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Cholangiography, the roentgen study of the biliary tract by means of the direct introduction of a contrast medium, may be accomplished in a number of ways and with a number of contrast substances. The material may be injected directly into the gallbladder or the common duct—immediate cholangiography—at the time of a surgical exploration of the biliary tract. Roentgenograms are then made on the operating table (Fig. 1). More commonly the injection is made postoperatively through a drainage tube previously inserted into the gallbladder or the common duct—delayed cholangiography. Recently some efforts have been made to inject a radiopaque substance into the gallbladder before operation. This can be accomplished by either of two procedures. A catheter can be placed in the gallbladder through a simple abdominal incision. Cholangiography is then done and the situation of the biliary tract determined (Fig. 2). The information obtained will govern the exact type of surgery to be undertaken. Another method is that...

To evaluate spin-echo and contrast material-enhanced dynamic magnetic resonance (MR) imaging in characterization of thyroid and parathyroid masses.Conventional T1- and T2-weighted, gadolinium-enhanced dynamic, and gadolinium-enhanced T1-weighted spin-echo imaging sequences were performed in 85 patients with thyroid and parathyroid tumors. Findings from spin-echo imaging and dynamic curve patterns from mean signal intensity ratios were evaluated for each histologic tumor type.T1- and T2-weighted imaging did not enable differentiation of benign from malignant tumors. Primary thyroid lymphoma enhanced less than other solid thyroid tumors, and parathyroid adenoma also enhanced less than other tumors (P.05 compared with papillary carcinoma.Gadolinium-enhanced MR imaging cannot enable prediction of histologic type in thyroid and parathyroid tumors. However, in cases of multiple tumors, the technique may improve the contrast between the different histologic types and sometimes suggest the diagnosis of primary thyroid lymphoma or parathyroid adenoma.

The discovery of a new type of radiation by Wilhelm Conrad Rontgen in 1895 had a profound impact on science in general and on the practice of medicine in particular; not the least of its revolutionary effects was felt in the field of diagnosis. A new page in the history of medicine was written with that epoch-making discovery. The writing on the first pages may have been hesitant and irregular, but here and there, even during the first few years, can be observed broad, bold strokes that were prophetic of the advances that were to come. The opinions as to the usefulness of Rontgen's rays in medical practice among the investigators and authorities in medicine in 1896 varied from extreme skepticism to surprising optimism. Indeed, it is a remarkable and astonishing phenomenon that the possibilities of x-ray diagnosis were so quickly and enthusiastically received. Contemplating the natural and beneficent conservatism which most medical men exhibit toward any new departure in medical science, one may well inqui...

Telepaque2 a new cholecystographic medium, is an iodine substituted organic compound, containing 66.68 per cent iodine as compared with 51.38 per cent in the cholecystographic medium now widely used. The chemical formula is: 3- (3-amino - 2,4,6 - triiodophenyl)-2-ethylpropanoic acid. Telepaque is supplied in 0.5-gram tablets which are about the size of aspirin tablets and easily swallowed. Experimental studies in animals have demonstrated a wide margin of safety in the doses used to opacify the gallbladder (1). To evaluate the clinical usefulness of the new agent, it was given to a consecutive series of patients who had been referred, because of symptoms, for roentgen study of the gallbladder. The telepaque tablets were issued by the Drug Department of the University of Minnesota Hospitals with no attempt at selection of cases. For the first series (83 cases), six tablets (3.0 grams) were given to each patient. Concurrently, a control series of cases was recorded using the cholecystographic medium now in ...

The voluminous literature on cystic disease of the lung has been thoroughly reviewed in many previous publications (1, 3, 5, 15, 16, 19, 20, 21, 24). The heterogeneous nature of the various processes included under this general title is indicated by the more than twenty terms which have been used to designate the condition (17). It has been well described by Bruce (3) and Diamond and Durham (7). Cysts of the lung may be either congenital or acquired, bronchial or parenchymal in origin, single or multiple. They may contain fluid, gas, or both, and are often designated as non-inflammatory, although they may be the sequel of an inflammatory process and they may become secondarily infected. The major portion of the studies on this subject have been devoted to the questions of classification (2, 21), etiology (18, 21), congenital or acquired origin (1, 2, 16, 27), and the mechanics of development of these pockets in the lung (13, 16, 26). Two decades ago lung cysts were regarded as something of an academic pro...

IT is becoming increasingly clear that the only real hope of materially diminishing the present incidence of tuberculosis lies in an earlier diagnosis than is possible by awaiting suspicious symptoms, or even by a physical examination. Such a diagnosis can be obtained only by systematic roentgen examination of large numbers of apparently healthy individuals. Certainly, all known contacts of every active case of tuberculosis should have roentgen examination, but this is not sufficient, as many patients spread the infection for months or years before their condition is diagnosed. Extensive surveys of large groups by the roentgen method are becoming, therefore, more and more frequent. Such surveys have almost invariably detected enough unsuspected cases to more than justify the expense involved. Nevertheless, they are expensive, and in many cases impossible on that account alone. In such a survey, the cost of films and chemicals is a major item, so, if a single film can be substituted for the stereoscopic pa...

CERTAIN conceptions about the distribution of fluid in the pleural cavity have been maintained since the earliest studies in physical diagnosis. The development of the roentgen examination of the chest has served, in some respects, to substantiate these conclusions. There is a general idea, expressed in most textbooks, in the literature, and widely held by roentgenologists and physical diagnosticians, that liquids in the pleural cavity, in the absence of pneumothorax, take on a fairly definite, uniform appearance on roentgen examination. This appearance is described, typically, as a dense shadow which, in the early stages of an effusion, obliterates the normal aeration of the costophrenic angle; as the fluid increases, the shadow extends medially over the diaphragm and upward along the periphery of the chest. The upper surface of this density is concave, and the shadow rises higher in the lateral and posterior than in the medial or anterior portions of the thorax. When a massive effusion is present the en...

Just as there are areas in the lungs silent to auscultation, so there are certain portions of the lung-fields relatively invisible to roentgen exploration. The conception that those areas of the lungs and pleura which are superimposed upon by the denser shadows of the heart and other mediastinal structures, the diaphragms and subdiaphragmatic organs, and even by the ribs, are not entirely amenable to roentgen study, has been partially responsible for the use of the stereoscopic, lateral, and oblique projections. To some extent, the introduction of bronchography served to make roentgen observation of certain sections of the lungs more successful. Nevertheless, the possibility that lesions may be present in the lung which are not visible in the roentgenogram, because they are hidden by the central shadow, is always to be considered. It is significant that in many textbooks on roentgen diagnosis the diagrammatic representations of roentgenograms of the thorax portray the cardiac area as a blank. The inferenc...

Dr. Lima (presenting the case history): A 60-year-old white male, a cabinet-maker, was first admitted to the hospital on July 9, 1942, after study in the Out-Patient Department two weeks previously. His complaints were weakness, anorexia, loss of weight, and a dry cough, all beginning about March 1942. Some seven weeks prior to admission the sputum became purulent and the breath bad, but there was no hemoptysis. There were no respiratory symptoms prior to the present complaint. The patient had lost 47 pounds in weight during the past year. The temperature was 100.8°, pulse 80, blood pressure 128/80. The patient appeared chronically ill and was raising large amounts of sputum. On physical examination there was evidence of atrophy of the pectoral muscles on the right side with greater expansion on the left. Breath sounds appeared normal. There were numerous crepitant medium rales at the right base posteriorly. Marked clubbing of the fingers and toes was present. There was no cyanosis. The urine was negative...

The large majority of primary bronchial neoplasms are malignant. The internist and the roentgenologist are encountering cases of bronchiogenic carcinoma with ever increasing frequency, and indeed it is now recognized that this tumor is among the commonest of malignant growths, occurring more often in autopsy series than any type except gastric cancer. It is also interesting to note that carcinoma of the bronchus has in the past twenty-five or thirty years increased in incidence to a considerably greater extent than can be accounted for by the advance of the average life expectancy. More significant for the clinician than the increasing occurrence of bronchial tumors, however, is the fact that during the past twenty years rapid progress has been made in the development of more accurate diagnostic means of identifying the condition in its early stages. Moreover, the recent strides of the thoracic surgeons have made it possible in suitable cases to treat cancer of the bronchus by removal of an entire lung, a...

The development of radiology as a medical specialty and its evolution into a scholarly academic discipline are traced. Its maturity is indicated by the remarkable increase in quantity and quality of applicants for residency and by the change in number and status of faculty. The conversion of radiology from a purely intellectual specialty to one which combines manipulative techniques with image interpretation has added to its attractiveness. The use of diagnostic techniques to mediate therapy, termed “remedial radiology,” is described in detail.

Congenital small bowel diverticula occur in about 2 per cent of adults. Most of these are Meckel's diverticula. The remainder are duplications of the bowel of different embryologic origin. Because of confusion in diagnosis, the relative incidence of the two types is not completely established. Meckel's diverticulum consists of a persisting portion of the yolk sac or vitelline duct. It occurs, therefore, on the antimesenteric side of the bowel at the junction of the cephalic and caudal limbs of the primitive gut loop. This site in the adult is 20 to 100 cm. above the ileocecal valve. The tip of the diverticulum may be joined to the umbilicus by a fibrous cord representing the remainder of the vitelline duct. Bowel duplication is of disputed, and perhaps variable, embryologic origin, but is unrelated to the vitelline duct. Its site is inconstant, but it is most frequent in the ileum and almost always on the mesenteric side. It may be tubular or cystic and may or may not communicate with the normal bowel lum...

IN the development of the roentgen examination of the heart, the accurate determination of the size of the organ has been chiefly considered. The differentiation of the normal from the abnormal heart by the increase in transverse diameter, surface area, or volume, as demonstrated in the teleoroentgenogram, or orthodiagram, has been well established. Much less attention has been given to the increases in size, which may take place in individual chambers. While changes in the shape of the heart shadow have been widely used to determine the exact nature of the defect which is present, these have been chiefly studied in the postero-anterior projection. Lateral views which might demonstrate enlargement of the posterior chambers of the heart, the left atrium, and left ventricle, have been less emphasized, chiefly, no doubt, because of the difficulty in interpretation. Cardiac disease, with or without failure, may, for certain purposes, be classified in two broad groups: left heart lesions and right heart lesion...

During the past ten to twelve years the ileocecal valve has commanded increasing attention from roentgenologists. Such interest has resulted in the publication of a number of papers that have contributed materially to an understanding of the normal roentgen anatomy of the area and to recognition of abnormal variations. The work of Fleischner Bernstein (5) has been particularly outstanding in this regard. During the same period, relatively little has been written about those structural aspects of the ileocecal valve that affect its normal dynamics. Studies by Rutherford (7), in 1914, and by Buirge (2), in 1943, have contributed to an understanding of the structural dynamics but have failed to completely elucidate them. The present study is based upon roentgenologic, histologic, and special experimental observations made during the past four years in the Department of Radiology of the University of Minnesota Hospitals. The normal roentgenographic appearance of the ileocecal valve has been touched upon by ot...

The man we honor today was born in Hagerstown, Md., in 1890. He received his A.B. degree from Western Maryland College, Westminster, Md. He was later graduated in medicine from Johns Hopkins University, Baltimore, and became its second Resident in Radiology. The major part of his professional life has been spent at the Henry Ford Hospital, Detroit, Mich. Howard P. Doub is a member of the American Roentgen Ray Society, the American Radium Society, the American College of Radiology, a Fellow of the American Medical Association, and a Diplomate of the American Board of Radiology. His true loyalty and service, however, have been to the Radiological Society of North America where he is closing a chapter of twenty-five years as Editor of its Journal, Radiology. Doctor Doub served on various committees of the Radiological Society of North America and was Chairman of two which were important to his future assignments, the Executive and the Publication Committees. In 1938, when he was also an Associate Editor of t...

The importance of the roentgen examination in the diagnosis of perforations of the hollow viscera has been repeatedly stressed and evaluated. In all cases in which a rupture of the stomach, small bowel, or colon, whether of spontaneous or traumatic origin, is suspected, the diagnosis can be made relatively certain by means of roentgen study. The roentgen findings depend upon the occurrence of a spontaneous pneumoperitoneum, gas from the gastro-intestinal tract escaping into the free peritoneal cavity. In all the literature on this subject it has been stressed that it is necessary to have the patient in the upright position in order that the gas may rise to the upper portion of the abdomen, coming to lie just inferior to the diaphragm. Thus the shadow of the gas can be made out by contrast with the diaphragm above and the denser shadows of the solid viscera below. When the upright position is impossible, it has been suggested that films might be made in the left lateral decubitus position, a postero-anteri...

The presence of moderate amounts of air in the small bowel loops is a normal finding in infants. The newborn infant swallows air with its first breath, and gas can be demonstrated by roentgenograms in the sigmoid colon usually in two to five hours (6, 14, 15). Complete absence of gas in the small bowel, or in the stomach and small intestine, as shown roentgenographically, is commonly interpreted as a sign of high obstruction and of grave significance. There is little in the literature to indicate that complete absence of gas in the infant bowel occurs under any other circumstances. In 3 cases to be presented here this finding was associated with severe diarrhea and dehydration without any mechanical obstruction. Severe diarrhea with resulting dehydration is not a true disease of infants, but rather a sign accompanying disease. In many instances it can be attributed to specific bacterial or viral causative agents (2–5, 7, 10, 13). As is well known, however, it may be due to parenteral infection elsewhere i...

THE active interest, in recent years, in the problem of obstruction of the small bowel, aroused by newly discovered methods of therapy and diagnosis, has served to obscure the importance of acute obstructions of the large bowel. Yet this condition presents a serious problem to the clinician, usually requiring emergency measures. It differs from a similar lesion at higher levels in the intestinal tract both in symptomatology and in treatment. Obstruction of the large bowel is not relieved to any degree by suction, so that temporization is usually unwise. For this reason it becomes necessary to make an accurate diagnosis at the earliest possible moment. Whether the obstruction be due to carcinoma, diverticulitis, benign stricture, volvulus, or to congenital anomalies, it is important for the surgeon to have as much information as possible concerning the nature of the pathologic process, the degree and position of the obstruction, and the possible etiologic factors. Toward achieving this end, the roentgen ex...

In a previous publication (2) we reported, in preliminary fashion, the production of a new rapid film-changing device which would be useful for general routine radiography. At that time the unit was in the course of preparation and only an experimental model was available. Since then a practical unit has been made and we have been able to test the device in practical clinical radiography. The history of the development of rapid film-changing cassettes and their utility in vascular radiography has been adequately reviewed by Scott (3). He is responsible, to a major degree, for the first rapid film-changing device utilizing roll film, although Dotter and his associates (1) no doubt also used roll film at a very early period. Since the original contributions on this subject, numerous papers have appeared and many types of apparatus have been designed to accomplish a similar purpose. The idea, however, of using a continuous strip of film, with intermittent contact with intensifying screens and automatic separ...

It is particularly appropriate to discuss medical education with a group of radiologists, since the radiologist almost more than any other specialist must live up to his obligations under the Hippocratic Oath. “ … and that by precept, lecture, and every other mode of instruction I will impart a knowledge of the art.” Every physician is charged with the responsibility of being a teacher, but the radiologist even more so. Whether he be full-time or part-time teacher, or practitioner, he is deeply involved in the educational process. The obligation to teach while practicing should be felt—and I believe it is felt—by all the practitioners of this specialty, because it serves as such an ideal medium for the propagation of medical knowledge. No one today will question the fact that radiology should occupy some position in the education of the medical student. Just what the student should be taught as to use of radiation is, however, still a matter of controversy. The teaching of undergraduate students in radiol...

THE determination of the presence, size, shape, position, and origin of a mass in the abdomen is a problem which has always intrigued medical men. While in some cases the answers to these questions may be readily obtainable from the history and physical findings, frequently these methods alone are insufficient. Hardly a more difficult task faces the clinician than that of deciding whether or not he feels an abnormal mass and, if so, whether it is intraor retroperitoneal in situation, pelvic or upper abdominal in origin, and to which organ it is attached. This diagnostic problem, no doubt, led to the discovery and use of pneumoperitoneum in roentgen diagnosis. It has led to many other methods of rendering an abdominal viscus or mass visible by the use of contrast media. The roentgen visualization of the gastro-intestinal tract, the urinary tract, the gall bladder, the uterus and tubes, and now the liver and spleen have all been steps in the advancement of the diagnosis of abdominal masses. The most recent ...

Diagnosis of benign gastric lesions by roentgen methods has been the subject of numerous papers (5, 7, 8, 9, 11, 13), and the varieties of tumors to be found in the stomach have been listed by many writers. In recent years it has become apparent that some non-neoplastic lesions, such as aberrant pancreas and certain inflammatory conditions, may simulate benign tumors roentgenologically. Most radiologists have assumed that a rounded, well defined filling defect which does not interfere with either the flexibility or peristalsis of the gastric wall, especially if the defect is movable and there is some evidence of a pedicle, is likely to be a benign polyp or adenoma. In routine examinations of symptomless individuals, particularly those with pernicious anemia or with achlorhydria, this is a frequent finding (3, 12). Recently, however, an unusual inflammatory lesion has been described which mimics the appearance of a benign polyp and should therefore be considered in the differential diagnosis of such defect...

DURING the past decade numerous investigations of the physical and mental characteristics of multiple birth siblings have been undertaken, largely with a view to determining the relative effectiveness of heredity and environment upon the individual. In studies of this type it is of crucial importance to determine the monozygotic or polyzygotic character of the multiple births; it is only from identical twins or triplets that conclusions can be drawn as to the effects of heredity. The determination of a monozygotic origin, however, is not at all simple. Numerous factors such as the history of the condition of the birth membranes, the number of placentae, anthropometric measurements, general physical appearance, finger prints, palm patterns, foot prints, dental measurements, psychological measurements, blood grouping, and sex must be considered. Unfortunately there is no absolute proof on this matter although reasonably positive conclusions may be drawn from a consideration of all the data at hand. Through t...

Introduction THE usefulness of thorium dioxide sol in the roentgen diagnosis of diseases of the liver and spleen has been well demonstrated by numerous articles in the recent medical literature (23, 24, 15, 16, 7, 33, 13). Its utility, however, has been greatly restricted by the fear, which has been so frequently expressed, that ill effects may follow its injection. The dangers associated with the use of this substance have been abundantly described and numerous conflicting opinions have been presented regarding the justification for its employment. While the original protagonists for the utilization of this colloidal suspension of thorium dioxide (thorotrast), Radt (24) and Kadrnka (16), apparently are satisfied that it presents no real danger; others, such as Anders and Leitner (1), Buchner (2), Cooke (4), Hanke (8), Shute and Davis (29), Pohle and Ritchie (21) and others, criticize the use of this material most emphatically. Naegeli and Lauche (20) take a middle ground, while numerous other authors, su...

Considering the relative frequency of pulmonary edema, the paucity of references in the literature concerning its roentgen findings is astonishing. Standard texts on roentgen diagnosis contain only brief references to this condition; the descriptions in the literature deal largely with clinical cases, and few reports of cases verified by necropsy have been presented. Furthermore, the greatest emphasis has been placed upon a classical roentgen picture. In our experience there have been numerous variations from this typical appearance which we feel should be more fully described. Many of these variations simulate other pulmonary lesions to such a degree that frequent errors in diagnosis must result. For purposes of orientation, a brief review of the pathology and of the theories of the etiology of pulmonary edema must be undertaken. The pathology of pulmonary edema, consisting essentially of heavy, sodden lungs, with a microscopic picture of alveoli distended with serous fluid, is sufficiently well known to...

The microscopic distinction between benign and malignant neoplasms of the stomach is occasionally impossible, often hazy, and, even in those instances in which it is clear-cut, there is a strong possibility that a lesion appearing benign may eventually become malignant. It would seem, therefore, almost foolhardy to attempt to distinguish them roentgenologically were it not for our experience which indicates that frequently, at least, even this differentiation may be made. The roentgenologic diagnosis “benign gastric tumor” has been confirmed frequently enough so that this terminology seems eminently justified. The demonstration by roentgen examination of the stomach of a benign tumor no larger than a hemp seed (2), or of a carcinoma which is barely distinguishable macroscopically (20), gives an indication of the possibilities of this method and lends encouragement to attempts at making such fine distinctions. An apt illustration of the faithfulness with which the roentgenogram may reproduce the gross path...

The long history of research into methods for the roentgen demonstration of the liver and its internal structures is a record of disappointments. Considering the five tubular structures and the two sets of cells, hepatic and reticuloendothelial, by which a contrast substance could be introduced into the liver, it is indeed surprising that more success has not attended such efforts. No doubt the great bulk of the liver and the lack of access to it from without have been in large part responsible for the unsatisfactory results. Attempts to find a harmless substance specifically excreted or secreted by the liver in sufficient quantities to make the internal anatomy of the organ visible in the roentgenogram have uniformly failed. That the size and shape of the liver can be demonstrated either by direct radiographic study or by pneumoperitoneum is evident, but such findings add little to our diagnostic ability. When cholecystography was first introduced, it was hoped that sufficient amounts of the contrast sub...

It has been customary on former occasions for the President to designate someone to introduce the Carman Lecturer to the members and friends of the Radiological Society of North America, but this is a privilege that I would not relinquish, the privilege of introducing a great scientist and a distinguished physician who is also an old and dear friend, Dr. Owen H. Wangensteen. Our speaker this evening is, I believe, the most creative mind in surgery in America—perhaps in the world. If I were to attempt to relate his accomplishments and his many honors, I might be forced to occupy this podium for the entire evening. Suffice it to say that he has been awarded honorary degrees by St. Olaf's College, the University of Buffalo, and the University of Chicago, as well as many honorary memberships in medical societies, both here and abroad. He has been given the Samuel Gross Medal, the Alvarenza Prize, the John Scott Medal, the American Cancer Society Award, and the Pittsburgh Surgical Society Award. Instead of lis...

Presumably, the President of the Radiological Society of North America should be old and wise, and thus able to give advice to his colleagues. This responsibility has weighed heavily on my conscience, for I do not consider myself very old as yet, and certainly I cannot lay claim to wisdom with any feeling of confidence. Nevertheless, I would take this opportunity to re-evaluate some ideas concerning the practice of roentgen diagnosis, and particularly our procedures of interpretation. That roentgen diagnosis is still a dynamic expanding field of endeavor, a productive outlet for brains and energy, is attested by the last Program of the Radiological Society of North America, and by many others offered in this division of Radiology. The opportunity to improve our diagnostic resources is still with us to a superlative degree. Spectacular new developments occur almost from day to day, so rapidly indeed that it is difficult to keep abreast of the new procedures. Much still remains to be done so to improve our ...

The separation of air-containing bowel loops on the supine plain film of the abdomen has, for many years, been an accepted radiographic sign of intraperitoneal fluid and more recently has been stressed as a sign of bowel wall thickening. While Nelson and Eggleston, in their excellent paper on mesenteric vascular occlusion, alluded to the possibility of intraluminal fluid giving the appearance of separated bowel loops, they offered no evidence or explanation. Intraluminal fluid can produce the appearance of abnormal separation of the walls of adjacent bowel loops. We will refer to this phenomenon as pseudo-separation. Our attention was directed to this sign when we encountered it frequently in patients having nonspecific abdominal pain. We even observed it in scout films of asymptomatic patients who showed anxiety concerning an impending examination such as intravenous urography, aortography, or gastrointestinal studies. Figure 1, A, demonstrates a case in which the scout film clearly shows “separation” of...

Any and varied instruments have been devised to permit the rapid changing of films or cassettes for special procedures in roentgen diagnosis, particularly in the field of angiography. One of the most commonly used types of apparatus for this purpose embodies a magazine loaded with a roll of film; the latter is moved rapidly between intensifying screens. The device will permit two exposures per second. Each year has brought forth several such pieces of apparatus, attesting to the fact that none available on the market are entirely satisfactory. Since such devices are expensive and as presently constructed are very limited in their utility, they are not commonly found outside of large institutions. The use of roll film for conventional x-ray examinations has had very little experimentation. At one time x-ray paper of 14 × 17-inch size was prepared on a roll for the rapid radiography of the chest, as a survey procedure, but this has largely been superseded by photofluorography. In the latter, roll film has b...

While agreeing that overutilization of radiological diagnosis creates an unnecessary increase in both medical costs and patient exposure, the author calls for a more sensible and economical approach to the number of radiographs taken as part of any given study, noting that in many cases the number could be cut in half without any loss of diagnostic efficiency. By limiting the number of views per study, the radiologist would be able to remain in a safe medico-legal situation without reducing his ability to function as a diagnostician.

The increasing incidence of carcinoma of the lung represents one of the urgent problems facing the medical profession. Whether this increase is real or relative, it is certainly true that the number of cases encountered seems to be greater each year. Surgical procedures have been developed to such a degree that the mortality has been reduced to as low as 5 per cent in one series (3), and five-year survivals after pneumonectomy are now in no sense rare. The importance of early diagnosis of bronchogenic carcinoma, therefore, is self-evident. For purposes of detection of the disease, to give the evidence which will lead to further investigation so that a definitive diagnosis may be made, x-ray examination is, without doubt, the only widely applicable method. The possibilities and limitations of the roentgen examination in the diagnosis of carcinoma of the bronchus are well known and will not be considered here. We propose rather to describe an early roentgen sign which has been insufficiently stressed, namel...

Advances in accuracy of diagnosis of lesions in the esophagus, stomach, duodenal bulb, and colon have far surpassed achievements in demonstration of organic lesions of the jejunum and ileum. Though great strides have been made by Mackie (25), Snell and Camp (39), Golden (19), Pendergrass and Comroe (31) and others in the demonstration of functional changes in the bowel, adequate examination of the small intestine and satisfactory delineation and demonstration of its lesions remain a challenge to the radiologist. There are three principal reasons for lack of progress in roentgen diagnosis of small bowel lesions: (1) the time-consuming nature of the examination; (2) difficulty in interpretation of minor changes in the bowel; (3) the extremely low incidence of organic disease in this part of the digestive tract, so that the examiner has little to show, in the way of positive diagnoses, for the effort expended in many examinations. It is the purpose of this paper to review the various methods of examination o...

Attention was first focused on rib notching as a roentgenologic sign in 1928 when Roesler (18) reported its appearance in patients with coarctation of the aorta. He later noted (19) that “the erosion of the ribs is the most unequivocal sign (of coarctation of the aorta), although it is not always present nor is it always very marked.” In 1929 Railsback and Dock (17), apparently unaware of Roesler's report, published a case of rib notching associated with aortic coarctation, the first to appear in the English literature. They asserted that costal erosion is “undoubtedly pathognomonic of coarctation of the aorta.” This roentgen finding enjoyed the distinction of being a pathognomonic sign for some years. The first evidence that rib erosion could be secondary to causes other than coarctation appeared in 1933, when Hench and Horton (10) reported notching of the inferior borders of the left 7th and 8th ribs in a thirty-three-year-old female who had a loud to-and-fro murmur over the area. There was no clinical ...

It is generally agreed that any decrease in deaths from bronchogenic carcinoma must come by way of early diagnosis and early treatment. Since this disease is usually found to be incurable at operation, the need for more prompt diagnosis is apparent (2). By the time the characteristic signs are discernible in the roentgenogram, the tumors are usually well advanced. In the past few years, routine chest roentgenograms and mass-survey chest examinations have been done on a great number of persons as public health, industrial, or hospital admission procedures. It seems logical, then, to look to this widely accepted and practical method for early diagnosis where no symptoms are present. However, disappointingly few bronchogenic carcinomas have been discovered in this manner. Can it be possible that we are reaching the point of diminishing returns in so far as the roentgen criteria of minimal lung cancer are concerned? For a number of years one of us (L.G.R.) has investigated the past roentgenologic history of i...

The effort to opacify the liver for roentgen examination has led to a large number of experiments, most of which have been strikingly unsuccessful. It is possible to introduce a contrast medium into the liver through intravenous injection, but in general the substances which have been useful have either been immediately toxic or have remained in the liver for so long a period of time as to produce deleterious effects. In more recent years, roentgen studies of the veins of the liver, particularly of the portal circulation, have been achieved through a direct injection of branches of the portal vein as described by Moore and Bridenbaugh (7, 8). This procedure, however, requires laparotomy for its accomplishment and is, therefore, of limited value. More recently, Bierman, Steinbach, White and Kelly (1) have studied the portal venous circulation roentgenologically by injection of a contrast medium following percutaneous insertion of a needle through the anterior abdominal wall into the liver substance and thu...

Primary Hepatoma is of relatively rare occurrence in infants but, in spite of its low incidence, it is one of the commonest neoplasms of the liver seen in infancy and early childhood. Although numerous articles have been written about its pathology, clinical aspects, and therapy, no study could be found in which there was an attempt to establish roentgen criteria for the diagnosis. This paper will deal with roentgen findings in 11 cases of primary hepatoma in infants and young children. It is significant that the cases to be presented, despite their relative rarity, were hitherto unreported. This may serve to indicate that such tumors are not really as rare as the isolated case reports (with reviews of all the previously recorded cases) would suggest. Steiner (18) found only 77 cases (including 2 of his own) in children under sixteen years in which he considered the diagnosis justified. Bigelow and Wright, in 1953, assembled 95 proved cases and added 1 of their own (2). Still another case was added by Tom...

The article by Lodwick, Keats, and Dorst (1), appearing in this issue of Radiology, raises some urgent questions concerning the use of computers in medicine. The future demands answers. We must decide if computers can serve medicine as they have begun to serve other fields of science. And, while we struggle with that first question, we must simultaneously contend with another—one that troubles not only physicians, or even scientists, but is a prime problem of our time—that is, how much can man rely upon these electronic assistants of his which are at once super- and subhuman? The answer to the first question is, I believe, an assured “yes.” It has become almost impossible to handle the large quantities of knowledge which are necessary to the proper management of disease without the aid of some mechanical or electronic device. Computers are now being developed which can prove theorems, play games with sufficient skill to beat their inventors, translate texts from one language to another, recognize the spok...