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. 

This post is dedicated to Dr.Konstantinos Boudoulas who is my cardiologist at Ohio State Medical Center. Dr. Boudoulas specialty is interventional cardiology. He and his colleagues continue to further develop the life saving procedure of coronary angioplasty. 

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.

A Pionneer; Melvin Judkins

Melvin Judkins (1922-1978) was a physician known for the development of pre-shaped catheters for the catheterisation of coronary arteries.  He received his M.D. from the College of Medical Evangelists.  Upon graduation he spent a year at Loma Linda Hospital.  He was then  commissioned by the Army during WWII and served in the 28th General Hospital in Osaka, Japan.

Judkins at the age of 40 studied radiology at the University of Oregon under Dr. Charles Dotter known today as the father of interventional radiology.  He continued his studies at the Cleveland Clinic under Dr. Mason Sones who pioneered coronary angiography.  Later he studied in Sweden under Dr. Sven Seldinger.  It was in Sweden he developed the pre-shaped catheters that could be introduced in the aorta without a need of a cut down of the brachial artery.  He brought these new techniques back to the University of Oregon in 1966.  Upon his return he further developed the Judkins' catheter.  He published his technique in Radiology in 1967 and by 1968, his pre-shaped catheters were commercially produced.

In 1969, he became the Chairman of Radiology at Loma Linda and also the director of the cardiovascular laboratories from 1970-1978, during which time his lab was frequented by physicians from all over the world.  Judkins retired in 1978 after suffering a stroke. 

A Pionner; F. Mason Sones, Jr

Mason Sones (1918-1985) was an American physician whose pioneering work in cardiac catheterization was instrumental in the development of coronary angiography based on which coronary bypass surgery was later developed.

Sones received his M.D. from the University of Maryland School of Medicine in 1943.  From 1944 to 1946, he served in the US Air Corp in the Pacific.  Sones did his residency at Henry Ford Hospital and later joined the Cleveland Clinic Foundation in 1950.

On October 30, 1958 while he was performing an angiogram of the ascending aorta the catheter inadvertently slipped in the right coronary artery.  Although it was attempted, the catheter was not withdrawn, thus a large amount of contrast was injected into the artery.  The patient's heart went into asystole but when the patient coughed as instructed the heart started beating again.

From this experience, Sones realized that smaller amounts of contrast media could safely injected in the coronary arteries an invention that resulted in a diagnostic method that revolutionized cardiology.  With the advent of coronary angiography, cardiologists for the first time, could accurately map stenoses or occlusions in the coronary circulation.  In 1967 a cardiac surgeon, Rene Favaloro, performed the first coronary bypass at the Cleveland Clinic.  it was Favaloro who called Sones "the most important contributor to modern cardiology."

Sones received numerous awards during his career.  He was one of the founders of the Society of Cardiac Angiography (now known as the Society of Cardiovascular Angiography and Interventions) and served as the first President of the new society. 

This post is dedicated to Dr. Harisios Boudoulas a cardiologist who established the division of non-invasive cardiology at the Ohio State Medial Center.  Dr.Boudoulas pioneered the study of diseases of the heart and the aorta. Professor Boudoulas was the Distinguished Research Investigator Division of the Academy of Athens. 

A Pionner; Sven Seldinger

Sven Ivar Seldinger (1921-1998), began his medical training at the Karolinska Institute and upon graduation in 1948, he went on to specialize in radiology.  It was at the Karolinska Hospital he came up with an ingenious idea on how to introduce a catheter in an artery or vein without the need of surgically exposing the vessel of entry with a cut down.

Seldinger first published his technique in 1953 in Acta Radiologica. The technique was based on introducing a guide wire through a needle that had punctured a peripheral artery such as the femoral artery leave the guide in place, remove the needle and introduce a catheter over the wire.  Thus, he could catheterize any artery or vein by manipulating the catheter and the guide wire.  Upon the completion of the procedure digital pressure over the puncture site produced hemostasis, obviating the need to suture or ligate the vessel of entry.

The Seldinger technique is used today for diagnostic angiography, interventional procedures, insertion of central venous catheters, insertion of chest or abdominal drainage catheters, insertion of the leads of cardiac pacemakers and many other interventional procedures. 

During his lifetime he received numerous awards from American, Swedish and German medical and radiological societies for his technique that made diagnostic and interventional procedures widely available thus he revolutionized medicine at large.  In 1984 Seldinger received an honorary doctorate from the Faculty of Medicine at Uppsala University in Sweden.

A Pionner; Reynaldo dos Santos

Reynaldo dos Santos (1880-1970) was a Portuguese physician, writer and art historian.  During WWI Dos Santos served as a surgeon in British Hospitals in France and, later, at the Portuguese Expeditionary Corps.  Once back in Portugal after WWI, he created a research and teaching center in Lisbon.

Building on the work of Antonio Egas Moniz who first developed cerebral angiography in 1927, Dos Santos performed the first translumbar aortogram in Lisbon in 1929.  He later reported 300 patients on whom the abdominal aorta and its branches were visualised with translumbar angiography.  He became a professor in 1930 and in 1941 became the Dean of the Faculty of Medicine of the University of Lisbon.

The procedure did not find immediate acceptance into clinical practice due to toxicity of the contrast media.  When water soluble iodinated contrast media were introduced the side-effects were diminished and interest in the procedure was revived. In 1947, Dos Santos had performed and reported on 3,000 angiograms without any fatality. 

Thus translumbar abdominal aortography performed with a  needle which was advanced under the 12th left rib at the level of L1 vertebra played an important role in the evaluation of abdominal aortic aneurysms, occlusions and/or stenoses of its branches.  It also became the method of choice in the diagnosis of congenital vascular lesions such as aberrant vessels, arteriovenous fistulae and aneurysms of the abdominal aorta's side branches.   

A Pioneer; António Egas Moniz

Antonio Egas Moniz, (1874-1955), introduced and developed (1927-1937) cerebral angiography, by injecting opaque contrasts to x-rays into the carotid artery.

Moniz experimented with different contrast media in order to visualise the brain vessels. He selected lithium bromide, strontium bromide and sodium iodide and he performed experiments, in cadavers, animals and humans.

His first eight attempts were failures with one patient dying after the injection of contrast.  Success was achieved on the ninth patient when the branches of the intracranial carotid appeared clearly visible on film.  This allowed Moniz to describe arterial displacement and abnormal vascularisation in brain neoplasms and also make the diagnosis of cerebral aneurysms.  Moniz found that sodium iodide was the less toxic. Twenty years later in 1957 an organic iodide contrast (Renographin) which had three atoms of iodine came into use and found to be less toxic.  The organic iodine contrast were replaced in the 70s with nonionic contrasts which had fewer adverse effects due to their decreased osmolality and are in use today in the performance of angiography, interventional procedures and also in intravenous injection in computed tomography.  

Although Moniz was nominated three times for the Nobel Prize for the discovery of cerebral angiography, he was never awarded for the discovery of this diagnostic tool.  Moniz won the Nobel Price for Medicine in 1949 (together with Walter Rudolf Hess) for the operation of prefrontal leukotomy which was used in the treatment of psychoses, a procedure less important than brain angiography and not in use today .

A pionner; Werner Theodor Otto Forssmann

Werner Forssmann (1904-1979) was a German physician who studied medicine in the University of Berlin. 

He thought that a catheter could be inserted into the heart, for such applications as delivering drugs, injecting radiopaque dyes and/or doing pressure recordings from the cardiac chambers.  The fear at that time was that such a procedure would be fatal.

In 1929, he performed the first human cardiac catheterisation on himself. With the assistance of an operating-room nurse, Gerda Ditzen he anesthetized his cubital fossa, and after a cutdown he inserted and advanced a urinary catheter in his anticubital vein.  He and Gerda then walked to the X-ray department, a floor down, where he advanced the catheter under fluoroscopy into his heart.  This was recorded on an x-ray film showing the tip of the catheter into his right atrium. 

During WW II, he served as a medical officer and held into a U.S. POW camp.  During his imprisonment, his paper was read by Andre F. Cournard and Dickinson W. Richards who developed ways of applying Forssman's technique to the diagnosis of heart diseases.  In 1956, the Nobel Prize in Physiology and Medicine was awarded to Cournard, Richards and Forssman. 

A Pioneer; Marie Curie

Maria Sklodowska-Curie (1867-1934) was a Polish-born French physicist who pioneered the study of radioactivity.

She moved to Paris to pursue her education where she met and married Pierre Curie, a physicist, and together they discovered two new radioactive elements: polonium which was named after Marie's native country and radium from the Latin word for "ray".  

She became the first woman to win the Nobel Prize in Physics in 1903 along with Pierre and Henri Becquerel, for their work in radiation phenomena.  She became the first woman professor of physics at the Sorbonne and she won a second Nobel Prize in Chemistry in 1911. 

Curie applied her knowledge of radioactivity to medicine and developed mobile x-ray units to help wounded soldiers during WWI.  In 1920 her health started to fail and she died 14 years later from aplastic anemia likely caused by radiation due her exposure to radiography.

The Genius; Nikola Tesla

Nikola Tesla was a Serbian-American inventor born on July 10, 1856.  He is regarded as one of the most brilliant and innovative scientists of the 20th century.  He is best known for the design of alternating current electricity supply system.   Tesla was a polymath who studied engineering and physics in 1870s without receiving a degree. He gained practical experience working for Continental Edison in Paris and later when he worked for Edison Machine Works in New York City.  Some of his AC inventions and patents were liscensed by Westinghouse Electric in 1888, earned him a considerable amount of money. 

Starting in 1894, Tesla began investigating what he referred to as radiant or "invisible energy" which had damaged films in his laboratory.  He may have inadvertently captured an x-ray image-predating, by a few weeks, Wilhelm Röntgen's December 1985 announcement of the discovery of x-rays-when he tried to photograph Mark Twain by a Geissler tube.  The only thing captured in the image was a metal screw on the camera lens. 

Tesla proceeded doing his own experiments in x-ray imaging by developing a high-energy single-terminal vacuum tube of his own design.  Interestingly he noted the hazards of working with single-node x-ray producing devices especially the damage they caused to the skin.  Although Tesla devised several experimental setups he credited Röentgen as the inventor of x-rays and radiographic imaging a major improvements in the practice of medicine. 

Despite his many achievements, Tesla was not without his challenges.  He struggled throughout his life as a loner, however his contributions to science and technology were undeniable, and he continued to work on his inventions until his death on January 7, 1943.

The Founder; Wilhelm Conrad Röntgen

Wilhelm Conrad Röntgen was born in 1845 in Germany.  When he was 3 years old, his family moved to the Netherlands.  He started his studies at the University of Utrecht and completed at Zurich's Polytechnic from which he graduated in 1869 with a PhD in mechanical engineering.

On November 8, 1895 while he was studying the passage of an electric current through a gas of extremely low pressure, the cathode ray tube, he discovered a new kind of rays, he called X-rays.  His discovery revolutionised the field of medicine and for his discovery was awarded the first Nobel Prize in Physics in 1901.  The first application in medicine was when he exposed his wife hand, on the same day, in the path of x-rays over a photographic plate and he observed after developing it, the image of his wife hand showing shadows of the bones and soft tissues of the hand and of the ring she was wearing.  This was the first "röntgenogram" ever taken. 

In spite of the numerous honours, Röntgen was a modest, amiable and polite man who preferred working alone.  He built most of the apparatuses he used with great ingenuity and experimental skill.  His discovery created the specialty of Radiology (Diagnostic and Therapeutic) a sine qua non in the practice of modern medicine.

A single Chest X-ray Could Predict 10-Year CVD Risk

Researchers presented in the 2022 RSNA Annual meeting the results of a deep-learning model (AI) based on which a single chest x-ray could predict a patient's 10-year risk of dying from a heart attack or a stroke.

They tested the algorithm against a group of 11,430 outpatients, with an average age 60-years who underwent outpatient chest x-ray and were potentially eligible to receive statins.  Of those patients ,1096 or 9.6% had a major adverse cardiac event in a median 10-year follow up.

There was a significant association of the CVD risk found by chest x-ray and those found with MACE.

This is an example on how AI could detect clinically relevant outcomes with a widely used and low-cost screening test.

The paper was presented at 2022 RSNA meeting, Abstract T#-SSCH04-1

As today is the first of a new year I want to wish you all a happy and healthy 2023.  I would like to thank the 14,000+ who read the 174 posts I published the last 7 years.  

I also want to extend my sincere appreciation to three mentors of mine; my late Chairman Dr. V Capek MD and late Dean B. Siegel MD at UIC and Dean M Tzagournis MD at OSUMC for guiding and supporting me during my academic career. Also the many associates and trainees who daily enriched my experience in our specialty that had an explosive growth in the last 50 years.  

Finally, I want to let you know that starting next month the blog will have a new editor, a talented young radiologist, who with her ideas and knowledge of recent developments and advances in Radiology will make Radiology Monthly better for the benefit of all who read it.