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Considerable diagnostic data can be gathered by selectively catheterizing the portal vein and the major tributaries of the splanchnic venous system to evaluate pressure and blood flow. Combined with cinefluorography, this is a superior method for demonstrating the anatomy and hemodynamics of portal hypertension as well as the effects of splenorenal shunt surgery. Thirty-one attempts with a 19 gauge trocar in 17 patients resulted in 28 successful portal entries and 24 successful selective catheterizations. Portal vein pressure, flow, and diameter were less after shunting.

Intravesical and intra-urethral pressures were recorded in 5 continent women and 10 women with urinary stress incontinence using combined urethrocystometry and cinefluorography. At rest, two types of stress incontinence could be recognized; one involved widening of the proximal urethra and the other did not. Under stress, the proximal urethra was rather mobile in the incontinent women. Artifacts caused by axial movement of the urethral microtransducer were eliminated by fixation of the catheter against the external meatus.

With the advent of high-gain image intensification and high-speed cine-fluorography, better and more informative cinefluorograms are obtained and more precise motion analysis is possible. Often the radiologist wishes a time-event were available to refer back to in a specific frame. This has been investigated and achieved in the past by several means, mainly split-mirror photography (1–3), and through film-base posterior approach (4). The first method implies a reduction in the amount of light reaching the camera from the output phosphor of the image intensifier (which has to be compensated by increasing the x-ray output), and the second requires an additional shutter-mechanism and specific modifications of the camera to be used. Since the shape of the image-intensifier output phosphor is circular and the motion picture frame rectangular, it is obvious and well known that the camera “sees” four additional corners and the possibility arises of centering the required information in one or all of these spaces...

Cineradiography is the method of choice for the roentgen study of the pyloric region in patients who have been subjected to pyloroplasty and vagotomy, operative procedures which are combined in selected cases of duodenal ulcer. Functional as well as anatomic demonstrations of the behavior of the operated stomach are provided by cineroentgenography. The examination also helps to evaluate the success of the operation by assessing the adequacy of the gastroduodenal channel and the progress and rate of gastric emptying and gastric peristalsis. On routine gastrointestinal examination, frequently only minimal changes are noted in the appearance of the distal antrum and the base of the duodenal bulb, although extensive pyloroplasty has been performed. It has often been observed also that in asymptomatic patients the x-ray findings suggest a partial obstruction in the distal portion of the stomach with proximal dilatation and retention of secretions. This same roentgen appearance has been described by Wilkins (9)...

Several recent publications have illustrated the usefulness of body-section radiography (6–8, 12–15) for the demonstration of calcified heart valves. Others have shown the value of spot films (9), fluoroscopy (5, 16, 17), and cinefluorography (1, 11). The study to be reported here compares the yield of calcified valves by fluoroscopy, cone-down spot-films with short exposures, body-section radiographs, and cinefluorography. The findings represent the author's impressions and are not confirmed by surgery or pathology. The technics employed are designed for the study of a number of patients in a short period of time. In consequence, they are not individualized nor are they exhaustive in scope. With the development of a greater variety of approaches to the surgical repair or replacement of diseased valves, there is an increasing need for an accurate preoperative estimate of valvular status. Calcification of a valve may influence the choice of the surgical procedure. It warns of the possibility of cerebral em...

Correct diagnosis of esophageal varices is a universal concern in roentgenology. Nearly every patient suspected of varices undergoes a radiographic-fluoroscopic examination. The criteria for roentgenologic diagnosis are well known (1, 2). Until recently it has been said that conventional esophagography with fluoroscopy is grossly unreliable, since a correct diagnosis is established in only 15 to 50 per cent of cases (3–5). The advent of image intensification has rendered esophagography considerably more precise and accurate, and we believe that with reasonable care varices are currently identified correctly in 50 to 75 per cent of the cases. More definitive diagnostic methods, although statistically more accurate, tend to be somewhat more complex, uncomfortable, and perhaps hazardous: esophagoscopy, mesenteric portography (6), splenoportography (7), and direct visualization during laparotomy or autopsy. None of these methods, however, is totally reliable. For example, during endoscopy varices may become o...

One year's experience with a remote-control x-ray and closed-circuit television unit has offered us an opportunity to evaluate the newer image intensifier in the routine office practice of radiology. Our impressions regarding its value are offered in an individual and critical appraisal of the television viewing, photofluorography, and cine studies performed in over 1,000 upper gastrointestinal studies and approximately 500 colon examinations. Technic of Photofluorography and Cine Studies The examination of the stomach has been modified so that mucosal relief films could be obtained on 8 × 10-in. spot-films. After several swallows of barium, 1 radiograph is made in the upright position, 1 in the supine position, and then 2 oblique roentgenograms are taken, allowing the ingested air to fill the antrum and cap as well as the fundus and cardia. The patient then assumes the prone position for a roentgenogram which includes the antrum and duodenum. In this projection, the antrum is ironed out by the spine pres...

In the practical application of cineradiography, the radiologist needs a reliable and speedy determination of proper film exposure. Failure to achieve this greatly hampers the full realization of the clinical potential of this method of studying dynamic motion and restricts the extension of its usefulness to other areas of diagnostic roentgenology. As with spot-film radiography, some type of phototiming would be a desirable means of assuring correct film density for any combination of emulsion speed, framing rate, object density, and radiation exposure factors. Unfortunately, phototiming as we know it in conventional radiography cannot be readily achieved without a radical change in commercially available cine cameras. The compact design of these cameras does not provide sufficient space for the insertion of even a small conventional photocell into the area of the filming aperture. It is conceivable that a tiny selenium (cadmium sulfite) type photosensitive crystal could be placed in the camera, but this ...

This paper is addressed primarily to those contemplating purchase of equipment for taking x-ray movies. Its aim is to provide information regarding facilities required, the investment in time and money, information obtained with the technic, frequency of its use, and its influence on the physician's practice. To make x-ray movies, the minimum requirements are an x-ray machine, an image intensifier, a movie camera, circuits to interrupt the beam during film movement, and a light meter or automatic brightness control. Although much information has been obtained with 5-inch image intensifiers, field size under these conditions is severely limited. Only the installation of a machine that permits films to be taken of a field not less than 8 inches in diameter should be considered. Films may be processed by professional processing agencies but, in general, that method has not proved efficient. The films cannot be checked quickly enough and, more important, they are usually developed to a gamma of only 0.6 to 0....

Television tape recording of fluoroscopic images is by no means new (5, 6). Until relatively recently, owever, such recording required large expensive television tape recorders under constant skilled pervision by technical and engineering personnel. This placed their use out of the reach of all but very large specialized institutions. With the advent of transistorized, compact helical scan recorders, the size and price limitations have been largely overcome. Such devices are now within the reach of the clinical radiologist in the community hospital or private office practice. Since August, 1963, it has been our custom to employ a video tape-recording device routinely in our luoroscopic procedures. During this period, many radiologists have shown considerable interest in this modality. This interest has prompted a review of the subject and a comparison of its merits with those of the other means of physiologic recording, cineradiography. I t is neither possible nor desirable to attempt to give an elaborate...

Study of the physiology of the renal pelvis and the ureter has been hampered by the relative inaccessibility of these structures. Frequently examinations have been performed with instruments and equipment which, by the very nature of their construction or method of application, yielded results rendered invalid through artefact production. Although at present several methods for the study of renal pelvic and ureteral function yield acceptable and reproducible results, (3, 5, 9–11) only radiography permits direct observation of undisturbed structures under consideration. A previous publication has shown that cinefluorography is a satisfactory technic for visualizing the dynamic changes which occur in the normal upper urinary tract (1). At that time, it was pointed out that the activity of the upper urinary tract could be divided into two patterns: that of the bifid renal pelvis, in which the contractions originate in the upper infundibulum and that of the ampullary renal pelvis in which the contractions ori...

The Use Of prosthetic cardiac valves in the therapy of valvular heart disease is currently on the increase (1, 3). Over 34,000 such valves have been distributed by one manufacturer (4). The radiologist is routinely called upon to examine postoperative prosthetic valve patients, a procedure which becomes of immediate importance if the clinical course is unfavorable. Variations in the cage position which indicate partial interruption of valve fixation are readily detectable by image-amplification fluorography. During follow-up examinations, it was noted that the “radiolucent” silastic ball currently in use could be detected on standard image-intensification fluoroscopy, and that ball motion could be recorded by standard 16-mm cinefluorography. The purpose of this communication is to describe the characteristic ball motion of currently employed prosthetic valves seen fluoroscopically, without the injection of contrast material or other nonphysiologic agents. Materials and Methods Twenty-two patients were exa...

The anatomical details of the urinary system may be investigated by intravenous urography, retrograde urography, aortography, retroperitoneal air insufflation, etc. Studies of the pathological physiology of the urinary tract have been limited by lack of a modality for the study of motion. Recently, however, the image intensifiers with attached movie cameras are allowing a more complete appraisal of the functioning urinary system. Equipment We are using a commercially available image intensifier and camera unit manufactured by Westinghouse. The field size of the intensification tube is limited to a diameter of 4.5 inches. An illumination gain approximately 400 times that of the average fluoroscopic screen is possible, but dark-adaptation principles should still be used for proper selection of the areas for photographing. The x-ray source is a heavy-duty Dynamax tube with full-wave rectification for fluoroscopy so that 120 pulses per second of x-ray are available for visualization. During cinefluorography, ...

In September 1955 Russell Morgan read (1), and in January 1956 published (2) a paper concerning the history and theory of image amplification. He dealt particularly with his own system that employs an RCA Image Orthicon but mentioned research that was in progress on television type amplifiers that are directly sensitive to x-rays without the necessity of first converting them into visible light. The x-ray image amplifier developed recently for General Electric by their Mr. John E. Jacobs is an instrument of this latter type. This report will describe its construction and operation and point out certain important differences between it and the amplifiers of Westinghouse, Philips, Morgan, and Moon. Preliminary cineradiographic results using the General Electric amplifiers will be presented. The Westinghouse (3) and Philips (4) amplifiers (Figs. 1 and 2) have been shown repeatedly at radiological meetings in recent years, are available commercially, and have enjoyed some clinical use in Europe and the United...

The advent of larger image-intensifying tubes with higher brightness gain has solved many of the problems of radiation dose and field size in cineradiography. Limited image detail remains as the most critical obstacle to be overcome if this method is to have a wider range of diagnostic usefulness. It is the purpose of this presentation to evaluate the relative merits of film size alone as a determining factor in the quality of a cine-image. Obviously, the film can record an image no better in detail than the quality and adjustment of the image intensifier and lens system will produce. It is obvious, furthermore, that the larger of two films with the same emulsion characteristics will present a greater number of photosensitive grains to accept the image; hence it can potentially yield more detail. Because of the very limited resolving power of present-day image tubes, the question of whether there is any critical gain in diagnostic yield through the use of 35-mm. film is pertinent. Factors Affecting the Ev...

In the past, many different methods have been employed for demonstrating calcifications within the heart, including roentgenography (1–4), roentgen kymography (5), and planigraphy (6). Each of these has definite limitations. Over the last two years there have been performed in the Veterans Administration Hospital, Minneapolis, Minn., 803 cinefluorographic examinations for this purpose, and it is the authors' opinion that cinefluorography is now the method of choice for detecting and localizing cardiac calcification. In the diagnosis, treatment, and prognosis of cardiac disease (7), the detection of calcification within the heart is of significance. Often its recognition in the mitral or aortic valve or in the coronary arteries helps in arriving at a differential diagnosis. Furthermore, it may modify the surgical approach. A calcified mitral valve may be fractured rather than cut. During mitral commissurotomy cerebral embolization occurs more frequently if there is calcification in the valve. In the corona...

There are increasing demands for angiocardiographic examinations, a procedure which yields considerable information. Its importance for the study of cardiovascular lesions and for the differentiation of vascular from non-vascular mediastinal lesions has been established. A multiple-exposure technic is desirable. Many attempts have been made to opacify the heart chambers and large blood vessels. Castellanos (1), examining infants, used two x-ray tubes at right angles to each other to obtain an anteroposterior and a lateral projection simultaneously with a single injection of contrast substance. Robb and Steinberg (2, 3) described a practical technical procedure whereby, with a single injection, two exposures are made in anyone desired position. Two additional exposures can be obtained following a second injection in any other position. This may be designated as a two- or four-film technic. In 1940, Stewart and Ghiselin (4) published their paper on cinefluorography, and in 1941, Stewart, Breimer, and Maier ...

Just as phototiming enhances the usefulness of spot-filming by eliminating exposure error, some means of assuring proper film density is a prerequisite for the broader clinical application of cineradiography. In the past, manual control of milliamperage by a millivolt monitor of the image tube current (Philips Co.) and a pre-read microammeter measuring the phototube current of a brightness-stabilizing circuit (Westinghouse) were used to establish correct cine film exposures in this work. Later, improved brightness stabilizers were employed in an attempt to maintain constant light levels for recording anatomical areas of varying opacity. While these devices, if properly used, permit one to achieve satisfactory film exposures, they are tedious to adjust, and the task of obtaining reproducible results under all conditions of cine operation requires a rather complicated procedure on the part of the radiologist. There is need for a simple-to-operate device which will assure constant film density at all film sp...

In the last ten years efforts to increase the accuracy of diagnosis in the radiographic investigation of the upper gastrointestinal tract have centered on the use of image intensification devices, cinefluorography, and combinations of these technics, complemented by a television monitoring arrangement. It has been generally conceded that the routine utilization of such equipment will undoubtedly expedite upper gastrointestinal examination and will result in a greater accuracy of diagnosis. Our experiences indicate that, in spite of such improvements, many pathologic situations, including advanced forms of malignant growth, will continue to be overlooked unless high-kilovoltage technics are routinely utilized. High-kilovoltage technics have proved of immeasurable value in roentgenography of the lower gastrointestinal tract. Numerous observers (1–4, 10) have documented results which establish beyond doubt that the use of such procedures has made possible a simpler and more accurate examination which can be ...

Rapid objective assessment by cinefluorography of the functional status of prosthetic heart ball-valves, either during routine postoperative examinations or in the presence of suspected complications (Table I), became practical once radiopaque material had been incorporated in the balls. The major advantages of this innovation are: (a) cinefluorographic study of mobility of the ball and of its retaining case and (b) prompt and positive localization of dislocated balls. We have, therefore, begun a follow-up program of serial examinations of intracardiac ball-valves. Two cases are presented herein,2 and a tentative outline of our criteria of normalcy by cinefluorography is presented. No evidence to date indicates that impregnation of the silicone rubber (Dow-Corning Silastic) with barium sulfate alters its mechanical characteristics according to laboratory testing, its durability, or its chemical, hydrostatic, or electrostatic resistance in vivo. Analysis of the first 100 patients with sutureless valves (1)...

Voiding urethrocystography is an important tool in the evaluation of urinary tract disorders. The examination is usually performed with serial radiography, conventional spot-filming, or cinefluorography, each of these methods having some advantages and some disadvantages. Serial Radiography (7, 11, 15): Morphology is well demonstrated and some information is obtained about the mechanics of voiding, but once filming starts, the act of voiding cannot be observed fluoroscopically. In small bladders with rapid emptying, the urethra may be incompletely demonstrated; unnecessary exposures may be made after the bladder has emptied or after micturition has stopped. A transient ureteral reflux may not be well shown, and the positioning of the patient cannot be readjusted for optimal demonstration of normal or pathologic anatomy. Conventional Spot-Filming under Fluoroscopic Control (3, 4, 16 et al.): The number of films which can be obtained during micturition is limited in most cases to 4 or 8 since the change of ...

During the last fifteen years, fluoroscopic equipment has changed fundamentally, primarily because of the introduction of the screen intensifier. The intensifier has not only tremendously improved the fluoroscopic image but has also resulted in further technical developments, such as cinefluorography, television monitoring, tape recording of the fluoroscopic image, and remote-control fluoroscopy. The day is not too far away when young radiologists will no longer have any knowledge of old-fashioned pre-intensifier fluoroscopy. They will be proud of their equipment which they will consider ever so much better than that of the previous generation. Are they correct? Is the examination with the intensifier and its various adjuncts that much better? Is it even possible that the use of the intensifier results in a poorer examination? An appraisal appears necessary in order to keep the new generation from growing up in an atmosphere of unjustified self-assurance. Such an appraisal is a somewhat unpopular, but—I b...

A versatile cine marker which allows correlation of cine films with simultaneous recordings of pressure, ECG, or other physiological data is described. A pre-settable portion of the cine film is marked while concurrently marking the hard-copy tracing of the monitored functions. The marker frequency and duration are easily adjusted.

In the attempt to attain maximum effectiveness of cinefluorographic analysis of palatopharyngeal movement, it has become clear that auxiliary equipment is needed. There are mechanical problems involved which hamper both accurate cine filming and cine scoring. The two following devices have been designed to alleviate several of these basic difficulties. Head Holder Cinefluorography of palatopharyngeal speech function is sensitive to subject motion in the plane of focus. The radiologist must hold the head of his young patient with a lead-gloved hand, although this procedure is often unsatisfactory in preventing lateral movement. A head-holder has been designed to insure correct positioning, while freeing the radiologist to monitor the focus of the machine. This unit (Fig. 1, installed in chair) was designed specifically for velopharyngeal evaluation, although it can be adapted for other head and neck studies. In the palatopharyngeal evaluation, the patient must be able to swallow barium and read cards held ...

Improved surgical and anesthetic technics permit removal or correction of esophageal lesions by thoracotomy in an increasing number of patients. For this reason, more precise anatomic and physiologic diagnosis is required. Since criteria for the roentgen diagnosis of hiatal herniation are disputed, and because the clinical significance of minimal to moderate degrees of herniation is often uncertain, a study was undertaken to evolve more specific criteria. A second objective was to evaluate these criteria by applying them to groups of patients in different age groups and over long periods of time. Initially, 300 cinefluorograms of the distal esophagus were reviewed. These were classified in three groups: (a) normal, (b) hiatal herniation, (c) other lesions. These interpretations were compared with the clinical histories of the patients and correlation between the roentgen diagnosis and the clinical impression was found to be poor. A restudy of the same group of cinefluorograms showed considerable intra-and...

In the face of the remarkable apathy of most radiologists the world over to the application of stereoscopy in roentgen diagnosis, we have remained convinced of the ultimate value to be derived from the clinical use of a refined system for stereoscopic fluoroscopy. A few other workers share our convictions, notably Lindblom (2), Webster (3), Potsaid (4), and Sones (5). Our Radiology-Physiology-Medical Physics Research Group demonstrated in 1954 the practicability of Vidicon closed-circuit television display from the first commercially available 5-in. Philips image intensifiers (6). However, the development of a stereoscopic televised fluoroscopy system required rapid handling of alternating images on the output phosphor from the two x-ray tube targets; we, therefore, selected the image Orthicon for this application since its photo-cathode can be pulsed and it is free of the objection-able lag of the Vidicon. In 1962, with Henny (7), we reported the development of a functioning experimental arrangement for ...

1. Cinefluorography: One of the image amplifiers we have employed (Philips) is equipped commercially with an f 1.5 50-mm. lens mounted at its focal length from the output phosphor; the emergent rays are thus approximately parallel. The camera lens, focysed at infinity, is brought into apposition to that of the image amplifier; this optical arrangement is not at all critical. An f 1.4 25-mm. camera lens reduces the 12- to 15-mm. phosphor image so that a complete circle is visible on each frame of 16-mm. motion-picture film. With an f 1.6 50-mm. lens the complete 16-mm. frame is covered, but a small portion of the top and bottom of the circular amplifier phosphor image is cut off. Comparable results have been obtained with a Westinghouse image amplifier made available for experimental purposes. Fluoroscopic viewing is accomplished either directly through the amplifier lens or by a right-angle telescope. A closed circuit television pick-up can be substituted for the motion-picture camera. We have found it e...