Wendell G. Scott

The Development of Angiocardiography and Aortography

This year, 1950, marks the 75th anniversary of the birth of Russell Daniel Carman—his diamond anniversary. Previous biographers have given us little about the fifteen formative years of Carmans professional life spent in St. Louis; yet it was there that the shining facets of his character were cut. It was there that the qualities which gave him outstanding brilliance in the radiological world took shape—a searching mind that was never satisfied until the diagnosis was verified, a keen power to observe what he studied, a smooth functioning capacity and application for work, and a natural “knack” for the mechanics of radiography—all encompassed by the charm of a warm friendliness which those who knew him well called “lovable.” The story of how Carman came to St. Louis is told in a letter from Dr. Thomas C. Witherspoon (1), his friend, associate, and brother-in-law, in answer to my inquiry. Dr. Witherspoon was a well known St. Louis surgeon who later retired to Los Angeles, and from there, at the age of eig...

Roentgen Kymographic Studies of Cardiac Conditions1

ROENTGEN kymography is an objective and accurate method of recording the physiological movements of an organ or structure on a single x-ray film. The original idea was conceived by Bronislaw Sabat (1), in 1911, when he was a physiologist in Warsaw, Poland. The American pioneer in the development of this work was A. W. Crane (2), of Michigan, who, in 1915, presented his kymograph, elucidated the principles of kymography, and pointed out its application in the study of heart disease. In 1928, Pleikart Stumpf (3), of Munich (Fig. 1), made and later perfected a kymograph with multiple slits. By 1931 (4) he had developed the procedure so that it was practical and of clinical value. I. Seth Hirsch (5, 6) introduced multiple-slit kymography to this country in 1934, improved the technic, and made important clinical contributions. It was his work that stimulated our interest in kymography. The procedure is simple (Fig. 2). The essential part of the apparatus is a large lead sheet in which narrow, horizontal slits ...

Bagasse Disease of the Lungs.

Bagasse is the name given to sugar cane after it has been crushed and the juice has been extracted. The term was originally used in Provence, France, to refer to the refuse from the olive-oil mills. Bagasse disease of the lungs, or bagassosis, is a pulmonary disorder brought about by the inhalation of dried bagasse dust. It is a rare disease, with only some 30 to 40 cases reported in the medical literature, having been first described in 1941 by Jamison and Hopkins (8), of New Orleans. So far as is known today, the disease occurs only in people who have been exposed to the inhalation of dried bagasse dust. Industrial engineers have been aware that exposure to the dust was an industrial hazard, but very few physicians are cognizant of this fact. The fibers of bagasse are tough and possess insulating properties, which explains its use in the manufacture of acoustical and thermal insulating building boards and materials. More recently it has been used in the production of refractory brick. Two factors are la...

Rapid Automatic Serialization of X-Ray Exposures by the Rapidograph, Utilizing Roll Film Nine and One-Half Inches Wide

Prior to the introduction of cardiovascular angiography in 1938 by Robb and Steinberg (1), there was little need for radiographic technics permitting rapid serialization of the x-ray exposures. In the radiographic demonstration of the cardiovascular system, we are dealing with a new and fast moving medium, namely, the flowing blood within the arteries, veins, and chambers of the heart. In the larger vessels and in the heart chambers the speed of the movement of the blood is much greater than in other structures or tissues of the body demonstrable by diagnostic radiography. Consequently, the success of all cardiovascular technics is dependent upon two basic factors: first, the speedy injection of an opaque chemical in such quantities that, even on dilution by the blood, its opacity remains sufficient to provide adequate contrast with the surrounding tissues; second, making the x-ray exposure at the instant the column or “bolus” of opaque substance completely fills the vessels or chambers of the heart. The ...

ROENTGENKYMOGRAPHY: ITS CLINICAL AND PHYSIOLOGICAL VALUE IN THE STUDY OF HEART DISEASE

Excerpt Until recently the fluoroscope has been the only clinical means for routinely investigating the functional movements of an organ or structure. Frequently these movements are so small and qu...

Roentgenologic Considerations in the Diagnosis of Congenital Tricuspid Atresia

Congenital tricuspid atresia is a complex congenital malformation manifested in a variety of forms. As Edwards and Burchell (8) point out, certain features are common to all cases: (1) atresia of the tricuspid valve, (2) atrial septal defect, (3) a large mitral orifice, and (4) hypoplasia of the right ventricle. Thus the venous return from the systemic circulation flows from the right auricle via the atrial septal defect to the left auricle, where it mixes with arterialized blood entering the left atrium through the pulmonary veins. It then enters the left ventricle, which functions as a single ventricle. Since the left ventricle expels blood into both the pulmonary artery and the aorta, cases of tricuspid atresia may be further subdivided according to the manner in which the blood is distributed through them to the two circulations. The traditional criteria for this subdivision have been the absence or presence of transposition of the great vessels and/or pulmonic stenosis. Thus, in Group I-a of Edwards ...

The Construction of Roentgenkymographs and Kymoscopes

THE widespread interest in the roentgenkymograph, and the fact that the apparatus has only recently become commercially available, lead us to describe a kymograph devised for the Edward Mallinckrodt Institute of Radiology. The roentgenkymograph is an apparatus designed to record the functional movements of an organ or structure on a single x-ray film. The kymograph records simultaneously the movements of multiple small points on the border of the heart or any other structure radiographed. The points are usually spaced 12 mm. apart and correspond in area to the width of the slit in the grid, namely, 0.4 millimeter. The grid is a large sheet of lead, one-sixteenth of an inch thick, in which horizontal slits are cut (Fig. 1). In using the apparatus for cardiac kymography, the patients chest is placed in contact with the grid in the postero-anterior position (Fig. 2). The radiographic tube is behind the patient at a 70 cm. target-film distance and during a single continuous exposure of one and one-half secon...

Developments in Cerebral Angiography with Rapid Serialized X-ray Exposures on Roll Film 9 1/2 Inches Wide

Cerebral angiography is becoming a common diagnostic procedure for three principal reasons: First, it is now recognized that disorders and malformations of the cerebral vascular system occur far more frequently than was generally believed. Second, angiography affords the best and, in most instances, the only means of demonstrating and localizing these abnormalities. Third, the improvements in the technic of injection of contrast media, and more especially the development of equipment for the automatic serialization of x-ray exposures, have made angiography a practical procedure. We have had very few indications for injecting the vertebral arteries which supply the posterior cerebral arteries and those in the posterior fossa, and for that reason this discussion will be confined to the technic and results of injection of the internal carotid arteries. Contrast Media The choice of a contrast medium is limited to 35 or 50 per cent diodrast, 50 per cent neo-iopax, and 24 to 26 per cent thorotrast. Recently we ...

The Right Anterior Oblique Projection in the Angiocardiographic Demonstration of Infundibular Stenosia1

At the present time, pulmonic stenosis is the most important single criterion in the evaluation of patients with cyanotic congenital malformations of the heart for the selection of those who may benefit from surgical measures. Furthermore, the accurate delineation of the infundibular portion of the right ventricle by angiocardiographic study may be of value in determining whether an aorticopulmonary anastomosis (1, 2) or an infundibular resection be undertaken (3). Dotter and Steinberg (4) have recently estimated that pulmonic stenosis is directly visualized in only one-half the cases of the tetralogy of Fallot. Cooley and his coworkers (5) have also reported that in many of these cases angiocardiography has provided only indirect evidence of pulmonic stenosis. With the development of biplane serial angiocardiography, which allows simultaneous right-angle exposures, greater precision and flexibility have been introduced into this procedure (6). While the number of cases examined by this technic has been s...

“Life is Short, and the Art Long; the Occasion Fleeting…”

In the future, more comprehensive and accurate diagnosis in medicine will depend on the improvement and expansion of the objective methods of examination. The most important of these methods has been the application of the roentgen ray. No field in medicine has enjoyed a comparable growth or seen so widespread utilization as that of diagnostic roentgenology. Its contributions to medical progress within the past fifty years have been phenomenal and at times startling. Today it still offers the investigator a broader field and one of more diversified interests in which to make worth-while contributions than most other specialties. The pre-eminent position held by diagnostic radiology can and will be maintained because no other medium has yet been discovered or devised for the visual demonstration of the anatomy, physiology, and pathology of the organs and structures concealed within the human body. The fact that several of the major organs and many different structures still elude satisfactory visualization...