X-RAY CELEBRATES CENTENNIAL

In 1995, medical science will celebrate the centennial of the discovery of the X-ray, or Roentgen ray. On Nov. 8, 1895, Bavarian physicist Wilhelm Conrad Roentgen revolutionized diagnostic medicine by making it possible to photograph the inner organs and bone structures of human beings and animals. Roentgen found that when a current was passed through a cathode-ray ultra-vacuum tube, a nearby piece of paper that had been painted with barium platinocyamide appeared to fluoresce brightly. Roentgen proved that the effect was caused by an invisible ray, and he announced his discovery to the Wurzburg PhysicalMedical Society Dec. 28, 1895.

In 1901, the first Nobel Prize in physics was awarded to Roentgen for his X-ray discovery. According to Ernie Adams, director of radiology at St. Francis Medical Center, those working with X-rays deal with the technology that Roentgen discovered, but there have been vast improvements in the field.

"Originally X-rays showed only bony tissue," Adams explained. "Now we are able to get excellent detailed film, such as mammograms. We are able to get images of coronary arteries, in the form of angiograms, in which opaque material is injected into the body to illuminate the arteries."

Another advancement in the field came with the introduction of computerized axial tomography (CAT scan), which is a computerized regenerated image, giving a cross-sectional view of the anatomy. A conventional X-ray is one-dimensional. Tom Welch, radiology manager at Southeast Missouri Hospital, said the first CAT scanner came out in the 1970s. Godfrey Newbold Hounsfield developed the first prototype CAT scanner at EMI (Electric and Musical Industries), in Middlesex, England. In the beginning, the major X-ray companies did not buy into the idea. Finally, they did become the dominant force in the manufacture of CAT scanners.

Welch gives credit to the Apollo mission for developments in the field of X-ray. "In the 1960s, John Kennedy said that in ten years we would put a man on the moon," Welch explained. "We did, and the computers that we use today can be traced directly to research work done to put a man on the moon." The most recent breakthrough in X-ray technology involves high-speed telemedicine, an advanced technology that can instantly transmit X-rays and other patient information anywhere in the world. This eliminates the need to move critically ill patients from small rural hospitals, disaster sites or combat zones to major medical centers for diagnosis. Patients can instead be diagnosed by specialists who view images that have been transmitted via the technology.

To demonstrate the technology at the Radiological Society of North America, medical images taken of U.S. military personnel in Haiti were simultaneously transmitted via the information superhighway to physicians positioned in sites in Illinois, California and Maryland.

"We are getting ready to go into electronic imaging at St. Francis," Adams said. "Now we use it among departments, and to send to radiologists' homes for interpretation. Washington University is heavily into it. We are waiting for the system to be perfected and less expensive."

Welsh agreed that Southeast Hospital is waiting for the same reasons. He sees a bright future for local hospitals with the use of telemedicine. "In the future we can send images from St. Francis to Southeast Hospital without having to package X-rays and send a runner," he said. "We must be sure to buy equipment that is compatible. We need the proper communication lines constructed between the two hospitals and Doctors Park. To transmit images over normal telephone lines takes too long. This will be improved in the near future."

As the pace of the radiologic technologist's professional life hastens, it is important that technologists become educated in their field. According to the Missouri Society of Radiologic Technologists, the practice of radiologic technology is so unregulated in Missouri that anyone can be the "X-ray technician" with absolutely no training or education. The chance of a missed diagnosis due to poor quality X-rays is a greater risk to the patient than the possible misuse of radiation. The technologists society is working with members of the Missouri legislature to develop certification for radiologic technologists. They have included provisions to accommodate doctors and clinics in small towns and rural areas. The group has also focused on keeping the regulations involved from being a burden on those affected. Twenty-nine states already have licensure or certification laws in place. Several states surrounding Missouri require licenses. These include Illinois, Kentucky and Tennessee.

Adams and Welch concur that it is important that Missouri require licensing of radiologic technicians. To become licensed, one would be required to complete a three-year associate degree and pass a state examination. Continuing education would be required each year to maintain the license. In Cape Girardeau, most physicians have registered, qualified personnel who take X-rays. Whenever a radiologist is involved, his personnel are properly trained. The diagnosis made by the radiologist can be correct only if the X-rays are properly made. Hospitals have qualified radiologieal technicians because the Joint Commission on Accreditation of Hospitals sets standards for radiology departments. An educated technologist can get the proper X-ray in the fewest possible exposures, thereby decreasing the need for the patient's exposure to radiation.

When Roentgen discovered X-rays, at first he did not understand what they were. He called the rays "X-rays' because X is a symbol for the unknown. The physicist would surely be amazed if he could see the advances in medicine his discovery has caused 100 years later.