Book Review

Origins and Development of Medical Imaging

N Engl J Med 1997; 337:1781December 11, 1997

Article

Origins and Development of Medical Imaging
By T. Doby and G. Alker. 170 pp. Carbondale, Ill., Southern Illinois University Press, 1997. $29.95. ISBN: 0-8093-2010-X

Our fascination with the complex workings of the brain has only recently been superseded by our morbid obsession to reduce health care expenditures. With one fell swoop, the introduction of computed tomography addressed both these issues and revolutionized outpatient medical care. The history of radiology is perhaps more labyrinthine than its empirical usefulness in patient care suggests.

With the discovery of the roentgen ray (also called x-ray, after the letter accepted in mathematics as representing the unknown), we were finally able to learn more about ourselves by looking within. Of course, this important advance was not made without detractions. Besides severe irradiation-induced effects stemming from an almost infantile disregard for safety, there were also issues concerning violation of privacy and perceived threats to the traditional sanctity accorded to the human soul. We have come a long way since then, to a point where the obstetrical sonogram and abnormal mammogram of the popular television character Murphy Brown are shared with millions of viewers.

Origins and Development of Medical Imaging falls short of exploring the magic and ritual of radiology. It dwells far too long on the history of medicine and anatomy before finally arriving at its subject. (Mr. Roentgen himself is not mentioned until nearly half the text has floated past.) The authors choose instead to tackle medical imaging in terms of the expansive fabric of generic human anatomy. A chance to display resplendent imagery, the only true virtue of this visual discipline, is effectively waylaid by the inclusion of a set of 54 unannotated black-and-white plates near the start of the book. Although obvious to a practicing radiologist, much of the pathology is merely indicated but not explained, leaving the images enigmatic.

The cardinal role of Leonardo da Vinci, easily the greatest contributor to the study of human anatomy, is rightfully highlighted, though other interesting tidbits are scant: luckily, descriptions of Forssmann's scandalous catheterization of his own heart and da Vinci's classic wax ventriculogram made the final cut. Many of the more controversial and disturbing but classically seminal landmark events in radiology have been omitted; they would have been preferable to the lengthy introduction, which examines the evolution of mathematics, pharmacology, and medicine.

The prose is lucid but staid and laced with pithy remarks that make my spine shudder, such as “chance, great ally of science, helped out occasionally,” “science as well as art thrives on a basic ingredient: surprise,” and “predictions seem to give less credit to future progress than it deserves.” The book functions as a rough tabulator of the leaps achieved in diagnostic imaging rather than as a guide to an adventure infused by the spirit and thirst for more insight into ourselves.

A far more enjoyable book, peppered with anecdotes and scaffolded on the clever device of descriptions of attempted assassinations of three American presidents — events that were dramatically altered by radiologic technology — is Naked to the Bone: Medical Imaging in the 20th Century (by B.H. Kevles. New Brunswick, N.J.: Rutgers University Press, 1997). It clearly illustrates the impact of radiology on our everyday lives; its effect on society, law, and the arts; and its necessity-based metamorphosis, sometimes too rapid to keep regulated. Its images are breathtaking, with the exception of an inverted magnetic resonance image of the cervical spine, which upset me endlessly. Although Naked to the Bone is slavishly devoted to descriptions of the art and skill of radiology, its companion video is not nearly as engaging and is quite simply wasteful of the viewer's time: more than half the speakers are nonradiologists, and too much of the thrill is lost in translation. It represents another case in which the book is better than the film.

Origins and Development of Medical Imagery ends with thoughts that we readers all too often have: “Of course we need machinery. But our personal contribution is indispensable. . . . The traditionally important factors in caring for patients are not yet manageable by computer: understanding their habitats, their pains, their fears, their hopes, their expectations, and their full personalities.” The book would similarly have been better served by celebrating to a greater degree the ingenious minds behind the evolution of radiology rather than the innovations themselves.

Sundeep M. Nayak, M.D.
University of Chicago, Chicago, IL 60637