Defining Moments In Medicine

MJA 2001; 174: 14-15

The second half of the 20th century witnessed an extraordinary and unforeseen escalation in diagnostic imaging. Australian radiologists initiated some of the advances and were quick to introduce others into local practice.

Mammography and mammographic screening: In 1957, radiologist Marjorie Dalgarno performed the first mammogram in Australia at the Rachel Forster Hospital in Sydney. This hospital also initiated the first Australian population-based mammographic screening program, in March 1988. A national program for detection of breast cancer was subsequently established in 1990.

Ultrasound examination: Following the successful use of sonar for submarine detection in World War II, the technique was applied clinically for fetal imaging. Physicist George Kossoff, assisted by David Robinson, designed and built the first echoscope at the National Acoustics Laboratory, Sydney. It was installed at the Royal Hospital for Women, Sydney, with a clinical service established in May 1962 by obstetrician William Garrett.

Greyscale sonography and the Octoson: Kossoff and colleagues at the Royal Hospital for Women, Sydney, first described greyscale sonography in 1972. This technique allows sonar echoes to be converted to a two-dimensional image in shades of grey on photographic film. In 1976, Kossoff developed the automated echoscope (the Octoson), which produced high-quality greyscale images.

Computed tomography: Evan Lennon, an Australian radiologist advising the Department of Health in the United Kingdom, was the first, in 1970, to recognise the clinical utility of computed axial tomography. This had been developed by Geoffrey Hounsfield, research scientist at the EMI company in London and Nobel laureate. The first clinical EMI computed tomography (CT) scanner in the UK, in 1971, was followed by the first Australian EMI CT scanner, at Sir Charles Gairdner Hospital, Perth, in 1975.

Magnetic resonance imaging (MRI): The application of nuclear magnetic resonance to cross-sectional imaging of human subjects was first described by Hinshaw and colleagues (Nottingham, UK) in Nature in 1977. The first MRI scanner in Australia began service in Sydney in 1986.

Minimally invasive techniques: The introduction of Seldinger's technique for percutaneous vascular catheter placement in 1953 meant direct needle puncture of the aorta and carotid arteries was no longer necessary. The evolution of other minimally invasive techniques for renal cyst puncture, biopsy and nephrostomy transformed the management of renal masses.

Coronary angiography and angioplasty: The development of defibrillation allowed selective coronary angiography, which evolved with the techniques introduced by Sones (1958) and Judkins (1962). It was subsequently performed in Australia in the mid-1960s. Endovascular therapy was the logical progression, with the first balloon angioplasty performed by Andreas Gruentzig, in ZYrich, Switzerland, in 1978.

Interventional neuroradiology: Improved catheter techniques and new biologically inert embolic materials facilitated neurointerventional techniques in the 1960s and 1970s. The first procedure (closure of a caroticocavernous fistula) was performed by Trevor Apsimon, a Perth neuroradiologist, in 1979.

Nuclear medicine: The commissioning of the nuclear reactor at Lucas Heights in 1958 provided a national isotope source. Technetium (99m-Tc) was first used in radiology in 1966, for bone scanning at the Peter MacCallum Cancer Institute in Melbourne.

Automatic film processing: This introduced new standards of efficiency and quality control not possible with the labour-intensive wet processing technique used before 1957.

Rolling-loop film transport system: This technical breakthrough was developed in 1966 by Jim Hood, a pioneering Brisbane cardiac radiologist. It allowed film to move continuously rather than intermittently past the shutter, making possible high speed image acquisition. The concept underlying this revolutionary cine-angiographic camera was subsequently incorporated into the projector system for IMAX theatres.

Digital imaging and image transfer: Historically, radiographic images have been displayed and stored on films. With the advent of radionuclide scanning and the cross-sectional imaging techniques of CT and ultrasound, along with the improvements in computer technology, the storage, display and transfer of digital images have become a practical reality. Picture archiving and communication systems which can receive, digitise, file and redisplay medical images are now being installed in major teaching hospitals. The same data can now be transmitted by telephone lines and satellite communications.

Evolution of the College examination system: In the mid-1930s, the University of Melbourne established a diploma course in diagnostic and therapeutic radiology. The University of Sydney soon followed suit. Previously, Australian doctors had travelled to Britain to undertake diploma courses. The first examinations of the Royal Australasian College of Radiologists (now renamed the Royal Australian and New Zealand College of Radiologists [RANZCR]) were held in May 1951, with a Board of Examiners being formed in 1953. The College examination system continues to evolve in response to technological changes and advances.

First Chair of Radiology: Edgar Rouse was a Melbourne philanthropist who supported the Baker Medical Research Institute in the early 1950s. His vision of the potential for radiology was fulfilled with a major benefaction to the College and a grant towards the first Chair of Radiology in the University of Melbourne and the Royal Melbourne Hospital. The Foundation Professor was W S C Hare.

Asian and Oceanian Society of Radiology: The Asian and Oceanian Society of Radiology held its inaugural meeting in Melbourne in 1971, with many Australian radiologists as active members. The RANZCR has held two of its annual scientific meetings in Asian cities -- Jakarta in 1976 and Singapore in 1986.

John W S Earwaker
Radiologist, Queensland Diagnostic
Imaging Holy Spirit Hospital, Brisbane, QLD

William S C Hare
Emeritus Professor of Radiology
Royal Melbourne Hospital, Melbourne, VIC

David A Lisle
Radiologist, Queensland Diagnostic Imaging
Holy Spirit Hospital, Brisbane, QLD

A pneumoencephalogram being performed upon a 6 year old child with temporal lobe epilepsy, 1967. Courtesy John Earwaker.

©MJA 2001
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