Breast Imaging; the early years

In 1913, Albert Salomon, a surgeon, described differences between benign and malignant findings in mastectomy specimens.

In 1949, Raul Leborgne, pioneered mammography by calling attention to patient's positioning, image quality, and the differences between benign and malignant calcifications.

In 1962, Robert Egan reported the first 53 cases of occult breast cancer detected at 2,000 mammograms.  He used films developed by Kodak, that allowed high MA and Kvp technique thus minimising the dose delivered to the breast.  He is considered the father of mammography due to his pioneering work at MD Anderson and Emory University. 

In 1965, Charles Gross, developed the first unit dedicated to mammography. It provided high differential contrast between the breast parenchyma, fat and microcalcifications. The unit came with a compression device that further improved the quality of imaging. 

As younger women get breast cancer the United States Preventive Services Task Force updated its recommendations last week and suggested that women make an individual choice at starting screening mammography at the age 40. 

This post is dedicated to my Chairman the late Vlastimil Chapek who introduced and taught me mammography at the University of Illinois in the early 70s and two young radiologists whom I met when I returned to Greece after 40 years; 

Stamatis Merkouris and Fotis Constandinidis.  They were eager to learn things I thought them and I learned from them too.  Stamatis is now the head of breast imaging at Metropolital General Hospital in Athens and Fotis practices breast imaging at the New Victoria Hospital in Glasgow UK

Pioneers; Purcell, Bloch, Mansfield, Damadian, Lauterbur

In 1946 Edward Purcell (1912-1977) and Felix Bloch (1905-1983) independently discovered Nuclear Magnetic Resonance (NMR) which is the basis for Magnetic Resonace Imaging (MRI).  In 1952 Purcell and Block shared the Nobel Price in Physics for their discovery.

Peter Mansfield (1933–2017) was an English physicist and a Professor at the University of Nottingham shared the 2003 Nobel Prize in Physiology or Medicine with Paul Lauterbur, for discoveries concerning (MRI).  His Echo Planar Imaging (EPI) method allowed later techniques like fMRI, diffusion ,DTI and perfusion to be developed. 

Raymond Damadian (1936-2022) an American physician and inventor of the first MRI machine.  In a 1971 paper in the journal of Science professor Damadian reported that tumors can be detected in vivo by nuclear magnetic resonance because of much longer relaxation times (which means the return of a perturbed system into equilibrium) than normal tissues and suggested that these differences can be used to detect cancers. Damadian perfomed the first full body scan in 1977.

Professor Paul C Lauterbur (1929-2007) was awarded the Nobel Prize in 2003 in Physiology or Medicine for his ground breaking research in the department of Chemistry at Stony Brook University that led to the invention of magnetic resonance imaging.

The above post is dedicated to my colleagues and prominent neuro-radiologists, Drs Don Chakeres, Eric Bourekas, Greg Christoforidis who worked with me during my tenure as Radiology Chairman at Ohio State University and Stathis Gotsis PhD whith whom I collaborated at the University of Illinois in Chicago and who introduced  NMR in Greece. 

Pionners; Dussik, Donald, Brown, Wild, Reid

 Ultrasound was first introduced in the practice of medicine approximately 90 years ago when Theodore Dussik and his brother Friederich attempted to use ultrasound to diagnose brain tumors.  In the ensuing time, ultrasound has become an important diagnostic modality in medicine.

Karl Theo Dussik (1908-1962) was born in Vienna, Austria and graduated from the University of Vienna Medical school where he worked as neurologist and psychiatrist.  Because of the difficulty in the diagnosis of brain tumors, Dussik, in 1937 started exploring the visualizatn of intracranial structures such as the ventricles with ultrasound. In 1945, Dussik together with his brother Friedrich constructed an apparatus and was able to visualise the brain and the ventricles. In 1947 he published his findings and thus is considered the "father of ultrasonic diagnosis" 

Ian Donald (1910-1987) was a Scottish physician who pioneered the use of ultrasound in obstetrics and gynecology. Donald graduated from the University of London in 1930.  During WWII he was drafted into the Royal Air Force during which time he developed an interest in radar and sonar.  After the war he became a Professor at Glasgow University where he explored the use of ultrasound in obstetrics in 1950 in collaboration with John MacVicar and Tom Brown an industrial engineer.  They developed the first compact contact ultrasound and were able to obtain an ultrasound image of a fetus. 

John J Wild (1914-2009) was an English-born American physician who received his medical degree from Cambridge in 1942 an immigrated to the United States in 1946 when he became a faculty at the University of Minnesota. Wild used ultrasound for body imaging notably for diagnosing cancer.  Modern ultrasonic medical scanners are descendants of the equipment Wild and his colleagues developed in 1950s.  In 1951 he and Dr. John Reid gained access to a unit that operated at the 15 MHz range, providing the detail needed to distinguish between healthy and cancerous tissues.  They were able to scan the breast and make the diagnosis of tumors by noninvasive means.  Reid and Wild developed tools for scanning the vaginal and rectal tissues.  Their work was published in the journal The Lancet in 1951 and in Science in 1952. They were credited as the first to develop equipment specifically designed for breast scanning and were able to differentiate between cystic and solid masses in the breast by means of ultrasonography. 

In the last 50 years due to technological advances, ultrasound units have changed from large machines to small user-friendly and sophisticated instruments.  Such evolution required contributions from the fields of physics, medicine and engineering.  Today ultrasound units are the sine qua non in the diagnosis of cardiac, abdominal musculoskeletal diseases and are also used in the guidance of interventional procedures. 

The post above is dedicated to Dr Nicholas Zannes who performed an ultrasound study on me recently for which I thank him. His contributions in radiology especially in the field of interventional radiology are noteworthy and help established the subspecialty in Greece.  In addition to being a good colleague I also thank him for being a good friend to me and my family for the past 50 years. 

Pioneers; Hounsfield & Cormack

Godfrey Hounsfield (1919-2004) was a British electrical engineer who developed computed tomography (CT). 

In 1949, Hounsfield began working at EMI, Ltd where he researched guided weapon systems and radar.  At EMI, he became interested in computers and in 1958, he helped in the design of the first computer system in Great Britain. Shortly afterwork he started work on CT scanner.   

Hounsfield came up with the idea that one could determine what was inside a box by taking x-ray readings at multiple angles around an object.  He then built a computer that could take input from x-rays at various angles to create an image of the object in slices.  Applying this idea to the medical field led him to what is known today as computed tomography. The scale of units he used (HD), running from -1000 HD for air, 0 HD for water, and +1000 HD for cortical bone are the quantitive measures used in obtaining, depicting and evaluating a CT scan.

At that time, Hounsfield was not aware of the work and the two papers Allan Cormack (1924-1988) had published in 1956 on the theoretical basis of such a device when he worked at the University of Cape Town and Groote Schuur Hospital.

Hounsfield built a prototype head CT scanner and tested it first on a cadaver's brain and soon after on a cow's brain and finally on himself.  On October 1st 1971, CT scanning was introduced in medical practice with a brain scan performed on a patient and in 1975 Hounsfield built a whole body scanner. 

In 1979, Hounsfield and Cormack received the Nobel Prize in Physiology and Medicine.  Both received numerous awards in addition to the Nobel and Hounsfield was also knighted in 1981.

The above post is dedicated to Dr John Andreou and Professor A Gouliamos  prominent Greek radiologists whose expertise in computed tomography contributed in establishing it as a pre-eminent diagnostic method in Greece.  in addition to being a good colleagues I also thank them for being good friends to me for the past 50 years.

A Pioneer; Michel Haïssaguerre

Atrial fibrillation (AF) is the most common heart rythm disorder, affecting 0.5% of the world's population and 3% of the population of Europe and North America.  According to the CDC approximately 2% of people younger than 65 years old have atrial fibrillation, while 9% of those over 65 are afflicted by AF and it is the cause of 20-25% of ischemic brain strokes.

Atrial fibrillation is treated with lifestyle changes, medicines such as beta and calcium channel blockers, anti-arrhythmics, anticoagulants and procedures such as catheter ablation in order to slow the heart rate and restore a normal heart rhythm.

In 1988, Michel Haïssaguerre a cardiac electrophysiologist in Bordeaux, France described the use of catheter ablation for patients with atrial fibrillation.  He founded that in 95% of the patients, AF episodes were caused by abnormal electrical "triggers" originating from within or the viscinity of pulmonary veins in the left atrium.  By mapping the triggers and ablating them, he was able to render 62% of patients free of AF without the need of using anti-arrhythmic drugs.  This landmark finding has led to the development of catheter ablation as a routine management strategy for atrial fibrillation.  His technique prevents this abnormal electric activity from reaching the atria  and is the sine qua non in the treatment of AF.  Although the patients may experience a return of the arrhythmia, the procedure is considered a safe, effective and minimally invasive method.  Studies have shown that the overall complication rate of cardiac ablation procedures is about 6%.

Michel Haissaguere was born in Bayonne, France on October 5th, 1955.  He became a Professor of Cardiology in 1994 and is the Chief of Cardiac Pacing and Electrophysiology Department at the Haut-Leveque Cardiology Hospital, part of the Bordeaux University.  Professor Haissaguerre was elected member of the French Academy of Sciences in 2010 and has received multiple awards such as the Best Scientist Gruntzig of the European Society of Cardiology, Pioneer of Electrophysiology of the North American Rhythm Society, the Gold Medal of the European Society of Cardiology and numerous others.  He and his associates have published more than 800 papers on this subject.  

The above post is dedicated to Dr Peter Danias who has been my cardiologist in Greece.  Dr. Danias' expertise in cardiac computed tomography and magnetic resonance imaging established these diagnostic methods in Greece.  

A Pioneer; Andreas Gruentzig

Andreas Gruentzig was born in Dresden, Germany in 1939.  He received his MD from Heidelberg University in 1964. In the late 60s, he learned of the angioplasty procedure developed by Charles Dotter at a lecture in Frankfurt.  Because he encountered bureaucratic difficulties in Germany, he moved to Zurich, Switzerland in 1969 and worked in the department of Angiology at the University Hospital of Zurich.

Gruentzig's first successful coronary angioplasty on a human was performed in 1977.  He expanded a 3mm atherosclerotic lesion of the Left Anterior Descending (LAD) which was causing an 80% stenosis of its lumen.

The immediate results of the treatment, despite using a kitchen built catheter, were quite good.  The patient became and remained angina free after the treatment.  The initial results were rechecked 10 years later and the lumen of the LAD remained patent.

In 1976, Gruentzig was presenting his animal research at a meeting in Miami where he met Dr. Spencer King, a cardiologist from Emory University.  In 1980, Dr. King visited Gruentzig in Zurich and convinced him to join Emory University where the two collaborated.

Gruentzig presented the results of the first four cases at the 1977 American Heart Association meeting, which led to the widespread acknowledgement of his pioneering work.

Gruentzig contribution in the performance of percutaneous coronary angioplasty instead of a bypass remains a major breakthrough in the field of medicine.

Gruntzig an instrument rated pilot and his wife died when his airplane crashed in Macon Georgia in 1985. 

A Pioneer; Charles T Dotter

 Charles T Dotter (1920-1985) who performed the first peripheral angioplasty is considered the father of interventional radiology.  Dotter did his undergraduate studies at Duke and got his M.D. from Cornell in NYC.  In 1952 he was appointed Professor and Chairman of Radiology at the University of Oregon and served for 33 years.

On January 16th 1964, Dotter performed the world's first percutaneous transluminal angioplasty on an 82-year old woman who refused amputation for a gangrenous foot.  Dotter diagnosed a stenosis of the superficial femoral artery and with the use of co-axial catheters dilated the stenotic segment resulting in complete healing of the gangrenous ulcer! Inititialy the technique was received with skepticism in the United States but was readily accepted in Europe.  The patient lived for another 2 1/2 years after this groundbreaking procedure.  Dotter also described other interventional procedures such as the use of arterial stents and the use of transjugular biospies of the liver. 

Dotter was a prolific researcher and published over 300 papers.  His trainee Melvin Judkins did the seminal work in percutaneous coronay angiography. Dotter had many interests such as music, painting, photography, flying airplanes and climbing mountains.

In 1990, the Dotter Institute was established in his honor to further studies in the newly established subspecialties of Interventional Radiology, Interventional Cardiology and in other fields of medicine such as Interventional Neurosurgery.