Transcript What is new in Chest Imaging

What happened
114 years ago
Dr.P.V.Ramachandran MD FICR, Professor of Radiology , AIMS, Cochin, INDIA
Working with a cathode-ray tube in his laboratory,
Roentgen observed a fluorescent glow of crystals.
When air in the tube was evacuated, and a high voltage
was applied, the tube produced a fluorescent glow.
The tube that Roentgen was working with
consisted of a glass envelope (bulb) with positive
and negative electrodes encapsulated in it.
Roentgen shielded the tube with heavy black paper,
and discovered a green coloured fluorescent light
generated by a Barium Platinocyanide screen
located a few feet away from the tube.
X…… Rays
• Roentgen concluded that a new type of ray
was being emitted from the tube.
• This ray was capable of passing through the
heavy paper covering and exciting the
phosphorescent materials in the room.
• Roentgen also found that the new ray could
pass through most of the substances
Did not think…but investigated
• It is interesting that the first use of
X-rays were for an industrial (not
medical) application, as Roentgen
produced a radiograph of a set of
weights in a box to show his
colleagues.
• And of course , the historic first
ever medical radiograph followed
within next 6 weeks( 22 Dec 1895)
Within a month after the announcement of the
discovery, several medical radiographs had
been made in Europe and the United States
In June 1896, only 6 months after
Roentgen’s discovery, X-rays were being
used by battlefield physicians to locate
bullets in wounded soldiers
This early radiograph was a 15
minute exposure of the hand
of Roentgen's wife –22 Dec ‘95
Hand of Von Kolleiker, President
of Wurzburg Physical and
Medical Society on 13th Jan 96
After 7 weeks of hard work W.C. Roentgen wrote a short manuscript
entitled "On a New Kind of Rays - First Communication" and handed it
to the secretary of the Würzburg Physical & Medical Society.
Because the society did not meet during the Christmas holidays,
Roentgen asked that the manuscript be published prior to its oral
presentation, which was scheduled for January 23rd, 1896.
The secretary agreed and the manuscript was published in the
"Sitzungsberichte der Physikalisch-Medizinischen Gesellschaft in Würzburg"
(S. 132-141, Band 137, 1895)
H.D. Ruhmkorff (1803-1877) who originally built musical
instruments, became famous for the invention of
electromagnetic devices such as the induction coil
J. W. Hittorf (1824-1914), Professor of Physics at the University
of Münster, studied cathode rays and developed a tube with a
vacuum more complete than had hitherto been available.
Sir William Crookes (1832-1919) built variety of vacuum tubes designed
for research into radiant matter. He was of such renown that even in his
lifetime "Crookes tube" was used to refer to any kind of vacuum tube
Lastly, Roentgen refers to P. Lenard (1862-1947), who was awarded
the Nobel Prize in Physics in 1905 ( 4 years after Roentegn) for his
ingenious work on cathode rays. In 1892 he has built a special tube
The text reads (note the corrections!):Ueber eine neue Art von Strahlen
von W.C. Röntgen
(Vorläufige Mittheilung)
1. Lässt man durch eine Hittorf'sche
Vacuumröhre,
2. oder einen genügend evacuierten
Lenard'schen, Crooke'schen oder
ähnlichen Apparat die Entladungen eines
grösseren Ruhmkorff's gehen, und bedeckt
die Röhre mit einem ziemlich eng
anliegendem Mantel aus dünnen
schwarzem Carton, so sieht man in dem
vollständig verdunkelten Zimmer einen in
die Nähe des Apparates gebrachten, mit
Bariumplatincyanür angestrichenen
Papierschirm bei jeder Entladung hell
aufleuchten, flueresciren, gleichgültig ob
die an gestrichene oder die andere Seite
des Schirmes dem Entladungs apparat
zugewendet ist. Die Fluerescenz ist noch in
2 m Entfernung vom Apparat bemerkbar.
Man überzeugt sich leicht, dass die Ursache
der Fluerescenz vom Innern der
Entladungsapparatur und von Keiner
anderen Stelle der Leitung ausgeht.
Concerning a New Kind of Rays
by W.C. Röntgen
(Preliminary Communication)
1. Upon passing the discharge of a large Ruhmkorff coil through
a Hittorf tube or a sufficiently evacuated Lennard, Crookes or
similar apparatus, the tube being equipped with a properly tight
fitting cover made of thin black card, then in a completely darkened
room one sees with every discharge, brightly emitted light, a
fluorescing…………………. Fluorescence is observable up to 2m
away from the apparatus. It is easily shown that the cause of the
fluorescence originates from inside the discharge apparatus and
from no other part of the conductors.
It is not known which of these various tubes W.C. Roentgen
actually used; in his original communication he merely
mentioned the three different types in a general way
Lenard, however, considered himself to be "the mother of X-rays"
while Roentgen was "the midwife who happened to deliver the
child". Certainly, both were nominated for the first Nobel Prize in
Physics in 1901; and the committee recommended that the prize
should be divided equally between Roentgen and Lenard . But the
Royal Academy of Science decided to award the prize to Roentgen.
In 1896, however, the two scientists were jointly awarded the
Rumford Medal of the Royal Society of London. Neither actually
travelled to London to receive his prize, and as a result, the two
men did not meet on this occasion, nor, indeed, on any other.
Prof. Lecher , a physicist from Prague borrowed the manuscript for a
single day for his father who was the editor of the Vienna newspaper
"Die Presse“ and it was he who wrote the first article on the discovery,
which appeared in the Sunday, 5th Jan. 1896, edn. of the newspaper.
Owing to haste in the preparation of the article the name of Roentgen
was misspelt as "Routgen". By the following evening, 6th Jan .1896,
the news had been spread around the world by cable from London.
"The noise of war's alarm should not distract
attention from the marvellous triumph of Science
which is reported from Vienna. It is announced
that Professor Routgen of Würzburg has
discovered a light which, for the purpose of
photography, will penetrate wood, flesh and most
other organic substances. The Professor has
succeeded in photographing metal weights
which were in a closed wooden case, also a
man's hand, which shows only the bones, the
flesh being invisible".
The London Standard printed the report on January 7th, 1896
adding the following remarks:
"The Presse assures its readers that there is no joke or humbug in the
matter. It is a serious discovery by a serious German Professor".
While the first reports in New York were published on January 8th, 1896,
the first report by the local newspaper, "Würzburger Generalzeiger",
did not appear until January 9th, l896 !
Thus, within ten days of the submission of the manuscript to a
publisher the news had spread to the entire world , even before
Roentgen had presented his findings to the scientific society .
An English translation of Roentgen,s communication appeared in
“ Nature” ( London ) and two weeks later, in Science (USA).
On January 13th, 1896, Roentgen presented his work to Emperor
Wilhelm II in Berlin and, on January 23rd, 1896, he eventually gave his
oral presentation to the Würzburg Physical Medical Society.
*PALL MALL GAZETTE (MARCH, 1896):
"We are sick of the Roentgen rays. It is now said, and we hope
untruly, that Mr. Edison has discovered a substance - tungstate of
calcium is its revolting name - which is potential (whatever that
means) to the said rays. The consequence appears to be that you
can see other people's bones with the naked eye and also see
through eight inches of solid wood. On the revolting indecency of
this, there is no need to dwell. But what we seriously put before
the attention of the government is that the moment this comes into
anything like general use it will call for legislative restriction of the
severest kind. Perhaps the best thing would be for all civilised
countries to combine to burn all the works on the Roentgen rays,
execute the discoverers and corner all the tungstate in the world
and whelm it in the middle of the ocean. Let the fish contemplate
each others' bones if they like but not us."
*Cited from Lord (Peter) Ritchie Calder's (1906 -- 1982) "Profile of
Science", George Allen and Unwin Ltd, London,1951, pp.41.
Shortly after the discovery of X-rays in 1895, an imaginative
English businessman started selling x-ray proof undergarments to women
who thought that they would be stared at by men wearing x-ray glasses.
The whole world became obsessed by these new rays.
Some feared them and spoke of similar rays that might bring death and destruction
to whole cities and armies by remote control.
Others complained of the banishment of all privacy,
for here was an agency that could see right through your clothes!
A bill was actually introduced into the New Jersey State Legislature
forbidding the use of X-rays in opera glasses on the grounds that
public modesty would be outraged,
as if X-rays could be incorporated in opera glasses!
A London firm actually advertised X-ray-proof underwear!
Roentgen did not relish the sudden publicity he gained after the
discovery of "a new kind of rays“ which were named "Roentgen rays"
following his oral presentation at Wurzburg. He was awarded numerous
honorary memberships, medals and other decorations but virtually
never accepted these accolades in person. He did travel to Stockholm,
however, to accept the first Nobel Prize in Physics in 1901, but did not
give an official speech even on that occasion.
He was honoured by the Prince Regent of Bavaria with the
Royal Order of Merit of the Bavarian Crown which carried with it
personal nobility. Roentgen accepted the decoration but refused the
status of nobility, a gesture which was most uncommon in those days.
He turned down several chances to make profit from his discovery.
Mr. Levy, a representative of a well known German company,
was sent to Roentgen to negotiate a contract for the
industrial exploitation of his current and future discoveries.
Mr. Levy recalled Roentgen's answer:
"He declared, however, that according to the good tradition of
German University professors he was of the opinion
that his discovery and inventions belonged to humanity
and that they should not in any way be hampered by
patents, licences, contracts or be controlled by one group."
Born on March 27, 1845 at Lennep, in
the lower Rhine Provine of Germany.
The only child of a cloth manufacturer
and merchant. His mother was
Charlotte Constanze Frowein of
Amsterdam,a member of an old
Lennep family settled in Amsterdam.
When he was three years old, his
family moved to Apeldoorn in The
Netherlands, where he went to the
Institute of Martinus Herman van
Doorn, a boarding school.
In 1862 he entered a technical school
at Utrecht, where he was unfairly
expelled, accused of having produced
a caricature of one of the teachers.
(“Consilium abeundi”)
He then entered the University of
Utrecht in 1865 to study physics. Not
having attained the credentials
required for a regular student, and
hearing that he could enter the
Polytechnic at Zurich by passing an
“ Entrance exam”, he tried it, got
through and began studies there as a
student of mechanical engineering.
In 1869 he graduated Ph.D. at the University
of Zurich, was appointed assistant to Kundt
and went with him to Würzburg .
Würzburg University, however, hindered
Roentgen's academic career. Acting under
Bavarian law, it barred his promotion because
of his lack of a school leaving certificate !
In 1874 he qualified as Lecturer at Strasbourg
University and in 1875 he was appointed
Professor in the Academy of Agriculture at
Hohenheim in Wurtemberg. In 1876 he
returned to Strasbourg as Prof. of Physics.
In 1879 He accepted the invitation to the
Chair of Physics in the University of Giessen.
In 1888, however, Roentgen received an offer which he
could not refuse: The same University of Würzburg,
which had previously obstructed his academic career
now offered him the position of full professor and
director of its highly esteemed and well equipped
Physics Institute. He accepted the appointment
and moved back to Würzburg. In 1894, he received the
ultimate academic accolade in his election as Rector.
In 1900 he accepted the request from Bavarian Govt.
to chair the department. of Physics, University of
Munich, where he remained for the rest of his life,
Röntgen's first work was published in 1870,
dealing with the specific heats of gases.
His other areas of interest and work were
Thermal conductivity of crystals ;
Electrical and other characteristics of quartz;
Refractive indices of various fluids;
Modification of the planes of polarised light
by electromagnetic influences;
Variations in the functions of the temperature;
Compressibility of water and other fluids ;
Phenomena accompanying the spreading
of oil drops on water.
Contemporary philosopher Münsterberg of Harvard University
who on January 15th, 1896 wrote in a report to Science:
"Suppose chance helped. There were many galvanic effects in
the world before Galvani saw by chance the contraction of a
frog's leg on an iron gate. The world is full of such chances
and the Galvanis and Roentgens are few."
Röntgen retained the characteristics of a
strikingly modest and reticent man.
Throughout his life he retained his love of
nature and outdoor occupations.
Many vacations were spent at his summer
home at Weilheim at foot of the Bavarian
Alps. He went on many mountain
expeditions .He was a great mountaineer
Amiable and courteous by nature,
he was always understanding the views
and difficulties of others. He was always
shy of having an assistant, and preferred to
work alone.Much of his apparatus was
built by himself with great ingenuity.
Röntgen married Anna Bertha Ludwig of Zürich
whom he had met in the café run by her father.
She was a niece of the poet Otto Ludwig.
They married in 1872 in Apeldoorn, The Netherlands.
They had no children, but in 1887 adopted
Josephine Bertha Ludwig then 6 year old
daughter of Mrs. Röntgen's only brother.
Anna died on 31st October 1919.
( For years, she had required five or more
daily injections of morphine which he administered personally.
("I want to help and console my poor wife in her dark hours").
Röntgen resigned his position at the university and in the inflation
that followed the war, he almost lived in poverty.
Loneliness weighed heavily on him . He wrote
("I try to live as I imagine my wife would find satisfactory").
Four years later, Röntgen died at Munich on
10 Febr. 1923 from large bowel cancer
Wilhelm Conrad Roentgen ( 1845- 1923),
the discoverer of X-rays in 1895,
In the pleasant wooded cemetery in Giessen
Initially his remains were in another cemetery.
Later his ashes were transferred to Giessen
where his wife and parents were cremated
Major inventions of 1895
Signals by Radio, Marconi (Italy)
Wireless High Frequency Telegraph, Marconi (Italy)
Diesel Engine, Diesel (Germany)
Safety Razor, King C. Gillette (USA)
Rayon (Acetate), Cross (England)
Photoelectric Cell, Elster (Germany)
X-Ray, Roentgen (Germany)
Discoveries in the Field of X-rays
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1901-W. C. Röntgen, in physics, for the discovery of X-rays.
1914-M. von Laue, in physics, for the discovery of X-rays by crystals.
1915-W. H. Bragg and W. L. Bragg, in physics, for the determination of
crystal structures using X-rays.
1917 C. G. Barkla, in physics, for the discovery of the characteristic
X-ray radiation of the elements.
1924 M. Siegbahn, in physics, for discoveries in the field of X-ray spectroscopy
1927 A. H. Compton, in physics, for revealing the particle nature of X-rays in
scattering experiments on electrons
1936 P. Debye, in chemistry, for determining molecular structures by X-ray
diffraction in gases.
1962 M. F. Perutz and J. C. Kendrew, in chemistry,
for determining the structure of hemoglobin and myoglobin.
1979 A. M. Cormack and G. N. Hounsfield, in medicine, for the development of
computerized tomography
Key Advances in Radiology
1896 - Henri Becquerel discovers radioactivity and nuclear medicine is born.
1901 – Roentgen receives the Nobel in Physics for the discovery of x-rays.
1905 - The first English book on Chest Radiography is published.
1910 - Köhler publishes the first edition of his classic book on normal variants
,
1913 –Coolidge hot cathode tube simplifies the work of technicians
1918 – Eastman introduces film, replacing glass photographic plates.
1920 - Society of Radiographers forms.
1930s – Doctors are appointed with specific interests in diagnosis or therapy.
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• Whole brain : 350 mSec
• One heart beat Coronary angio !
• Whole Liver : 350 mSec
– Arterial phase ~ 8 sec
– Portal phase ~ 10 sec
• Faster than blood flow in many parts of the
body
Government budget
Is there more money allocated for this ?
Or Is this at the expense of other facilities ?
Cost
Individual patient
Same questions
Since patient is not capable of analysing the technology,
it is the role of government to evaluate technology and
make recommendations based on efficacy
and make the medical system follow those recommendations
Efficacy of technology
• Technical Capacity
• Replicability
• Reliability
• Diagnostic accuracy
• Sens, Spec, PPV, NPV
• Diagnostic Impact
• Does result affect subsequent testing ?
• Therapeutic impact
• Does the test change treatment ?
• Patient outcome
Efficacy : Performance of test under ideal conditions
Effectiveness : Performance in real life `average` condition
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“I have seen further by standing on the shoulders of giants”
Isaac Newton