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.

 

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The advent of radiation protection through WWI radiology martyrs

Dr Adrian Thomas

As we commemorate the centenary of the outbreak of World War One and as we approach Armistice Day on 11 November, Dr Adrian Thomas, BIR Honorary Librarian, reflects on the huge impact that the WWI radiology martyrs had on the radiation protection standards we take for granted today.

 

Many things were to change in 1914 at the start of hostilities and were never quite the same afterwards. The old confidences were shaken.

One item that symbolizes this period for me is an old wrist watch given to me by Yvonne Beech. It was presented to Corporal Edward Wallwork RAMC (Royal Army Medical Corps). Wallwork was from Lancashire and had worked in the cotton industry; he came to London during the Great War, joined the RAMC and trained as a radiographer.

 

The wristwatch presented to radiographer, Corporal Walwork, by three London radiologists

The wristwatch presented to radiographer, Corporal Walwork, by three London radiologists

At the outbreak of hostilities the War Office requisitioned a newly completed five-storey warehouse, H.M. Stationery Office in Stamford Street, for a 1650-bed Red Cross military hospital. The hospital was close to Waterloo Station and was connected by a tunnel. The building today is part of King’s College London.

The silver Swiss wristwatch was presented to Wallwork by doctors Ironside Bruce (1879–1921), Stanley Melville (1867–1934) and George Harrison Orton (1873–1947).

2bThe three doctors had all served in the forces as radiologists. Before the war men wore pocket watches and only ladies wore wristwatches. It was said that a man would sooner wear a dress than a wristwatch! However, pocket watches were not practical in the trenches. The wristwatch is a typical good quality Swiss wristwatch from the end of the First World War period and the numerals and hands were designed to be filled with radium to create a luminous dial.

The presentation of the watch was as a token of appreciation for Wallwork’s work in the X-ray department of the King George Hospital from 1915 to 1919.

Patients rehabilitating at King George Hospital

Patients rehabilitating at King George Hospital

All of the three doctors were deeply involved in the BIR or its predecessor organisations and sadly all three suffered from radiation-induced disease.  Their names are recorded on the X-ray martyr’s memorial in the grounds of St George’s Hospital in Hamburg.

Ironside Bruce was on the staff of Charing Cross Hospital and the Hospital for Sick Children in Great Ormond Street. He was very talented and published widely and his well known book “A System of Radiology; with an Atlas of the Normal” came out in 1907.

The British radiological world was shocked when Bruce died of radiation-induced aplastic anaemia in 1921 at the young age of 42. The outcry resulting from his death resulted in the formation of a radiation protection committee.

George Harrison Orton was a pioneer of radiotherapy and was in charge of the X-ray department at St Mary’s Hospital in London. After his death it was said in his obituary that he was “perhaps the last martyr pioneer of radiology”. Stanley Melville worked at St George’s Hospital in London and was BIR president in 1934. Both Orton and Melville served periods as co-secretary with Sidney Russ (physicist at the Middlesex Hospital) of the newly formed British X-ray and Radium Protection Committee set up by the BIR, and radiation standards were set.

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About Dr Adrian Thomas

Dr Adrian Thomas

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.

BRITISH INSTITUTE OF RADIOLOGY www.bir.org.uk

BRITISH SOCIETY OF HISTORY OF RADIOLOGY http://www.bshr.org.uk