Nuclear Medicine; Part II

Rosalind Yalow and her colleague Solomon Benson were nuclear medicine and internal medicine physicians at Bronx Municipal Hospital in New Yolk.  Rosalind Yallow received the Nobel Prize for developing the radioimmunoassay in the 1950s.  Yalow and Benson employed Iodine 125 in their assay after years of failure attempting to employ Iodine 131 as the tracer.

William Myers at the Ohio State University introduced several radioisotopes including Iodine 125 and Cobalt 60.  He was able to convince Benson and Yalow to switch to Iodine 125 as a tracer leading to their success. 

Dr Myers and Charles Doan who was the Dean at Ohio State University College of Medicine introduced the first treatments of an overactive thyroid gland with Iodine 131. 

Drs Myers and Doan also assisted in the production of the first to commercial Nuclear Medicine camera as initially developed by Paul Anger. This production was contracted to Nuclear Chicago which was acquired by Searle and then by Siemens in the late 70s.  Their original camera is now in the Smithsonian Institute. 

Michel Ter-Pogossian, the father of PET, using filtered back projection mathematics introduced his PET scanner and enabled many companies such as General Electric, Siemens and others to copy the CT technology originally developed by EMI without regard to patents leading to the the rapid advance in CT imaging. 

Both computed tomography and immunoassay which were among the greatest medical developments in the second half of the 20th century had their roots in Nuclear Medicine.

Dedicated to Drs Mark Tetaleman and Ernest Mazzaferri.  Mark who was the chief of Nuclear Medicine at OSU met an untimely death when he was murdered while attending a meeting in Atlanta, Georgia.  Ernest Mazzaferri was an endocrinologist and Chairman of the Department of Internal Medicine at OSU.  Ernie was an ardent supporter of Nuclear Medicine and world recognized for the treatment of thyroid cancer.

Nuclear Medicine; Pioneers

Nuclear Medicine is the field that combines principles of chemistry, physics biology and medicine to develop diagnostic and therapeutic techniques with the use of a radioactive substance.  Several pioneers have contributed to the field:

Marie Currie (1861-1934) discovered the radioactive elements plutonium and radium.  Her work led to the use of radioactivity in medicine.

George de Hevesy (1885-1966) he suggested and developed the tracer principle, using radioactive isotopes to study chemical processes in living organisms. He won the Nobel Price in Chemistry in 1943 for his work on radioactive tracers.

Earnst Lawrence ( 1901-1958) he invented the cyclotron, a particle accelerator which was used to produce radioactive tracers in nuclear medicine 

Benedict Cassen (1902-1972) he developed the rectilinear scanner in 1950s, the first imaging device for nuclear medicine that preceded the gamma camera. 

Hal Anger (1920-2005) he invented the gamma camera (also known as Anger camera) in 1957.  The Anger camera is the key imaging device used in nuclear medicine today to detect radiation emitted by radioactive tracers in the body.

Michael Phelps, Edward Hoffman and Michael Ter-Pogossian are credited with the development of the modern PET scanner. Michael Phelps in particular is credited for his work in creating the first practical PET scanner in the mid-1970s.  The collective efforts of these researchers led to the establishment of PET as a powerful medical imaging technique.

The above mentioned pioneers, among others have contributed in the establishment and advancement of nuclear medicine, making it an important field in modern diagnostics and treatment. 

This post is dedicated to John Olsen who was the Chief of Nuclear Medicine during my tenure as Department Chairman at Ohio State University and Lyda Gogou the Dean of Health Sciences at West Attica University who was among the PET pioneers in Greece.

Breast imaging: newer developments

 Mammography is a medical imaging study that uses low dose x-rays to examine the human breast.  It can detect tumors before they are felt on physical examinationand can find microcalcifications that may indicate breast cancer.  Recently digital imaging has replaced film/screen mammography as it provides better image quality and allows easier storage and image sharing. Three dimensional mammography known as tomosynthesis is a newer mamographic technique which is useful in women with dense breast parenchyma.  Multiple randomized studies have demonstrated decreases in mortality from breast cancer by approximately 30% when screening mammograms are performed annually in women whose age is between 40 to 70. 

In 1990, Jackson in a Radiology article suggested ultrasound as a valuable tool in breast imaging especially when a mass is felt clinically or detected on mammography. Ultrasound helps in differentiating between solid masses that can be cancerous and fluid filled cysts that are benign.  In cases when a cancer is suspected ultrasound is used to guide needle biopsies and other therapeutic procedures such as breast cancer ablation. While useful, ultrasound is not a replacement for mammography.  For women with dense breasts when combined with mammography and clinical examination they provide a comprehensive evaluation.

In 1976, Frank, Ferris et al in a NEJM article described the technique of needle localization that allows placement of a wire with its tip adjacent to the lesion.  The technique ensures tat the surgeon can remove the suspicious finding with minimal tissue removal.  Wire localization can be performed either under mammographic or ultrasound guidance.

Magnetic resonance imaging (MRI) is using a magnetic field and radio waves to create detailed images of the breast.  Research in breast MRI started in 1980 in the USA and Germany.  MRI is highly sensitive and can detect abnormalities not seeing in either mammography or ultrasound.  In 1986, Heywang et al demonstrated that breast cancers enhance following gadolinium administration. In 1990, Kuhl et al published their study in the use of MRI in the screening of women at high risk for breast cancer, such as those with strong family history or genetic mutations like BRCA1 or BRCA2.

This post is dedicated to my friend and associate John Olsen MD who introduced the concept of mobile mammography and was the first who did stereotactic biopsies at Ohio State University.  He was the chief of Nuclear Medicine and Breast imaging at OSU and President of our departmental corporation URI.  I had the pleasure working with him during my tenure at OSU and learning from him on how to allay cancer patients fears.

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.