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A dedicated lecture for the 100 years anniversary of the Royal Belgian Radiological Society and the 25 years anniversary of the Belgian section of Paediatric Radiology. E. Pouders, R. Van Tiggelen Belgian museum of Radiology Introduction The Royal Belgian Society of Radiology is achieving its tenth decade of existence. There the actual president, Rausin Léon of Liège, is a paediatric radiologist ,we felt that this event merited reflection- a look back into the past- so as to better appreciate where the paediatric radiology come from. "Victory has many fathers but defeat is an orphan!!" In the early years of radiology, as in many other specialties, the colleagues read the literature exclusively in their own language or from their own country. That reason makes it hard sometimes to define with certainty to whom an innovation or a particular research should be attributed. And this observation applies to radiology as well. Yet a few weeks after its discovery, the technology was in use all over the world. So, already in the beginning of the year 1896, children were radiographed either for traumas, or to follow up on the ossification of the skeleton, either to find pathologies or malformations of the bone. The harmful side effects are already known in 1896. Thus E.A.N. Grigg reports that the Belgo-American electroradiologist, J. Daniel at the Vanderbilt University described yet in April 1896, the case of hair loss and burns on a child’s head being radiographed one hour long ! However several years still will pass before substantial improvements appear in the field of radioprotection, as in adult radiology as in paediatric radiology as well. This pioneering effort had also an unexpected high price. Many radiologists sustained such severe radiation damage from repeatedly placing his unprotected hands and face in the x-ray beam that the ultimately underwent operations for radiodermatitis and radiation-induced cancer. In 1899 in the USA, the first department of paediatric radiology of the Children’s Hospital of Boston sees the daylight, under direction of P. Brown 1875-1950. But owing the truth the right of way it looks like the first department of paediatric radiology be European ! It should be the German physician and bacteriologist, Th. Escherich (1875-1911) who founded it in 1897, in Graz in Austria. His name stays familiar forever since he proved the existence of a bacillus carrying his name : Escherichia Coli. The major problem was the length of the exposure. To circumvent the motion inevitably present, during the earliest radiographs and because the early tubes emitted rays of insufficient kilovoltage and milliamperage to penetrate ,immobilization must being frequently achieved by administering a general anesthesic, usually ether by mask! How to immobilise the little patients in a more simple and better way? Many systems have been worked out since 1900 and still are in use to date. Based on the techniques applied on adults, our predecessors try, mostly with success, to apply them on children. When we watch the illustrations of radiopaediatric examinations performed by our elders, one realizes better which hurdles they had to overcome. They truly were pioneers who deserve all our admiration and respect. Progress in paediatric radiology slowly continued, focused more on techniques and equipment than on the medical components of the radiology of children. The practice of paediatric radiology was changing. More powerful x-ray tubes made shorter exposures possible; this greatly improved radiology of the chest and abdomen, especially in children, and, for the first time, radiologic examination of newborns was feasible. Intramuscular urography – injection of contrast material into the buttocks or thighs of infants in whom venipuncture was difficult – was used less and less. "Special procedures" such as Lipiodol myelography slowly became more common. Angiocardiography was possible in children for the first time. Cerebralangiography also began to be performed. Plain radiography continued to dominate the practice of paediatric radiology, however automatic film processing was widely used only toward the end of this period. Gravity and horizontal-beam images began to be used more effectively in air studies of the head. The pneumoencephalographic wheel was invented and adapted for use in children. Starting in 1974, CT suddenly made pneumoencephalography and ventriculography almost completely obsolete, and paediatric neuroradiologic studies abruptly became less invasive. The cross-sectional approaches (US, CT, and then MR) imaging became avalaible; these years saw an increasing technical quality of radiological images, although the diagnostic quality of plain radiographs was already greatly improved. Rare earth . screen-film combinations lowered radiographic exposures even further. Radiology was only in the very early stages of being established as a speciality, and the radiologic subspecialities lay far in the future. It was left to T. M. Rotch, (1849-1914), professor of paediatrics at Harvard Medical School, Boston, to compile and publish the first book in any language dealing with the radiology of children. Other authors distinguish themselves also by composing treatises which became great classics. Let us not forget to mention the work by S. Engel and L. Schall published in Leipzig in 1933. During the first 50 years of paediatric radiology, progress had been slow and halting. With the 1945 appearance of Caffey's (1895-1978) revolutionary text, this began to change. Next we need to quote the work of W. Greulich and S.I.Pyle , allowing to determine the bone age, and also the book that studies the bone diseases by P. Maroteaux (1926- ). The work by J.Lefebvre (1907-1974) holds a classic treatise in French, and finally the works by H. Taybi (1919- ) and R. Lachman treating metabolic and dysplasic symptoms and complications. In the late 1950s, the need for an organization to promote the science and art of paediatric radiology became apparent for Ed. Neuhauser (1908-1987) F. Silverman (1914-2006) and J. Caffey. Accordingly, in September 1958, the day before the annual meeting of the American Roentgen Ray Society, the first meeting of the Society for Paediatric Radiology was held. Ed.Neuhauser(1908-1987) was elected president. Under the impulse of J. Lefebvre with the collaboration namely of J. Sauvegrain and C. Fauré in 1963, this organisation was succeeded by the European Association of Radiopaediatrics. Belgium will provide two chairpersons, Mrs N. Cremer in 1977-78 and Mr F. Avni in 1993-94. The latter fills since then the position of Secretary General. In 1971 at last, the section Radiopaediatrics appears within the Belgian Society of Radiology. Conclusion "History can be told in words but better shown in images". This last motto we withhold to present the talk in Liège on November 18th 2006 ! |