By Brian Nett, PhD / History
Highlights of X-ray radiology from the discovery of x-rays through its multiple uses including: radiography, fluoroscopy, mammography, cardiac catherization, digital subtraction angiography, and bone densitometry.
Crookes Cathode Ray Tube Invented
Modern X-ray Tube Predecessor
The cathode ray tube was invented by English physicist William Crookes before scientists had discovered x-rays or electrons.
After later research it was discovered that the cathode rays were actually electrons being drawn across a positive potential.
X-Ray Imaging Predecessor
Rontgen discovered the unknown particles and hence called them x-rays as x typically is an unknown variable.
He did so by using a cathode ray tube and covering it in paper so as to block the electrons from escaping. However, the x-rays penetrated the paper and were detected using a phosphorous screen.
The first human x-ray was of Rontgen’s wife hand (print of this x-ray shown above).
The first imaging devices used to provide realtime feedback for guiding medical procedures was invented by Thomas Edison.
Nobel Prize Physics
Discovery of X-rays
Rontgen given the first Nobel prize in physics for the discovery of X-rays.
First Anti-scatter X-ray Grid
Gustav Bucky invented the first x-ray grid. He is still the namesake for the Bucky factor which is a measure of the efficiency of a grid as it is the ratio of x-rays that are stopped in the grid to those that pass through the grid.
Modern x-ray tube developed
The hot cathode x-ray tube which uses thermionic emission was patented in 1913 and produced in 1917 by GE lead by William D. Coolige. Thus, the design of the modern tube is often still referred to as the Coolige tube.
First Dedicated Radiograph of Breast Tissue
German surgeon Albert Salmon took a radiographs of breast tissue after it was excised from a mastectomy. He studied over 3000 mastectomies and found: micro-calcifications and different types of breast cancer. Salmon was later discharged from the University of Berlin during the Hitler regime and after forced time in a concentration camp he left Germany for Holland.
X-ray Film Introduced
Eastman introduces film to radiography, which replaced the glass plates previously used.
X-ray imaging used for fitting shoes
Beginning before but continuing long after the genetic effects of radiation were known. This practice was used to fit shoes with brands such as Foot-o-scope and Pedoscope.
First Demonstration of Genetic Effects of x-rays
Hermann Joseph Muller found a strong relationship between the x-ray dose fruit flies were exposed to and legal genetic damage. This was the first direct evidence of genetic effects from radiation.
Cath lab predecessor
The first clinical cardiac catheterization was performed by Werner Forssmann.
First Clinical Breast x-ray Imaging
Stafford Warren, a radiologist a Rochester Memorial Hospital, conducted the first clinical mammography trial with 119 patients.
First X-ray tomography
Ziedes des Plantes demonstrated the technique that by moving the x-ray source and image receptor (film) that a tomographic image can be generated. In this image structures above and below the focal plane are blurred out whereas those lying in the focal plane remain in focus.
G. Holst from Phillips developed an early image intensifier. After about a decade of development an image intensifier was then produced for medical applications.
Nobel Prize for demonstrating the Genetic effects of radiation
Hermann Joseph Muller received the Nobel prize in Physiology or Medicine for being the first to link radiation and genetic damage.
Breast Compression Introduced
Raule Leborgne from Uruguay introduced breast compression to breast x-ray imaging to reduce x-ray scatter, anatomical clutter and x-ray attenuation.
Bernard George Ziedes des Plantes who trained in Utect (Netherlands) used two consecutive x-ray exposures: one with contrast and one without contrast to highlight just the contrast enhanced region.
Nobel Prize for cardiac catheterization
The Nobel prize in physiology or medicine was awarded to Werner Forssmann, Andre Frederic Cournand and Dickinson Richards for the cardiac cathereterization. The first cath lab being at Bellevue Hospital in New York City, which is associated with Columbia University.
Interventional Radiography Predecessor
Charles Dotter proposed and demonstrated the first use of percutaneous angioplasty such that a clot could be removed from within rather than performing imaging only to inform the recommendation of invasive surgery.
First Tomosynthesis Imaging
D. G. Grant expanded on earlier x-ray tomography approaches by proposing a method that enables reconstruction of planes above and below the focal plane.
Percutaneous coronary angioplasty
Andreas Roland Gruntzig, a German Radiologist and Cardiologist, was the first to perform a coronary angioplasty on a human that was awake. The procedure was performed in Zurich Switzerland.
Digital Subtraction Angiography
Chuck Mistretta from UW Madison was granted the US patent for realtime subtraction imaging. This is particularly helpful to suppress the background tissue such that only the contrast agent will be present in the images.
Dual Energy X-ray Absorption (DEXA) demonstrated in bone density measurements
Following previous work at UW Madison using Gd sources, the Mazess lab demonstrated that bone densitometry is possible using x-ray projections acquired with a standard x-ray tube at tube at two different energies. Mazess founded a company in his nighttime hours based on this concept, hence Lunar. Which was subsequently acquired and is now GE Lunar.
Computed Radiography (CR) system used clinically
As an intermediate improvement from film processing a reusable phosphor stimulated detector was used. This was termed Computed Radiography (CR). This wins the award for most deceptive naming used on this page as there is no actual computing as in computed tomography.
Digital X-ray Detectors used commercially
Radiography and mammography specific detectors were introduced and began clinical use.
First Breast Tomography FDA cleared
Hologic received FDA clearance for breast tomosynthesis, i.e. commercially referred to as 3D breast imaging. In reality tomosynthesis is ~2.5D where standard projection imaging is 2D and true breast CT is 3D.