going

Where we came from, Where we are and where we are
going.
William “Tony” Walton RT (R )

Disclosure:
• I have not been compensated in any form for
mentioning people,products, or places.
• This presentation, while being correct historically, is
really meant to present you with the ideas and
backgrounds of those who laid the foundation for
Interventional Radiology.
• There will always be opinions debated over who, or
what happened first. This is my egg.

CE Information
• This course awards the attendee 1.0 A credit.
• Registrants who provided an email address will be sent
a certificate of attendance from the AVIR with the CE#
and title/date. This is only offered for the live course.
• Those with groups of technologists participating, and
registered under one individual should send an email
with name, email, ARRT# and location to :
membership@avir.org

Objectives
• Present a extrospective review of the advent and
progress of technology through 5 eras.
• Review the impact of technology and course of change
that evolved in those time periods.
• Examine the inventions that formed the foundation of
Interventional Radiology and the procedures that
arose from them.

13 Jan 1983

• Five eras:
History of Angiography
A. Pre-clinical: 1895 – 1927 (before clinical
application)
B. Pre-Seldinger: 1928 – 1952
C. Post – Seldinger: 1953 –1964
D. Dotter Era 1964- 2000
E. New millennium: 2000 - present

Timelines…..
•Radiation Technology- Rise of the
Machine
•Radiology Practice- Pioneers in
Medicine
•Device Development-
Interventional Inventions

• 1880-1900 The Second Industrial Revolution & The
Gilded Age.
• 1895: The discovery of X-Rays
• 1914 WW1
“Copy from one, it's plagiarism; copy from two, it's research.”
Wilson Mizner
Credit should be given to the erudites of the age, a majority which resided
in Europe.

Or Do We?
•Julius Plucker (1801-1868) - In 1858, published a paper relating the effects of magnetism on electrical current in rarified gases.
•Johann Hienrich Geissler (1814-1879) Worked with Plucker to create the Geissler tube, later to become the foundation of what
we know as neon lights.
Johann. Hittorf (1824-1914)- In 1869, discovered that varied gases and pressures, produced different types of fluorescence in the
vacuum tube.
Sir William Crookes (1832-1919) Around 1875, invented the first CRT or Crookes tube, this led to the electron being studied
further at a subatomic level
Eugen Goldstein (1850-1931) – Credited with naming Cathode Rays (1876), and eventually discovered Anode rays (1886)
Heinrich Hertz (1857-1894) In 1892, demonstrated Cathode Rays could penetrate very thin metal foil ( aluminum)
Philipp Eduard Anton von Lenard (1862-1947)- A student of Hertz and awarded the 1905 Nobel Prize in Physics for the Cathode
Ray Tube, demonstrated penetration through other materials, , Lenard did not realize he was producing X-rays.
Heinrich Ruhmkorff‘ (1851) and Nicholas Callan (1836) invented / patented the induction coil , which led to the early formation
of transformers which literally empowered the gas tube discoveries

Recognized early developments from :
Hauksbee- gas discharged lamps 1705
Farraday- Voltaic cells 1810
J. Nollet/ Franklin- Egg vs Jar 1853
A. Goodspeed- UPenn 1890

Wilhelm Roentgen, Nov 8 1896, “accidentally”started the
revolutionary science of Radiology as we know it today. He was
awarded the first Nobel Prize in Physics in ?.
Anna Bertha’s Hand

Wilhelm
Conrad
Roentgen
Discovered X-Rays
on a Friday evening
in Warzburg.
50 days later, presents a paper to
the Medical Society of Warzburg.
28 December 1895.

The 1901 Nobel Prize for Physics
Lenard and Roentgen were
colleagues leading up to the 1896
discovery.
Lived within 200 miles of each
other.
1845-
1923

Other Advancements Which Affected
Technology
From the 1830’s – transatlantic ship crossings accounted for all
commerce and communication between US and Europe
Telegraph -1866 First TA communication- Cyrus West Field ( ATC)
Wireless TA Radio Communication- 1901-1903 Marconi, Tesla, Bose
Air- 1910 First Dirigible /Airship Transatlantic Flight – Walter Wellman
Air- First Solo Nonstop TA Flight ( May 1927) - Charles Lindbergh

Within 2 months after Roentgen’s discovery, January 17, 1896, Eduard Haschek
and Otto Lindenthal produce first arterial map of an amputated hand, with a
solution of iodine, chalk, cinnabar, and parrafin. And a 57 minute exposure!!
Yikes!!!

• 1880-1900 The Second Industrial Revolution & The Gilded Age.
• 1895: The discovery of X-Rays
• 1896- “Angiogram” of amputated hand

German Beginnings
• Siemens was the first company to patent the x ray
tube in 1896. German patent.
• Roentgen reportedly refused to patent the first tube.
• Moritz Jastrowicz , Neuropsychiatrist
• As early as January 12, 1896, first reported use ( Spies)
on a 4 y/o FB.
• “obviously important for medicine” 30 Jan 1896.

30 Jan 1896
Jastrowicz
article from
Deutsches
Medizinische
Wochen schrift

Other Notable Firsts
• First medical litigation involving malpractice
occurred in England in the summer of 1896. Cuboid
fx.
• First radiation burn of a hand reported by Leppin in
1896, later to contribute to the ICRP .
• First pioneer to die from radiation exposure was C.M.
Dally While Experimenting with X-rays. Worker with
Edison For Seven Years. 1904

Other Radiation Related Notable Events
1896 January 3 - X-Ray report made public
• February - Discovery of Radioactivity -----H. Becquerel
• March 3 - First reports of possible x-ray injury; damage to eyes -----T.A. Edison, W.J.
Morton
• March 14 - Concern expressed over possibility of x-ray injury -----F. Battelli
• April 10 - Epilation noted from x-ray exposure -----J. Daniel
• April 18 - Skin effects first noted -----L. G. Stevens
• July - First x-ray protective device: a heavy glass plate to protect the eyes during
dental radiography -----W.H. Rollins
• Reports of accidental injury (burns) -----H.D. Hawks
• November 18 - Deliberately induced experimental injury (burns) -----E. Thomson
• Gold leaf electroscope used to make ionization measurements -----L. Benoist
1897 Air thermometer used to measure energy transfer by x-rays -----E. Dorn
1898 January - Aluminum filter used as protective device -----E. Thomson
• May - Dark adaptation prior to fluoroscopy suggested -----F.H. Williams
• July - Leaded x-ray tub housing; collimators -----W.H. Rollins
• July - Word "radioactivity" coined -----P. & M. Curie
• December - Radium discovered -----P. & M. Curie
• Gamma rays discovered -----P. Villard
1899 April - Radiographer licensure recommended to protect public -----J. Dennis
• May - Malpractice award for x-ray burns

Monument to Radiation workers
at the Allgemein Krakenhaus St.
George in Hamburg, Germany.
Erected in 1936, by the German
Roentgen Society.
136 Individuals from 15
countries
71 German
15 Britain
“They were heroic pioneers for a safe
and successful application of x-rays to
medicine. The fame of their deeds are
immortal.”

•Ronald A. Fessenden
Applied August 7 , 1899 , Issued May 1, 1900 (

William Andrews
General Electric Company
Filed January 20, 1898
Issued September 4, 1900

Humble Beginnings in the U.S.
• Victor Electric plunged into the x-ray business and by
1896 (one year after Roentgen discovery) were making
x-ray machines.
• The business grew rapidly and so, in 1896, moved into
new premises three times the original size, but this did
not solve the space problems and the company made 3
moves by 1899.
• Later bought by GE, by 1913 became sole
manufacturer of Coolidge tubes in the US. GE Origins
as Edison Electric 1876

Samuel Puffer
Applied February 27,1898, Awarded August 8,1899

A. Pre-clinical Era
• 1895: X-rays discovered
• 1896: “Angiogram” of amputated hand
• 1898: visualization of pellets “floating” in heart
• 1900: First Diagnostic Apparatus
• Still Radiography
• Cavaderic Studies
• Isolated Silos of Inventors

Gallot- Pilon France 1910-1920’s
Courtesy BRM

Other contributors throughout the
era …
William Coolidge – (GE) First X-Ray tube with a focal spot (Nov 1913) First transformer
feed x ray apparatus (1920), allowed consistent timed high voltage exposures.
Albert Hall (GE) – Filter for monochromatic X-Ray photographic imaging
(1921).
Samuel Shepperd (Kodak)- First intensifying screen technology (1922)-
meant lower exposures .
James Haste (Kodak)- First cellulose based film for radiography (1922)

Add Fluoroscopy to the mix…….
Snook and Kelly 1914 in
Philadelphia
Utilized mirrors to visualize a
fluoroscopic screen

1933 Flouroscopes just
prior to image
intensification.
Room would have been
darkened…

Angiography
• Angiography dates to 1895
Angiography from Greek
• Angeion = vessel
• Graphein = to record
• Discovery of X-rays: Wilhelm Conrad Rontgen
• Pre-Seldinger Era begins with Moniz
• Involves the evolving of the x ray apparatus
• The evolution of image capture
• Add the contribution of contrast media

Angiographic Techniques
• Interventional Radiology origins came from early
pioneers in angiography
António Egas Moniz
Reynoldo Dos Santos
Moniz formulated
strontium bromide
65% and sodium
iodine contrast 65%>
25%.
Thorotrast (thorium
dioxide) was used later
in the 1930’s .
28 June 1927
January 1929

Cerebral Angiography
• 1927: Egas Moniz (Portugal) radiologic demonstration of
cerebral vessels (25% NaBr)
• Direct exposure of CA
• 1931: Moniz: 25% of Thorium dioxide (Thorotrast)
• Thorotrast: “no pain”
• 1950s: Thorotrast: angiosarcomas

Early Aortography
• 1929: Dos Santos (Portugal) – 1 st desciption of TLA for
Drug delivery and dx
• 1937: Dos Santos > 1000 TLA
• “No suitable contrast material”
• 1960 – 1970s: TLA “popular”
• 2000: Technique unchanged

Technology of the time
• Bill Hogan (1920”s)- Modest Electrician- Most
influential of non- physicians of his time. Started as a
repairman, then moved to installing the then modern
day systems for Standard X-Ray Company, Chicago, Ill.
• Influenced technology at G.E., Westinghouse, and
Picker.
• In 1932,Started the Franklin X-Ray Company in
Philadelphia designed the franklin head unit.
• Franklin Biplane Angiographic Machine –developed
for Dr. Edward Chamberlain ( Temple); also cinefluoro
camera apparatii.

Sure they invented it, but how did they do it?
• All the early cerebral arteriograms were done using the cut-down
technique, exposing the CA, occluding flow, injecting the
contrast, and resuming flow while taking 3 serial radiographs.
• Saito,Makato-A Japanese pioneer, in 1930, cited over 100 cerebral
arteriograms injecting sodium bromide via direct puncture of
the superior thyroid artery.
• Dr. Werner Forssmann- In 1929, Catheterized his own heart
(venous ) via antecubital vein, self-experimentation led him to
quit cardiology and become a urologist. 1956 Nobel Prize.

B. Pre – Seldinger Era
• 1923: Berberich: arteriograms and venograms with 10 –
20% solutions strontium bromide
• 1923: Siccard & Forester: no untoward reaction with iodized
oil in canine A and V
• 1924:Brooks: sodium iodide injection in surgically exposed
SFA
• 1927: Post Moniz-Carnett: “arteriograms” of LE with iodized
oil
• 1930: Saito in Japan: “fine iodized oil”

Angiography Timeline
• 1930s: “direct” puncture of TA
• 1939: Robb and Steinberg: injection of CM in vein to visualize heart
chambers -Harvard
• 1947: Radner: cut down in radial artery, catheter advanced into aorta: TA
Britain
• 1949: Johnson: TA by direct puncture of CA -U Penn
• Opacification of TA and coronary A, Mapping potential for CEA
• CAROTID ANGIOGRAPHY A CLINICAL EVALUATION OF 200 CONSECUTIVE
CASES DWIGHT PARKINSON, M.D.* and A. E. CHILDE, M.D.,t Winnipeg,
Man. 1950- 3 fatalies, few side effects
• 1950: IV injections of large volume CM to opacify TA and AA

Pre- Seldinger Techniques
• (a) Percutaneous trans-lumbar needle puncture
of the aorta as introduced by Dos Santos, Lamas
and Pereira Caldas (1929).
• (b) ' Cut down ' or modified ' cut down ' transfemoral
arterial catheterization of the aorta as
advocated by Farinas (I946) and Lindgren (I953).
• (c) Percutaneous transfemoral retrograde aortography
• as introduced by Seldinger (1953).

Pulmonary Arteriography by Direct
Puncture

Technology Timeline….
• Caldas “Carousel” 1931- Allowed up to six exposures,
manual. Developed in Portugual. Allowed 6 exposures in
6 seconds.
• Sanchez- Perez Film Changer – up to 6 films, manual
crank, then electrified, 1 film every 0.7 sec ( late 1940s).

Sanchez-Perez. First Patent.

If only ……..
Life could be this simple!!!!

The Franklin Biplane Multi Film
Radiographic Device
Developed in the early
1940’s, 3 built in first
year
Temple, UPenn Chicago
Veterans Hospital
Synchonized exposures
Same 9 ½ film format
Still purely serial
angiographs…

Fairchild
• Fairchild Roll Film Changer –
75ft of
9 ½ inch film, 2 f/s capability ,
late 1940’s.
• “Engineered” by C.T. Dotter
• Origins came from WW2, aerial
camera technology

Injectors in the 1940’s. Your basic
design.

Pre- Seldinger
• Up until 1952, arteriography /angiography was
typically performed by surgical exposure of the artery
or a direct pucture by a needle or trocar.
• Trocar/needles were often larger than the catheter
being inserted.
• In 1952, Seldinger reported his technique

Seldinger Technique
• Contrast could be injected at any level
• Less risk of extravisation
• Very simple technique
• Patient can be in any position
• Catheter could be left in place for longer periods of
time

Post-Seldinger Period
• From the advent of the percutaneous technique,
angiography and the disciplines that arose over the
next 3 decades would shape IR as we know it today.
• Technology advancements in imaging and devices
would generate new diagnosis/therapies.
• The developments are as unique as the minds that
shaped them.

Selective Angiography
1954: Seldinger: parathyroid
1956: Odman: radiopaque polyethylene selective catheter
Odman, P.: Percutaneous Selective Angiography
of the Main Branches of the Aorta.
Acta Radiol. (Stockh.), 45:1, 1956.
•Polyethylene can be reshaped by steam and cooled
•Holes can be made
•Different sizes and diameters
1966: Boijsen: abdominal arteriography
1969: Reuter: pancreatic arteriography
1965: Viamonte: selective arteriography
1969: Rösh: superselective arteriography

The Modern Day injector.
Developed in the late 1950’s, first “automatic” “safe”
injector by Williamson (Cordis)

Elema- Schonander AOT-S
Late 1950 through 1970’s
Became the standard in High Tech Labs of the time period.
Programmable up to 4 f/s.
Magazine held 30 14”x
14” films , separated by
wire looms- Very heavy
Early units had dial selectors
for frame rates and intervalsup
to four
Advanced to use key punch
cards to program exposure
sequences

Long Leg Film Changers by C. Medical Manufacturing,Canada
Held 6 Long cassettes – 14” x 51” tri-fold film
Required 84-112” focal distance, usually a ceiling
mounted tube configuration.
Patient had to be positioned on or
over a separate radiographic
table.
Visualize the entire LE vasculature
Cassettes were heavy and
cumbersome, to say the least.

With Cut Film , comes subtraction!!
The technique is not cited in journals or
patents until the late 1970’s, Kodak/Fuji

Subtraction Procedure
(Cerebral angiogram)
1. Before angiogram, take scout
skull x-ray on angio equipment
that will be used – looks like
regular skull film (this is for
technique only , zero image is
first radiograph taken during the
angiogram!)
1. Place subtraction mask film in
copier with original (zero)
lateral skull film - expose and
process
• (original x-ray (negative)
converts into “positive” )
Zero (base, scout)
Subtraction mask

Creating Image free of background –The Art of
Subtraction
+
=
Mask-series
combination
Mask
(Inverse of
original)
Series
(Like original but
with Contrast)
Vessels appear
white on black
background
+
Subtraction
copy film
(Reverses
tones)
=
Finished product
Vessels appear
black,
background clear

First in Film