other investigations such as cervical myleograms. I had learnt to do lymphangiograms in Aberdeen and I used to spend many a quiet morning performing them.

With my interest in cardiac imaging, I was appointed as a consultant cardiac radiologist at the cardio-thoracic centre. I was one of the few radiologists in the country with an interest in echocardiography and in close cooperation with the cardiac surgeons, introduced intra-operative trans-oesophageal echocardiography into the operating theatres, a technique now commonplace and performed usually by anaesthetists today. As a radiologist, the hospital management were used to me asking for expensive pieces of equipment and when it came to replacing our echocardiography systems, they didn’t ask any questions when I told them that digital imaging was now standard, replacing VHS tapes, and that we required a digital archive. The result was the largest digital echocardiography department in Europe complete with a 400 GB optical jukebox the size of a small room. I followed this up by persuading them to install the first dedicated cardiac MRI scanner in the country.

I started my career by learning invasive cardiac catheterisation and ended it by performing CT coronary angiograms, such has been the pace of change in the last 40 years. Unfortunately, imaging appears to have superseded history and the workload is now excessive. The hospital I worked in now has three MRI scanners (two cardiac), two CT scanners, numerous echocardiography systems, two SPECT systems and a PET scanner; all imaging techniques that didn’t exist or were in their infancy when I started in medicine. What does the future hold?


About Dr Richard Keal

1973

I was born in 1953 and educated at Alleyn’s School in Dulwich. I scraped into the Middlesex Hospital Medical School in 1971 with three Cs at A-level having never studied any biology. After an uneventful medical school career, apart from failing pharmacology twice, I qualified in 1976. I immediately married the lovely nurse I had met over the tea urn on the first ward I was on as a medical student. Uncertain as to what area to specialise in, I tried several specialities as a junior doctor including A & E, cardio-thoracic surgery, thoracic medicine and cardiology. I finally settled on radiology and was offered a registrar post in Aberdeen in 1983 after being sent to see a psychiatrist to ensure I was sane. I moved to Leicester in 1986 as a senior registrar and was appointed as a Consultant Cardiac Radiologist at Groby Road Hospital on 1April 1990. In 1995, I became Head of Department at Glenfield Hospital and continued in post until deposed by the merger of the three Leicester Hospitals in 2002. I spent the next years as the grumpy old man of the department gradually withdrawing from various modalities as new consultants were appointed. I retired in 2013, but continued part-time as clinical head of cardiac nuclear medicine and ARSAC license holder. I finally retired in 2017 when the MDU fees became greater than my private practice earnings. Our three sons are pursuing highly successful careers outside medicine.

Hats off to Sir Peter Mansfield (1933-2017)

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Sir Peter Mansfield left school with no qualifications to become one of the most eminent scientists in the world of physics. Here, Dr Adrian Thomas pays tribute to the man who lived through World War Two and with dogged determination forged his way in science to become a distinguished and recognised physicist who played a major part in the story of MRI.

 

Sir Peter Mansfield was born on 9 October 1933 in Lambeth in London, and grew up in Camberwell. His mother had worked as a waitress in a Lyons Corner House in the West End of London, and his father first worked as a labourer in the South Metropolitan Gas Company, and then as a gas fitter. Mansfield recounted being sent with other children on a holiday to Kent for disadvantaged London children by the Children’s Country Holiday Fund.

Peter Mansfield was 5 years old when the war broke out in 1939. He remembers standing with his father at the entrance of an air raid shelter watching anti-aircraft shells exploding around German bombers caught in the searchlights. As the Blitz intensified he was evacuated from the dangers of the capital, as were so many other London children. With his brother he was sent to Devon, where he was assigned to Florence and Cecil Rowland who lived in Babbacombe, Torquay. The Rowlands were called Auntie and Uncle, and Mansfield  attended the nearby junior school. Cecil Rowland was a carpenter and joiner by trade, and encouraged Peter to develop his practical skills by giving him a toolbox, and tools were slowly acquired. He obviously obtained some proficiency since with some guidance he made several wooden toys which he was able to sell at an undercover market and a toyshop in Torquay. His life was not without danger even outside London, and in early 1944,whilst out playing, he saw a German twin-engined Fokke-Wulf plane flying at rooftop level. The tail gunner was spraying bullets everywhere, and he rapidly took shelter behind a dry-stone wall.

On his return to London his secondary schooling was at Peckham Central, moving  to the William Penn School in Peckham. Shortly before he left school at 15 he had an interview with a careers adviser. Peter said that he was interested in science, and the adviser responded that since he was unqualified that he should try something less ambitious. He was interested in printing and so took up an apprentice in the Bookbinding Department of Ede and Fisher in Fenchurch Street in the City of London, and whilst there he took evening classes.   Developing an interest in rockets he was offered a position at the Rocket Propulsion Department (RPD) at Westcott, near Aylesbury.

In 1952 he was called up into the Army for his National Service, where he joined the Engineers. The Army allowed him to develop his interest in science. On demobilization he returned to Westcott and completed his A levels. This enabled him to apply for a special honors degree course in physics at Queen Mary College in London. In 1959 he obtained his BSc, and three years later he was awarded his PhD in physics. From 1962 to 1964 he was Research Associate at the Department of Physics at the University of Illinois, and in 1964 was appointed Lecturer at the Department of Physics at the University of Nottingham.

During a sabbatical in Heidelberg in 1972 Mansfield corresponded with his student, Peter Grannell in Nottingham, and became interested in what became MRI, presenting his first paper in 1973 at the First Specialized Colloque Ampère. Mansfield developed a line scanning technique, and this was used to scan the finger of one of one of his early research students, Dr Andrew Maudsley. The scan times required for these finger images varied between 15 and 23 minutes. These were the first images of a live human subject and they were presented to the Medical Research Council, which in 1976 was reviewing the work of various groups including those in Nottingham and Aberdeen.

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In 1977 the team at Nottingham, which included the late Brian Worthington, successfully  produced an image of a wrist. The following year Mansfield presented his first  abdominal image. In 1979 Peter Mansfield was appointed Professor of Physics at the University of Nottingham. As the Nobel Committee emphasized, the importance of the work of Peter Mansfield was that he further developed the utilization of gradients in the magnetic field. Mansfield demonstrated how the signals could be mathematically analyzed, which resulted in the development of  a practical  imaging technique. Mansfield also demonstrated how to achieve extremely fast imaging times by developing echo-planar imaging. This is all very impressive for a boy who left school at 15 with no qualifications.

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Peter Mansfield was awarded many prizes and awards including:

the Gold Medal of the Society of Magnetic Resonance in Medicine (1983); Fellow of the Royal Society (1987); the Silvanus Thompson Medal of the British Institute of Radiology (1988); the International Society of Magnetic Resonance (ISMAR) prize (jointly with Paul Lauterbur)(1992);  Knighthood (1993); Honorary Fellow of the Royal College of Radiology and Honorary Member of the British Institute of Radiology (1993);  the Gold Medal of the European Congress of Radiology and the European Association of Radiology (1995);  Honorary Fellow of the Institute of Physics (1997); the Nobel Prize for Medicine together with Paul Lauterbur (2003);   Lifetime Achievement Award presented by Prime Minister Gordon Brown (2009).

His autobiography The Long Road to Stockholm, The Story of MRI was published in 2013. This is an interesting read, particularly in relation to his early years, and is recommended reading for everyone interested in the radiological sciences. This is a revealing account of a remarkable life. Whilst we may discuss the complexities of the development of MRI and exactly who should have received the Nobel Prize, there can be no doubt about his major contributions. MRI has made, and is making major contributions to health care. He died age 83 on 8 February 2017.

The University of Nottingham has set up an online book of condolence http://www.nottingham.ac.uk/news/sir-peter-mansfield/

About Dr Adrian Thomas, Honorary Historian BIR

Dr Thomas was a medical student at University College, London. He was taught medical history by Edwin Clarke, Bill Bynum and Jonathan Miller. In the mid-1980s he was a founding member of what is now the British Society for the History of Radiology. In 1995 he organised the radiology history exhibition for the Röntgen Centenary Congress and edited his first book on radiology history.

He has published extensively on radiology history and has actively promoted radiology history throughout his career. He is currently the Chairman of the International Society for the History of Radiology.

Dr Thomas believes it is important that radiology is represented in the wider medical history community and to that end lectures on radiology history in the Diploma of the History of Medicine of the Society Apothecaries (DHMSA). He is the immediate past-president of the British Society for the History of Medicine, and the UK national representative to the International Society for the History of Medicine.

See more on the history of radiology at http://www.bshr.org.uk