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.

Improved Fracture Recognition with AI assistance

 A retrospective study published in Radiology that included 489 patients with fractures that were interpreted by 24 readers showed a 10% improvement of fracture detection (75% vs 65%, superiority P<.001) when Artificial intelligence (AI) assistance was used.  AI also decreases the reading time by 6.3 seconds.  

The authors concluded that AI assistance improved the sensitivity and specificity of fracture detection for radiologists and non-radiologists alike  and shortened slightly their interpretation time.