Radiography and Fluoroscopy, To The Present: Jack S. Krohmer

Radiography and Fluoroscopy,
1920 to the Present

Jack S. Krohmer, Ph.D.
Georgetown, Texas
introduction Potter (1915), and marketed as Potter-Bucky

grids in 1920; (5) motor-driven, O_900 tilting ta-
By 1920, many significant advances had bles, by W. Caldwell (for whom the American
been made in radiographic and fluoroscopic Roentgen Ray Society’s annual lecture is
equipment and techniques. The advances named) (1912) (Figure 2); (6) beam-limiting
were dictated by medical needs and by the devices, first used by a Boston dentist, W. H.
disturbing realization that these spectacularly Rollins, before 1900; (7) “hot” valve tubes, de-
promising x rays were also very dangerous veloped by Saul Dushman (1915); (8) “relnfon-
when improperly used, as evidenced by the cing” (intensifying) screens, first used by M. I.
growing list of radiation martyrs. Equipment Pupin before 1900; (9) Eastman Kodak Com-
that was available by 1920 included: (1) “in- pany’s double coated film, first available in
ternuptenless” transformers (alternating current 1918, and (10) lead protective devices, such
transformers) with mechanical rectifiers, devel- as leaded glass and leaded aprons, gloves
oped by Clyde Snook’s Victor Electric Co. etc. (Figure 3). Techniques were finally be-
(1904) (Figure 1); (2) hot cathode x-ray tubes, coming predictable because of the Coolidge
devised by W. D. Coolidge in 1912 and com- tube, and a variety of radiographic proce-
mencially available in 1917; (3) “shockproof dunes were developing. At the same time, Rus-
and ray-proof” systems, developed by H. F. sell Canman repopulanized and increased the
Waite, M.D. (1918); (4) Gustav Bucky’s anti- safety of fluoroscopy. (The Annual Oration of
scatter grids (191 1), made movable by H. E. the RSNA was originally named for Canman.)
Figure 1
The Snook interrupterless, me-
chanically rectified x-ray unit.
Radloraphlcs Index terms:

HISTORY OF RADIOLOGY
IMAGING TECHNOLOGY
. HIstory
CumulatIve Index terms:
RadIology and radIologIsts,
history
Fluoroscopy
RadIography
Address reprint requests to Jack S. Krohmer. Ph.D.. I 17 Highvlew Road. Georgetown, TX 78626.
Volume 9, Number 6, Monograph November,

#{149} 1989 RadioQraphlcs
#{149} I I 29
Radiography and fluoroscopy, 1920-1989 Krohmer
Patented 1,l73.4
Campbell -Tube -Tilt -Table

Horizontal 1 STEREOSCOPIC RADIOGRAPHY
Figure2 Angular . AND
The W. CaIdwell table, built by Vertical J PLUOROSCOPY
Campbell Electric Co. TUBE TILTS WITH TABLE

Pronounced by Leading Roentgenologiats U OO of the
Greatest Strides in Years in the Develop-
ment of X-Ray Apparatus
Easily movable, with patient, to any position

Patient once on table remains there until complete X.Ray
examination has been made, including the radiographs
SAVES .
INVESTMENT
SPACE
TIME
RENT
UBE
ANGLAR FLUOROSCOPY
Send for description i L T
One of she many positIons.
tube tilts with table
Note that and prices ABLE
CAMPBELL ELECTRIC CO., LYNN, MASS.
Figure 3
Lead protective devices.
I I 30 RadioGraphics November,
#{149} 1989 Volume
#{149} 9, Number 6, Monograph
Krohmer Radiography and fluoroscopy, 1920-1989
The 1920’s
Because of the relatively recent availabil-

ity of many of the devices listed above, the
1920’s were mainly a time of consolidation and
learning. Advances during this period often
took the form of new uses and refinement of
existing equipment and techniques, though
some new devices and techniques were de-
veloped. A device that evolved late in the
20’s, as a result of new techniques, was the Ke-
leket Technon generator (Figure 4). It resulted
from the “measurement of part” technique of
Mowry and Kotraschek. This generator was the
forerunner of all of the anatomically-pro-
grammed x-ray units that were developed lat-
en. To use the Techron generator required that
one measure the centimeter thickness of the
part to be nadiognaphed; this measurement .. -
was set on the “Technon” dial (essentially to
set kilovoltage; kVp =2 x Techrons + 23). The
vertical slide pointer was then set at the ap-
propniate anatomic part, the desired density
was selected and the exposure was made. . PIOE[R CREATORS OF A RAY EQUIPMENT SINCE 900
The heart of the operation of the Technon gen-
erator was what amounted to a built-in tech- Figure 4
nique chart that was entered and checked at The Keleket Techron anatomically-programmed gen-
the time of installation and checked again at erator.
later service calls.
in this country, the Engeln Electric Company of er tube, generator or screen modification.
Cleveland, Ohio introduced, in 1926, the “Du- New or refined ancillary equipment that
plex,” a combination radiographic and fluoro- appeared in the 1920’s included a spotfilm de-
scopic unit (Figure 5); while in Germany, Siemens vice produced by Siemens in 1923, a focused
produced the first three phase unit, in 1928. grid conceived by Rex Wilsey of Eastman Ko-
This unit could be operated at an amazing dak Co. in 1923, cassette changers, 5tstereo
2000 mA at 80 kVp. One of the most important shifters” and stereoscopes. As a result of the
developments during this decade, and one development of new, and the refinement of
that has been given little publicity, was the old techniques, the 20’s also marked the be-
manufacture, in 1929, of the first rotating an- ginning of extensive research and develop-
ode x-ray tube (the Rotalix) by Philips, in Hol- ment in the field of contrast materials.
land. Because of this x-ray tube modification, it In order to measure and predict radiation
eventually became possible to make a single doses to the patient, in both diagnosis and
exposure at instantaneous electrical power therapy, two quantitative measuring devices
hundreds of times greater than was possible were designed: an x-ray dosimeter, by 0.
with a stationary anode tube, and without Glasser and R. Fricke, in the mid-1920’s; and
damage to the focal spot or track. This single the “Roentgenometer,” a monitor attached
development, which was duplicated in the to the x-ray unit, by R. S. Landauer, Sr. in 1929.
United States in 1934 by the General Electric (The former was included, in 1929, in the
Co. (G.E.), contributed more to the develop- Glasser-Seitz Condenser R-meter produced by
ment of rapid filming techniques than any oth- the Victoreen Company.)
Volume 9, Number 6, Monograph #{149}

November, 1989 RadioGraphics
#{149} I I 31
Arranged for Radio graph’ Arranged for Fluoroscopy

5A 5B
Figure 5
The Engeln Duplex.
The 1930’s a solid tungsten disk for the anode.

The 1930’s also saw the development of
With continued striving for faster expo- new and specialized equipment such as the
sures, the 1930’s saw new entries in the gener- Paul Hodges Head Unit, the Squire and Young
ator field. Several 1000 mA, 100 kVp units Urological Table and the Hirsch and Schwans-
came into being, and Picker X-ray Corporation child pianigraphic attachment. Planigraphy, or
(Picker) brought out the first, three phase unit tomography, was investigated and came into
to be built in the United States in 1933. A one rather widespread use. Extensive chest surveys
microfarad capacitor discharge unit was pro- were initiated using photofluorographic de-
duced, and Charles Slack of Westinghouse X- vices in travelling vans. These surveys, which
ray Company developed the “Micronex” field are presumed to have had a significant effect
emission tube for microsecond exposures in upon the control of tuberculosis, continued nel-
1939 (Figure 6). Note the image of a football atively unchanged for more than two decades.
kick made with the “Micronex.” (Figure 7). A bi-piane fluoroscopy unit was devel-
(Later, during World War Ii, the Field Emission oped by Picker in 1934 (Figure 8). Multiplane
Corp. of McMinnville, Oregon combined the fluoroscopy was introduced with a homemade
capacitor discharge unit and the field emission unit designed by W. E. Chamberlain and G.
tube to produce a 90 pound apparatus for the Henny of Philadelphia (Figure 9). This home-
armed forces.) General Electric, in 1931, pro- made unit, which was never produced com-
duced a 1000 mA diagnostic x-ray tube for use mercialiy, bears a primitive resemblance to
with its 1000 mA generators. In 1934, General modern isocentric, parallelogram configured
Electric duplicated Philips’ manufacture of a special procedures apparatus. Dr. Chamber-
rotating anode tube, and in 1937, produced lain, Chairman of the Department of Radiology
the first oil-immersed rotating anode tube with at Temple University, in his “Carman Lecture”
I I 32 RadloGraphics November,
#{149} 1989 Volume
‘w
Slack and the Micronex, a Micronex radiograph of a football kick; a one milli-
cold-cathode, field emission tube. second exposure.
Figure 8
A bi-plane fluoroscopy unit by Picker.

#{149} 1989 RadioGraphics
#{149} 1133
at the RSNA in 1941, covered many of the the-

oretical aspects of fluoroscopy, which he had
investigated with physicist, George Henny.
These included definitive studies of dark adap-
tation, which was required of fiuoroscopists be-
fore the development of the image intensifier.
He also discussed visual acuity of both rod and
cone vision and the effect of tube-screen dis-
tance in fluonoscopy (Figure 10). Dr. Chamber-
lain noted that Camp’s specially built double
fulcrum fiuonoscopic table (Figure 1 1) offered
a definite possibility of increasing the tube-
screen distance without an objectionably high
tabletop. Mobile fluoroscopy units, such as
those of Westinghouse and Continental (Fig-
unes 12A&B) also came into being.
True portable x-ray units were available
from several companies (Figure 13). Some mo-
bile units, as late as 1933, were still of the non-
shockproof variety with cables exposed (Fig-
une 14). All of these portable and mobile units
operated at 30 to 50 mA and up to 80 or possi- .
bly95kVp.
.4:’
Figure9
The multipiane fluonoscopic device made by W. E.
Chamberlain and G. Henny.
Figure 10
The image of a pin at various tube-fluoroscopic
screen distances Distances from left to right were
1 6, 25, 30 and 48 inches. (Obviously, greater tube-
screen distances provide beffer images.
Figure 1 1
Dr. John Camp’s specially built double fulcrum fluo-
roscopic table.
I I 34 RadloGraphics November,
#{149} 1989 Volume
12A
Figure 12
(A) A Westinghouse Diadex mobile fluoroscopy unit
in use (1936) (B) A Continental Pacemaker mobile
fluonoscopy unit.
Figure 13 12B
The General Electric Co., Model F
“Suitcase Portable” x-ray unit.

#{149} 1135
The 1940’s
.s---.
The 1940’s, as is well known, were disrupt-

ed by World War II. Advances in radiology
were in some respects hampered by the war,
but in other respects, the war provided an im-
petus for advancement. The development of
portable (in most cases mobile) radiographic
equipment was stimulated by the needs of the
armed forces. Picker responded strongly and
became the sole supplier of the Army Field X-
Ray unit (Figure 15). This unit was widely used in
frontline, as well as in rear echelon military
medical installations. (it should be noted that
James Picker, then President of the company,
donated the profits Picker made during the
war to the United States Treasury.)
Despite the wan, there were three major
developments that occurred in the 1940’s. The
first of these was the design, by Russell Morgan,
of a phototiming unit and circuit. Morgan was
a radiologist, working at the time under Paul
Hodges at the University of Chicago, but many
THE \E\\’ KELFRFT \T TITLE N! F have said that he was a physicist in disguise.
Morgan acknowledged that the first papers
Figure 14 relating to phototiming were by H. Frank
A non-shockproof mobile unit
(1929) and R. Pape (1936), both in Germany.
(1933).
Because of the very low sensitivity of their pho-
toreceptors, their systems were not used ex-
tensiveiy. The “929” phototube, developed by
RCA, proved to be much more sensitive than
earlier receptors. This led Morgan to proceed
with the design of his system, on which he ne-
Figure 15
The Picker Army Field X-Ray Unit in
action in World War ii.
I I 36 RadioGraphics #{149}November, 1989 #{149}

Volume 9, Number 6, Monograph
ported in May, 1942 (FIgure 16). By August of To

1942, he had substituted the newer “931” pho- A
tomultiplier tube, developed by Zwonykin and SW
Rajchman of R.C.A. This photomuitipiier tube
completely solved the sensitivity problem, and
the device has been used extensively ever
since. Today ion chambers are often used as
receptors, and the concept has come to be B
known generically as “automatic exposure
T
termination.” The first phototimer was market-
ed by Westinghouse in 1945.
The second very important development
in this decade was the design of an image in-
tensifien by J. W. Coltman
1948. Although irving Langmuin
of Westinghouse,
was given the
in T
Figure 16
original patent for an intensifier (1937) (Figure The essential components of R. H. Morgan’s photo-
I 7), his design would not have provided suffi- timer: P = phototube, T = thyratnon switching tube,
cient intensification for clinical use. it required Re = relay with termination switch, Sw = exposure
Coltman’s modifications and additions before switch, F radiographic film.
=
A ECTR MUOSCOPE
#{182}E:=:
kMl1d
I tisl
SM.*TIc1
LLIRSI
____
__
I
__ __ __
[LERS
3ouRcr
COND(NS(R J(CTIVf INT(RPffDIAT( MACFIIFI[D
IMAGE IMACE
PROJ (CIOR
Figure 17
Irving Langmuir’s patent for an im- I auocv n NIPLIFIER
age amplifier (Brightness gain =
about 100).
U.S. PATENT Z.I*479

To tvusi LANGNUIR

#{149} I I 37
Radiography and fluoroscopy, 1920-1989 Krohmsr
in 1942. Although it required about 40 minutes

The C.7hC42tetoF gives you to process an individual film, about 120 films
MORE INFORMATION
could be processed in an hour using special
film hangers and a film transport system. This
device provided a control on the develop-
ment process and a predictability of radio-
graphic results that had not been known be-
fore in the field of radiology. It made it immedi-
ately obvious that automatic film processing
was an absolute necessity if consistency in ra-
diographic imaging were to be achieved.
The 1950’s
Unique to the 1950’s was a large influx of

physicians and scientists who had returned
from the wartime armed forces with a driving
need to learn and to participate in the devel-
opment of radiology as a medical and scientif-
Ic field. These young people, who had had
their careers interrupted, helped to make the
50’s a dynamic period in all of medicine and
especially in radiology. X-ray equipment man-
ufacturers were happy to cooperate, and
hence, many changes and innovations came
Figure 18
into existence in this decade. Problems identi-
The Fluorex by Westinghouse; the first commercial
fied at that time, for which solutions were
image intensifier unit.
sought included: (1) a need for even shorten
exposures to prevent motion artifacts and to
a usable intensifier with a brightness gain of facilitate rapid filming for dynamic studies, (2)
over 1000 became available for fluoroscopy. a need to make fluoroscopic procedures easi-
The brightness gain permitted fluoroscopy to er to perform and more informative, (3) a
be performed with cone vision rather than rod need to make soft tissue detail more available
vision. This promised to be a tremendous ad- in chest and other studies in which the pres-
vantage to the radiologist who would no long- ence of overlying bone masks desired informa-
en need to dark adapt, and who would be tion, (4) a need to improve the flexibility and
able, for the first time, to fluoroscope using accuracy of placement of the x-ray beam in
central, detail vision. The first commercial radiography, (5) a need to decrease patient
model of the image intensifier by Westing- exposure and increase information retrieval, in
house did not appear, however, until 1953 complex fluoroscopic studies such as angiog-
(Figure 18). Although the first commercial in- raphy and cardiac catheterizations, (6) a
tensifier used mirror-optics for viewing the out- need for more rapid and more controlled film
put phosphor, Morgan had used television processing, (7) a need for improved tomo-
viewing in 1948, and it is the viewing system graphic equipment, and (9) a need to make
that is still employed today. “portable” radiographs comparable with
The third important addition to the field of those obtained with stationary equipment. Es-
radiology in the 1940’s, although not as dna- sentially all of these objectives were accom-
matic as the first two, did much to advance pushed.
the field of radiography. This device was the X-ray generators were “beefed up” to
first automatic film processor. It was intro- provide tube voltages up to 150 kVp and to
duced by the Pako Corporation of Minneapolis provide tube currents up to, and exceeding
#{149} 1989 Volume 9, Number 6, Monograph
1000 mA, in contrast to the 100 kVp at 500 mA The table, which was provided with power-as-
that had been available at the start of this de- sisted longitudinal and transverse tabietop
cade. Paul Hodges, of Chicago, designed and motions, was mounted as a chord on a circular
built an x-ray unit with an anatomically pro- support. This provided 360 degree table rota-
grammed phototimer that provided for 6 chest tion with the axis of rotation above the table-
and 9 “table” techniques). This device was top (thus providing for smooth “90/90” fluoro-
never produced commercially, however. In an scopic positioning). The original Imperial in-
effort to improve chest radiography, Tudden- cluded a radiographic tube mount with a
ham, of the University of Pennsylvania, in 1954 longitudinal rail that was attached to the top
reported on using a G.E. Maxitron 2000, 2 million of the circular frame. Later it was provided
volt x-ray generator for “supervoltage” chest with a ceiling mounted tube suspension and
radiography. Chest images obtained with this an image intensifier (introduced by Westing-
equipment had minimal bone masking, and house in 1953). This unit proved to be very
hence, provided better mediastinal and apical popular and many are still in use. (An interest-
lung information. Other investigators tried “su- ing sidelight is that Dale Trout, physicist for G.E.,
pervoltage” radiography with similar results, but investigating to determine why radiation quali-
problems such as cost, excessive patient expo- ty and quantity from the Imperial were greater
sure, excessive focal spot size, and relatively than expected, determined that the capaci-
low output caused the procedures to be aban- tance of the very long cables required for the
doned. They are, however, still carried out as two x-ray tubes smoothed the single phase
“port filming” in radiation oncology depart- waveform to produce a near constant poten-
ments. At the other end of the energy spec- tial waveform.) Other manufacturers followed
trum, Y. V. Paatero of Finland conceived the G.E. in providing 90/90 fluoroscopy and very
first panoramic dental x-ray unit in 1954. flexible ceiling tube suspensions (Figure 20).
G.E. impressed the field in 1952 when it Profexray added a further vertical, power-dniv-
brought out the “Imperial” unit for radiograph- en motion to the x-ray table; and to provide
ic and fluoroscopic procedures (Figure 19). very complete flexibility of patient positioning
,. -.
Figure19
The Imperial radiographic/fluoro-
scopic unit by General Electric.

#{149} 1989 RadloGraphics
#{149} I I 39
Figure 20 .-.S’:s..-
The advantages of a ceiling tube

suspension.
:2 ..
i1
,‘L:
during cephalographic procedures, the Stryker roll film changer, the Sanchez-Perez cassette
Orthopedic Frame Co. of Kalamazoo, Michi- changer, the Sch#{244}nander cut film changer,
gan produced the Garcia-Oiler Radio-Chair. the Elema roll film changer and the Franklin roll
Howdon-Videx produced the first light lo- film changer. Note that bi-plane, angiograph-
calizing collimator in the United States in 1954, ic, rapid filming was performed as early as
and Dunlee introduced valve tubes with thor- 1950, using two rapid filming devices (Figure
iated tungsten cathodes in 1957. (Thoniated 21). Cineradiography was introduced in 1954,
tungsten cathodes produce a copious elec- by producing motion picture images of the im-
tron emission at much lower temperatures age intensifier output phosphor. In order to
than untreated tungsten cathodes. Because eliminate patient exposure during cine film
untreated tungsten cathodes must be operat- framing and transport, Machlett, in 1959, pro-
ed at temperatures near their melting point, duced a grid-controlled tube whose emission
they tend to “burn out” much earlier.) could be synchronized with the cine framing.
During the 1950’s, many rapid film chang- Thus, the patient was irradiated only when
ens came into being for angiographic and car- cine frames were actually being exposed.
diac procedures. These included the Fairchild Fluoroscopic spotfiim devices were pro-
- p
Figure 21 . “wi1$ CDQU

A bi-plane angiographic ex-
hibit displayed at the Amen- a’,..
can Roentgen Ray Society
(1950).
. tit.
I I 40 RadioGraphics November, 1989 Volume

duced by Scholz (1950) and Leischman (1953), tnical outlets for these units, they have disap-
and eventually, each x-ray company included peared from the market. They have been re-
its own spotfilm device with its fiuoroscopy ta- placed in recent years (with a sacrifice in
bles. power) by rechargeable, battery-operated
In 1951, a greatly improved tomographic and capacitor discharge mobile units, which
device with complex motions, called the Poly- can be plugged into existing I 15 volt outlets
tome, was developed by Massiot in France. It for charging or operation.
was eventually marketed worldwide by Philips In 1956, Eastman Kodak introduced the
(Figure 22A). A sophisticated vertical tomograph- X-Omat automatic processor, a nylon roller
ic device, the Baltomix, was produced in the system that required no fiim hangers. This de-
same period, by Baiteau of Belgium (Figure 22B). vice was capable of processing about 600
In 1958, Picker introduced a high powered films of mixed sizes per hour, with individual
mobile unit that could produce 300 mA at 125 films requiring 7 to 10 minutes from dry-to-dry.
kVp. Other manufacturers followed, but be- (Modern X-Omats process films in 90 seconds
cause of the very high cost of providing elec- with an associated increase in capacity.)
POLYTOME
Figure 22
(A) The Polytome tomography unit by Philips, show-
ing hypocycloidal motion.
(B) The Boltomix upright tomography unit by Bol-
teau.
22A

#{149} 1989 RadloGraphics
#{149} I I 41
The 1960’s it in 1947. The first investigations of its medical

usefulness were conducted by J. Roach and H.
This decade was similar to the 1920’s in Hilleboe (Director of the N.Y. State Department
that it became a period of consolidation and of Health) of Albany, New York. Their work ex-
refinement of equipment and techniques. In tended from the late 1940’s to the mid 1950’s,
1960, the Field Emission Corp. made a com- and was reported in the American Journal of
mercial mobile version of its Army Medical Roentgenology in January, 1955. Roach & Hille-
Corps field model, Fexitron. This unit, which boe investigated the application of the tech-
used a capacitor discharge generator and a nique to all types of radiographic studies, but
cold cathode, field emission tube, was capa- did not report on its use in mammography. They
ble of operating at well over 100 kV with very obtained promising results, which led the State
high (2500 mA) tube current. This allowed ex- of New York to buy 30 units, to be available on
posures as short as 1/1000 second. Oddly trailers at select locations throughout the state,
enough, however, this unit did not become for Civil Defense and other emergency uses.
very popular. In 1963, the X-Ray Manufacturing Between 1955 and 1966, many others used and
Corporation of America marketed a dedicat- tested the original rather primitive xeroradiog-
ed mammography unit, probably the first raphy system, but the process was never used
American entry in this field. to any great extent except for mammography.
Later in the decade, remote control fluoro- It now appears that it may be disappearing,
scopes were produced by both G.E. and Picker. even from that application.
Remote controlled units were now possible be- The second exciting new direction in rn-
cause of television viewing. They offered the aging was the adaptation, in 1968, of rare
advantage that the radiologist could be out- earth phosphors, which had been Investigated
side the x-ray room during fluoroscopy and, for color television, as intensifying screens for
hence, did not receive the somewhat elevated general radiography. The phosphors in the
dose received by personnel in the room. Anoth- original rare earth screens were terbium acti-
en and more scientific advantage was that, as vated gadolinium or lanthanum oxysulfide on
Chamberlain had reported in 1942, an in- both. The first report of their usefulness, by R. A.
creased tube-screen (i.e., tube-input phosphor) Buchanan, S. I. Finkeistein and K. A. Wicker-
distance resulted in greatly improved images. sheim, appeared in 1972. These and other
This was possible with remote units. The remote phosphors of mid range atomic number have
control Picker Satellite retained the old tube K-shell discontinuities at energies that are
beneath the table configuration, with its re- nearly optimum for the absorption of usual di-
stricted tube screen distance; but G.E’s Teietrol agnostic x-ray photons. This is not true for cal-
put the tube above, and the image intensifier cium tungstate phosphors, which were onigi-
below the table. This made it possible to in- nally used by Pupin in 1896, and which were
crease the tube-screen distance, which im- used extensively from then until the mid-1970’s.
proved fiuoroscopic image quality. The unit The K-shell edge of calcium tungstate is at
also provided spoffilms the quality of which was nearly 70 keV, which is above the energy of
equal to that of tabietop nadiognaphs. most diagnostic x-ray photons. As a result, rare
Two other new and exciting additions to earth screens are at least twice as efficient as
the image production and recording field absorbers of diagnostic x-rays as are calcium
came to light during the 1960’s. First, as a result tungstate screens. In addition, these phos-
of papers by John Wolfe of Detroit, which were phors have a much higher conversion efficien-
published in 1966, xeroradiography became cy than calcium tungstate, and hence, emit
widely accepted for mammographic studies. much more light pen x-ray photon absorbed.
Actually, this recording medium was first discov- These middle atomic number screens are used
ered by Carison of the Batteile Development almost exclusively at the present time.
Corp. of Columbus, Ohio, in 1937. He obtained In order to eliminate images of grid lines
a patent on the medium and its use in 1944, appearing on images made with stationary
and Battelle licensed the Haloid Co. to market grids, fine line grids were introduced in the
#{149} 1989 Volume
1960’s. Liebel-Fiansheim produced its Superfine that the design of CT apparatus included the
grid in 1961; it had 133 opaque lines per lineal first real effort to eliminate scattered radiation
inch. Most grids in use today have more than since the development of the grid by Bucky in
100 lines pen inch. 191 1 Very little scattered
. radiation reaches
Very different, but also very important de- the CT detectors because of pne- and postpa-
velopments that occurred in the 1960’s were tient collimation, and as a result, the contrast
first, the Philips Alternator, an automated film resolution of the CT device is far superior to
viewing system whose 20 or 31 viewing frames that of any other imaging device. In a related
could be loaded by staff with as many as 360 development, emission CT using radionucildes
small radiognaphs prior to the radiologist’s film was first used in 1976.
reading. This device, and those made by other The first proposal to use nuclear magnetic
manufacturers, made maximal use of the ra- resonance techniques for medical imaging
diologist’s time and have proved especially was advanced by R. Damadian in 1971, and P.
well adapted to “film viewing” conferences. A Lauterbur, in 1973, suggested modifications to
second and potentially more significant devel- the technique and system. The first human im-
opment was that of computer-aided diagno- ages were produced in Great Britain in 1977. in
sis. The concept was introduced and demon- order to eliminate the word “nuclear,” with its
strated by Lodwick of the University of Missouri unpopular public connotation, the name was
between 1958 to 1963. This is just one of many changed from nuclear magnetic resonance
possible uses of computers in diagnostic radiol- imaging to magnetic resonance imaging on
ogy. MRI. The spatial resolution of CT is, at best, less
than two line pairs per millimeter (ip/mm);
The 1970’s whereas conventional screen film radiograph-
ic image resolution is between 3 and 10 Ip/
Despite other relatively important ad-
mm, depending mainly upon the screen used.
vances which were made in diagnostic radiol-
MRI spatial resolution is less than that of CT and
ogy in the 1970’s, historians will mainly recall
probably no better than one lp/mm. The obvi-
that both computed tomography (CT) and
ous clinical usefulness of both CT and MRI, de-
magnetic resonance imaging (MRI) became
available for medical imaging in this decade.
A computer-facilitated image construction
technique was first used in astronomy (1957)
and later in electron micrognaphy (1968). W.
Oidendorf tested the use of such techniques in
the medical field in 1961, and D. Kuhl used am-
enicium-241 for CT transmission imaging in
1963. In 1972, G. N. Hounsfield of Great Britain mCOLD
reported on a medical CT imaging system that CATHODE
was made available by EMI (Electno Musical in-
stnuments Ltd.) and was marketed first in 1973.
Most individuals assume that the main advan-
FIELD
tage of CT is the computen-aided construction
- EMISSION
POINTS
that yields transverse, cross sectional images.
This essentially eliminates the third-dimensional
uncertainty that in many instances, is a prob-
lem to the radiologist using a two dimensional
image. (It should be stated, however, that ra-
diologists became unusual experts in visuaiiz-
ing three dimensional structures from two di-
mensional images, and it was only in unusual Figure 23
situations that the 3rd-dimensional uncertainty The field Emission Co. cold cathode x-ray
became a problem.) it should also be noted tube.

November, 1989 RadloGraphics
#{149} I I 43
spite their relatively poor spatial resolution, has same improved absorption of diagnostic x-ray
caused radiologists to reevaluate their previ- photons as was achieved with rare earth inten-
ous striving for better and better spatial resolu- sifying screens in radiography. In addition, the
tion. They have come to realize that high spa- cesium iodide material has properties that al-
tial resolution is not always needed to achieve low much more of it to be “packed” onto a
accurate diagnosis. (All of these systems (CT, given area of the input screen than was possi-
emission CT, and MRI) are discussed in detail ble with other phosphors. The use of cesium io-
elsewhere in this monograph.) dide, which results in a decrease in patient
During this decade, the Hewlett Packard dose and provides spatial resolution as high as
Co. , which had acquired the Field Emission 4 p/mm, has become universal in all image in-
Corp. , used the cold cathode field emission tensifier tubes. Also in the field of fluoroscopy,
tube (Figure 23) to produce a 350 kVp chest in the late 1970’s, Mistretta et al., of the Univer-
radiographic unit, which could produce milli- sity of Wisconsin, introduced a digital or corn-
second images. These images are somewhat putenized fluoroscopy apparatus (Figure 24).
comparable to the “supervoltage” images of The static film images produced, using this de-
the 1950’s with little bone masking, but are vice, are sometimes referred to as digital ra-
made with much less expensive and more diographic images. In fact, they are actually
compact equipment and with better spatial light images of the output phosphor of an im-
resolution. These units never achieved great age intensifier tube. They are obtained with
popularity, but many are still in operation. the help of a video camera and a digital im-
In the early 1970’s, a cesium iodide input age processor. In the digital fluoroscopy sys-
phosphor was developed by Philips for image tern, the variations in the brightness of the out-
intensifier tubes. This phosphor, which is a mid- put phosphor of the image intensifier tube
die atomic number phosphor, provides the present as an analog image; that is, an image
Scintillator Photoemitter Output

X-ray Cal Phosphor
Source Anti-Scatter P.20
Grid
Light Coupling
Optics
Video Signal
Display
Figure 24
Block diagram for computerized fluoroscopy.
#{149} 1989 Volume
with an infinite number of brightness levels. The cated chest radiography devices became
image is digitized by an analog to digital con- available. in a very short time, these units fed
verter (ADC), after which the data may be exposed films directly into a well-shielded,
computer processed and stoned in the memo- dedicated processor that discharged pro-
ry of the digital image processor. For viewing, cessed radiographs in the same room or an
the digital data is retrieved and converted adjacent space. The cassetteless, in-line pro-
back to an analog image by a digital to ana- cessor principle was extended by Picker to the
log converter (DAC). The regenerated analog Rapido radiographic unit. It had in-table mag-
image is then viewed on a video monitor. A azines of various sized films and a table mount-
film of the image on the monitor can be made ed x-ray tube with collimator. The useful x-ray
for a static record. The video image can also beam was always directed at the center of
be recorded with a cine camera for a dynam- the “clamshell” film holder below the Bucky,
ic record. Types of study that can be carried and the beam was automatically collimated
out with the digital fiuoroscopy device are: (1) to the size of the film chosen. The “clamshell”
mask mode fluoroscopy, (2) K-edge fluorosco- film holder contained the screens chosen and
py, and (3) time-interval-difference mode. provided excellent film-screen contact by me-
Mask mode fluoroscopy is very similar to chanical means. In-room discharge of radio-
film subtraction angiography using contrast graphs, with 90 second processing, made
material. In that technique, a preinjection im- these units especially well suited for emergen-
age on “mask” is subtracted from a postinjec- cy room radiography. The first Rapido was in-
tion image to yield an image of only the con- stalled in 1973. The Rapido was copied by oth-
trast filled structures. in the digital mode, the en manufacturers, and it and other units are still
digitized mask may be computer processed being used and marketed.
prior to its subtraction from the digital postin- A second modern effort to reduce the del-
jection and processed image. In fact, the digi- etenious effects of scattered radiation on im-
tal mask may be subtracted from each of ages (in addition to the development of CT)
many sequentially obtained postinjection digi- was reported in 1975 by C. Jaffe and E. W.
tal images (up to about 60/second), and the Webster. it was the principle of “moving slit ra-
results can be viewed as a dynamic study on a diography.” This was followed in 1976 by similar
video monitor or as a movie on cine film. Thus, reports from a number of other investigators.
one can follow the transport of the contrast The first suggestion for the use of moving slits
material over time. K-edge fluoroscopy actual- to decrease scattered radiation in radiogra-
ly depends on the subtraction of x-ray ener- phy had come from 0. Pasche who used a sin-
gies just above and just below the K-edge of a gle pair of slits (1903), but little was done with
contrast agent. In the case of iodine for exam- the method until the work of Jaffe and Web-
pie, the technique yields information on ster. All of the systems developed in the 70’s
changes in the iodine content in a structure. used a linear slit motion except for the studies
Time interval difference imaging is similar to by Sorenson and Nelson, and Rudin and Bed-
mask mode fluoroscopy except that masks are narek in which a rotational slit motion was
changed continuously, and the study yields in- used. The system used by Barnes et al. is shown
formation on changes in the contrast material in Figure 25. As can be seen, the scanning mui-
content of a structure as a function of time. it tiple slit assembly consists of a set of beam de-
should be noted that images may be manipu- fining slits between the tube and the patient
lated by computer processing (e.g. combining and set of scatter removing slits between the
or averaging a number of frames) to yield im- patient and the film. The size and motion of
proved visibility. Digital or computerized fluo- the fore and aft slits is coordinated so that de-
roscopy became very popular for a time, but fined beams from the “fore” slits pass precisely
seems to be used less often in recent years. through the corresponding “aft” slits, the scat-
A very significant refinement of existing ten being intercepted by the lead septa be-
equipment occurred early in the decade, tween the slits. In a later report, Barnes et al.
when magazine-loaded (cassetteless), dedi- used a scanning grid whose leaves moved dun-

November, 1989 RadloGraphics
#{149} I I 45
Focal Spot
Collimator/Shutters
Figure 25
The scanning multiple slit assem- Beam Defining Fore Slits
biy of G. T. Barnes and I. A. Brezo-
vich (1978).
Primary Radiation
Radiation
Patient
Table
Cassette
focal point
--
linkage arm
Figure 26
The continuously focussed scan- upper grid slat spacer
ning grid of G. T. Barnes et aI.
(1980).
-grid slats
receptor
slat spacer
#{149} 1989 Volume
giA
*-,- . I
27A 27B
Figure 27
(A) Lateral sacral spine; conventional radiograph exposed with a 12:1
grid. (B) Lateral sacral spine; scanning multiple slit image.
ing scanning to continuously focus on the x-ray tions up to 2: 1 and higher. This decade saw an
source (Figure 26). A comparison of radiography increase in the use of magnification and air
obtained using the scanning grid and a 12:1 gap techniques. (2) Because of regulatory
conventional grid is shown in Figures 27A & B. It pressures, positive beam limitation (PBL) came
can be seen that for equal entrance skin expo- into existence. This system uses a collimator
sures, the scanning grid study is far superior to that automatically changes the size of the
that made with a 12:1 grid. If comparable quali- useful beam to correspond to the size of the
ty films had been obtained, the skin exposure for cassette, for standard table and chest radiog-
the scanning grid would have been significantly raphy. The purpose of the system is to assure
lower. It should be noted that no plans have that the image forming remnant of any radia-
been made for producing and marketing a tion to which the patient is exposed can be in-
commercial model of any of the moving slit or tercepted by the receptor cassette. There is a
grid devices. This is probably because it is pre- provision to bypass the PBL system, when the
sumed that solid state digital radiographic de- useful beam is not normal (or nearly normal) to
vices will eventually dominate the radiographic the plane of the receptor cassette and bucky
field, and scatter elimination will be an integral tray. The PBL system has significantly increased
part of these devices; they will eliminate the the price of x-ray equipment, and it is still add-
need for scanning slit or grid devices. ing cost because of excessive service require-
Other innovations which occurred in the ments. One large x-ray distributor has indicated
1970’s included: (1) The construction of tubes that approximately one-half of its service calls
with small focal spots (0. 1 to 0.3 mm) to allow are related to PBL problems. It is truly question-
magnification techniques, yielding magnifica- able whether the perceived increase in patient
Volume 9, Number #{243},

Monograph #{149}
November, 1989 RadioGraphics
#{149} I I 47
safety is worth the real increase in cost. known will, in the future, change to one in
Dupont developed a Daylight film loading which images are mainly digital, computer
and processing system, in the 70’s, that can be stored; and electronically retrieved, viewed
used without a usual darkroom. It consists of and recorded. Implicit in this view is the as-
shielded film magazines, which can even be sumption that the radiologist, sitting before his
placed in radiographic rooms, from which spe- monitor panel, will in the future have immedi-
cial cassettes can be loaded under daylight ately available the results of all imaging stud-
conditions. Also included, are special film pro- ies, of whatever type, performed on a given
cessors into which film can be transferred from patient, as well as all of the medical informa-
the cassette under daylight conditions. These tion on the patient. It is predicted that conven-
systems, which have become relatively popu- tional film-screen radiography will decrease
Ian, have decreased darkroom costs, in- greatly in importance and that much of the
creased departmental efficiency, reduced present “conventional” equipment will disap-
the number of cassettes required for an instal- pear. The important questions are “will all of
lation or department and eliminated many this take place, and if so, when?”
problems of screen damage and mainte- In 1981, R. A. Mattson, R. A. Sones, J. B. Stick-
nance, since the screens, always within the ney and M. M. Tesic of Picker International and
protective interior of the special cassette, are G. T. Barnes of the University of Alabama ne-
never exposed to damage in the darkroom. ported the development of a scanned projec-
During the 1970’s, most manufacturers de- tion digital chest x-ray unit. The device con-
veIoped computer-controlled, self-calibrating sisted of a single scanning slit which defined an
generators, some of which even provided a x-ray fan beam and which was positioned be-
printout of technique factors. (Since the ad- tween the x-ray tube and the patient. An
vent of rare earth screens, generators are not aligned second slit collimator was positioned
usually designed to operate above 1000 mA. between the patient and the detector array.
Those designed for use in the United States op- A 20 inch vertical detector array included
erate up to 150 kV, however.) Some of the gen- 1024 photodiodes coupled to a gadolinium
enators designed in the 70’s provided for ana- oxysuifide screen (Figure 28). This entire coaxi-
tomical programming. They were somewhat ally-oriented assembly was scanned across the
reminiscent of the Keleket Technon of the 20’s patient while the signals from the detectors
and the Hodges’ phototimed unit of the 1950’s. were sampled to yield 1024 horizontal pixels for
They were, however, considerably more sophis- each of the 1024 detectors in the vertical an-
ticated. Computer-controlled generators are ray (Figure 29). The digitized data was viewed
now widely used, but anatomically-pro- on a video display terminal. The horizontal
grammed units have never become popular. scan time (exposure time) was 4.5 seconds,
the maximum skin exposure was reported to
The 1980’s be 26 mR, the spatial resolution was one Ip/
In the present decade, x-ray equipment mm and there were 256 (8 bits) shades of
manufacturers are maintaining and making gray.
modest improvements in their conventional ra- In 1983, M. Sonoda, M. Takano, J. Miya-
diographic and fluoroscopic equipment. Their hara and H. Kato of the Fuji Photo Film Co. of
main efforts, however, are directed at the Japan reported on the development of so-
more commercially viable and technologically called scanning-laser-stimulated lumines-
sophisticated equipment of the future. This at- cence, a digital imaging device using photosti-
ten equipment, in addition to CT, MRI and so- mulable phosphors (Figure 30). Later, C. R. B.
nographic devices, includes digital radio- Merritt, C. C. Matthews, D. Scheinhorn and S.
graphic and digital fluoroscopic equipment Baiter of the Ochsner Clinic and Philips Medical
and computer storage, retrieval, viewing and Systems reported on clinical applications and
recording systems, for all types of imaging tests of the device. The device uses an imag-
methods. This direction of their efforts reflects ing plate coated with a europium-activated,
the widely held opinion that the field we have barium fluorohalide phosphor; most commonly
#{149} 1989 Volume 9, Number 6, Monograph
Figure 28
Digital chest unit geometry.
Detector Array
& Electronics
the halide is the bromide. This plate is exposed

in the conventional manner with the plate sub- focal spot
stituted for the screen-film receptor. Remnant (0.4mm x 1.9mm)
radiation emerging from the body of the pa-
tient activates the plate, and a latent image is
created. The plate is then scanned with a heli-
um-neon laser that releases the trapped enen-
gy as light. The light, in turn, is picked up by a
photomultiplier and its intensity is digitized. The fore slit
digital image is recorded on film, which can be
viewed in the conventional manner. This sys-
tern requires a time of 90 seconds, yields a
spatial resolution 2.5 Ip/mm or more, has 1024
levels of gray, has a dynamic range of 4000:1
and reduces patient exposure to between aft slit,
one half and one twentieth of the exposure detector array
doses associated with conventional studies.
and electronics
M. L. Giger reported a film-based digital
imaging system that uses a radiographic im- Figure 29
age on film, which is secondarily converted to Diagram showing motion of coaxial scanning slit as-
a digital image. Th digital image can be sembly for digital chest radiography.
viewed on a video display terminal or record-
ed on film. The original radiograph is digitized A. W. Templeton, S. J. Dwyen III, G. G. Cox et
by a video camera scanning device, a laser al. described an image intensifier-based digital
scanner, a rotating drum scanner on a special- chest system (Figure 31). This system uses a large
ly designed digitizer (e.g. the du Pont FD2000). field-of-view image intensifier and creates an
This system requires up to 60 seconds or more image with standard digital fluoroscopy tech-
in addition to the time required to produce the niques, a 12:1 grid and a high resolution vidicon
original radiographic image. The digital im- TV camera. Images are viewed on a video dis-
ages produced with this system hove a spatial play terminal or recorded on film. This system re-
resolution of up to 5 Ip/mm, 256 or more levels quires about the same time as a conventional
of gray and the patient dose depends on the chest examination, yields a spatial resolution of
exposure required to produce the original ra- up to I .5 lp/mm, 256 levels of gray and a dose
diograph. of about 45mR for an average chest.

#{149} I I 49
X-Ray Photons
I i tI iI ii
Ii iiii lii Barium +
.ft I
**
I I }ScannInLaser
Fluorohailde Receptor Laser Stimulated Phosphorescence

- }support .. .. . ... . .. :: Barium
. Exposedreceptor sloring latent image
0 Unexposed receptor - . }Support
30A 30B
30C
Figure 30
Photostimulable phosphor system and scanning-laser-
stimulated luminescence. (A) The barium fluonohailde
phosphor stones a latent radiographic image. (B) Stoned
energy is released by laser scanning. (C) Photomultiplien
detects emitted light; the resulting signal is digitized.
DISPLAY MONITOR
FLUOROSCOPY
TABLE
Figure 31
An image-intensifier-based digital chest system.
#{149} 1989 #{149}Volume 9, Number 6, Monograph
X.Ray Beam
Figure 32
Dual-energy detector sandwich for scanning-slit,
digital chest unit. F Tantalum lt
Photodiode
Connections
4v_’_’__Low Atomic
1
No. Phosphor
.. ‘4.- Copper FiNer
Ceramic Substrate 1High AtomNo. Phosphor
Photodiodes
The four systems (in italics) that are de- system and selective processing, one can
scnibed above are digital or computer ra- obtain (1) a soft tissue image, (2) a bone
diognaphic systems. They have all been image and (3) a composite image, in-
reported in this decade and are being cluding both soft tissue and bone (Figures
clinically tested extensively at the present 33A, B & C). A group from the University of
time. Only the first system eliminates most Alabama reported on the value of this
of the scattered radiation, and only the procedure for the detection of calcified
second and third are capable of being and noncalcified pulmonary lesions in
used for mobile radiography. The second 1986. They found this dual-energy system
and third also provide the best spatial res- to be fan superior to the conventional
oiution. It should be noted that after digiti- chest unit for the detection of both types
zation in any of the systems, various types of lesion. This was attributed to the fact
of image processing can be carried out that “the dual-energy unit is able to re-
before viewing on recording, in order to move structured noise and because the
enhance the image. it remains to be seen slit system results in nearly complete re-
whether all of these systems will remain in moval of scatter.”
the radiologist’s anmamentanium, or A more mundane development of the
whether one on more, or possibly other sys- 80’s was the advent of more than 30 van-
tems will become the system(s) of choice. eties of dedicated mammography units.
Although dual-energy digital radiogna- Following evidence that mammography could
phy is possible with any of the four systems be safely and effectively carried out for worn-
described, G. T. Barnes et. al. in 1985 ne- en over age 50, the American Cancer Society
ported that a high/low atomic number sponsored many state mammography screen-
detector sandwich could be used with ing programs and this was followed by an
the scanned projection digital system to American College of Radiology mammogna-
accomplish dual-energy digital radiogna- phy accreditation process. These events have
phy without switching the x-ray tube volt- caused the popularity of mammography to in-
age (Figure 32). Using the dual-energy crease dramatically.
Volume 9, Number 6, Monograph #{149}November, 1989 e RadioGraphics I I 51

Figure 33
(A) Dual-energy digital soft tissue image; bones
have been subtracted.
.1,:”1
Figure 33
(B) Dual-energy digital bone im-
age; soft tissues have been sub-
tracted.
Figure 33
(C) Composite dual-energy image
including both soft tissue and
bone.
#{149} 1989 Volume
Summary amount more in private offices and clinics. It is

true that the amount has diminished in recent
A survey of radiological procedures car- years, but this has been more because of
ned out in 1980 by J. L. Johnson and D. L. Aben- DRG’s than because of “takeover” by new
nathy indicated that of the 181 million proce- modes of imaging. It is not likely that this in-
dunes performed in that year, there were vestment will be given up quickly or easily.
77.5% plain radiographic studies, 12.7% con- One must also keep in mind that the film digiti-
tnast studies, 4.0% sonographic studies, 3.2% zation and the photostimulabie phosphor digi-
nuclear medicine studies, I .8% CT studies and tal systems, described above, do use existing
0.8% special vascular procedures and cardiac radiographic equipment, and the image inten-
catheterizations. Note that oven 90% of all the sification system uses a great portion of exist-
studies were of the “conventional” type and ing fluonoscopic equipment, therefore “going
that fewer than 2% were CT studies. In the ear- digital” may not require complete replace-
ly 70’s when CT was introduced, it was predict- ment of existing equipment.
ed that it would soon take oven most of radiog-
naphy; some 7 or 8 years later, it was obvious
that this would not take place. According to
Tanako of the Fuji Photo Film Co. Ltd., conven- Suggested Reading
tional radiography has resisted being pushed
1. Grigg ER. The trail of the invisible light: From X-Strahlen
aside because of its very high information con- to radiobiology. Springfield, Ill: Thomas, 1965.
tent: 4-6 megabytes per image. A CT image 2. Hendee WR. Medical radiation physics. Chicago: Year
contains about 0.5 megabytes. If a system is to Book Medical. 1979.
take over from conventional radiography, it 3. Haus AG. The physics of medical imaging: Recording
will have to overcome this large difference in system measurements and techniques. New York:
American Institute of Physics. 1979.
information content. Digital or computed radi- 4. Coulam CM. The physical basis of medical imaging.
ognaphy seems capable of this, but probably New York: Appleton-Century-Crofts, 1981.
not for some time (perhaps, 10 or 20 years). It 5. Tateno Y. lunuma T. Takano M. Computed radiography.
seems unlikely that there will be much change, Tokyo: Springer-Verlag, 1987.
6. Chamberlain WE. Fluoroscopes and fluoroscopy: Car-
except for refinement, in the image intensified
man Lecture. Radiology 1942; 38:383.
fluoroscopy equipment used for observing dy- 7. Morgan RH. A photoelectric timing mechanism for the
namic processes, and it will probably not be automatic control of roentgenographic exposure. Am J
replaced. Roentgenol Pad Ther 1942; 48:220.
Another situation which will preclude the 8. Fraser PG. Sanders C, Barnes GT. et al. Digital imaging
of the chest. Radiology 1989; 17 1:297-307.
rapid demise of conventional radiography is fi-
9. Kato H, Miyahara J, Takano M. Computed radiography
nancial inertia: There is between 5 and 10 bil- with scanning-laser-stimulated luminescence. Medical
lion dollars worth of diagnostic equipment in Physics Monograph no. 12. 237. New York: American In-
hospitals in this country and a significant stitute of Physics. 1984.

#{149} 1153

Radiography and Fluoroscopy, To The Present: Jack S. Krohmer

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Radiography and Fluoroscopy,

1920 to the Present

introduction Potter (1915), and marketed as Potter-Bucky

Radloraphlcs Index terms:

Volume 9, Number 6, Monograph November,

Campbell -Tube -Tilt -Table

Campbell Electric Co. TUBE TILTS WITH TABLE

Easily movable, with patient, to any position

examination has been made, including the radiographs

CAMPBELL ELECTRIC CO., LYNN, MASS.

Because of the relatively recent availabil-

Volume 9, Number 6, Monograph #{149}

Arranged for Radio graph’ Arranged for Fluoroscopy

The 1930’s a solid tungsten disk for the anode.

Volume 9, Number 6, Monograph November,

at the RSNA in 1941, covered many of the the-

Volume 9, Number 6, Monograph November,

The 1940’s, as is well known, were disrupt-

I I 36 RadioGraphics #{149}November, 1989 #{149}

ported in May, 1942 (FIgure 16). By August of To

U.S. PATENT Z.I*479

Volume 9, Number 6, Monograph November,

in 1942. Although it required about 40 minutes

Unique to the 1950’s was a large influx of

Volume 9, Number 6, Monograph November,

The advantages of a ceiling tube

Figure 21 . “wi1$ CDQU

I I 40 RadioGraphics November, 1989 Volume

Volume 9, Number 6, Monograph November,

The 1960’s it in 1947. The first investigations of its medical

Volume 9, Number 6, Monograph #{149}

Scintillator Photoemitter Output

Volume 9, Number 6, Monograph #{149}

Volume 9, Number #{243},

the halide is the bromide. This plate is exposed

Volume 9, Number 6, Monograph November,

Fluorohailde Receptor Laser Stimulated Phosphorescence

.. ‘4.- Copper FiNer

Ceramic Substrate 1High AtomNo. Phosphor

Volume 9, Number 6, Monograph #{149}November, 1989 e RadioGraphics I I 51

Summary amount more in private offices and clinics. It is

Volume 9, Number 6, Monograph November,

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