cineradiography by prash248


									1973, British Journal of Radiology, 46, 885-888                                                         OCTOBER     1973

By G. M. Ardran, M.D., F.R.C.P., F.F.R.
Nuffield Institute for Medical Research, University of Oxford

                         ABSTRACT                               was covered with a piece of black paper, upon which
   The history of cineradiography from the discovery of         the limb of an animal, say a frog, could be photo-
X rays in 1895 until 1972 is briefly reviewed. Maclntyre
reported in 1897 on his method of attempting cineradio-         graphed. As yet, the movement must be slow and
graphy both by photography of the fluorescent screen and        consequently carried out by an artificial or slow
by the direct method whereby the X-ray image was recorded
directly onto film. The methods were not of great value         anaesthesia. In the present stage of our knowledge
until the speed of films, fluorescent screens and optical       the former gives the more satisfactory result. Some
systems had improved together with increased outputs from       months ago Dr. Maclntyre showed, by means of the
X-ray tubes and improvements in focal spot size were
attained.                                                       mercury interrupter, that he could obtain instan-
   The contribution of early French workers and other           taneous photographs of the bones of his finger by a
British workers is discussed. Cineradiography was really        single flash of the tube, due to one vibration of the
shown to be of value following the work of Janker in Ger-
many in the 1930s.                                              contact breaker. At a meeting of the Glasgow
   The developments and applications made by Barclay in         Philosophical Society recently, he was able to pass
Oxford and subsequent work at the Nuffield Institute for        films forty feet in length through the cinematograph:
Medical Research is briefly described. The advent of
electron optical image intensifiers in 1953 made the method     the movements of the leg of a frog could clearly be
practical and fairly universal. The intensifiers enabled an     seen when demonstrated on a magic lantern screen
improvement in the quality of work and considerable re-         by means of the cinematograph." Five pictures of a
duction in patient X-ray exposure. The introduction of
stereoscopic cineradiography and cineradiography with           frog's knee illustrated part of the action of flexion of
sound recordings is reported together with the advent of        this joint.
high-speed cine up to 400 frames per second. The study of
the mechanism of swallowing, the investigation of the               It is clear that Maclntyre appreciated the two
urinary tract, speech difficulties, and angiocardiography are   basic methods of recording movements using X
some of the principle uses today. The introduction of time
lapse cinefluorography for examination of the large bowel       rays and paved the way for the future development
at one frame per minute for up to two hours is reported. The    of rapid serial radiography and cineradiography. The
competition from recordings on video tape are discussed         two methods were firstly the indirect, which photo-
                                                                graphs the fluorescent image or secondly the direct,
Cinematography and radiography were both born                   whereby the X-ray image was recorded directly
at approximately the same time. The Lumiere                     on to the film or via intensifying screens in contact
cinematograph was given a press showing at the                  with the film.
Empire Theatre in London on February 7, 1896.                       Following the pioneer work of Maclntyre, he and
Paul, a London instrument maker, demonstrated his               other workers pursued both methods. Because of the
"Theatregraph" on February 28, 1896 at the Royal                slow speed of the systems much of the early work
Institution. The first "Vitascop" developed by                  really consisted of rapid serial radiography either
Edison arrived in London on April 30, 1896. X rays              with full-sized films or by photofluorography. Copies
were discovered in 1895 and it is remarkable that               of the full-sized serial films might be made on to
Maclntyre of Glasgow is reported in Volume I of the             cine film so that they could be projected in motion.
Archives of Skiagraphy in April 1897 in the follow-             From these early beginnings until the present day all
ing way:—                                                       manner of full-sized rapid serial equipment has been
   "Doctor Maclntyre has for some time been ex-                 produced, improvements being made and superior
perimenting on the best method of obtaining rapid               results obtained as X-ray tube outputs were in-
exposures with a view to recording the movements                creased and finer focal spots became available and as
of organs within the body. Two methods have been                the speed of films and intensifying screens were
adopted, one in which the shadow of the object, as              increased. Except for certain experimental purposes
seen upon the potassium platino-cyanide fluorescent             these were not usually transferred to cine film for
screen, was photographed by means of the ordinary               projection since in most instances this produced a
camera. This, however, was found to be too slow                 jerky movement, the films having been exposed at
for the purpose. The other method was to allow the               rates of about 2-12 per second (Ardran, McLaren
sensitive film to pass underneath the aperture in a              and Sutcliffe, 1950). A tremendous amount of work
case of thick lead covering the cinematograph. This             was done on this type of serial equipment in the early
opening corresponded to the size of the picture, and             years of this century in many counties though
 VOL.   46, No. 550
                                                   G. M. Ardran
   clinically useful equipment only really became              largely due to his use of 35 mm film instead of 16
   available in the 1950s. Rapid serial equipment will          mm. Since one needed the fastest film emulsion
  not be further considered and the following will             obtainable this was inevitably very grainy. This
  refer to the production of X-ray films designed to be        meant that for otherwise similar speed systems the
  projected as cine films to demonstrate movement.             grain on the 16 mm film was four or five times as
      Maclntyre continued with his work and is re-             large, relative to the image, as with 35 mm film, and
  ported to have shown cinematograph films in 1914             this caused considerable deterioration of image
  taken by both methods. He is stated to have said             quality. One of the reasons for the relatively poor
  that when photographing the screen image the best            quality of the Russell Reynolds equipment was the
  results were obtained with a barium platino cyanide          adherence to 16 mm film and his results were not as
  screen which had been moistened (MacLean, 1927).             good as Jankers. He appreciated this point and
     Jarre (1933) in his excellent review of this subject      about 1950, again with Messrs. Watsons produced
  states that: "It seems certain that Bleyer (1896),           a 35 mm cineradiographic equipment though this
  Battelli and Garbasso (1896) and McKay (1896)                almost immediately became obsolete with the pro-
 contemporaries of Maclntyre's, had rontgen cine-             duction of image intensifiers in 1953. Although
 matography in mind, when they devised means to               Russell Reynolds made many films, which he dem-
 photograph the fluoroscopic image". For some years           onstrated, I can find no evidence that he published
 most of the more useful clinical or physiological            any results scientifically or clinically valuable which
 study of movements was carried out by the rapid              he discovered by his method (Reynolds, 1935).
 serial method employing full-sized films, cineradio-            Barclay, when he came to the Nuffield Institute
 graphy not yet being good enough to be really                for Medical Research, University of Oxford, in 1936,
 valuable.                                                    inherited a Russell Reynolds Watson 16 mm equip-
     Lomon and Comandon (1911 and 1924) in France             ment but found it too low powered for serious work
 developed a "Radio cinematographic" and had, at              in man and modified it for some animal experimen-
 their disposal, lenses of/I-55 aperture and in 1911          tal studies (Barclay, Franklin and Prichard, 1940).
 were able to demonstrate movements of the heart,             He, with Seddon (1947), produced a useful film on
 thorax, intestines and some joints. It is not possible       the movements of joints in man which was used for
 to say whether their results were superior to those of       teaching purposes for many years. At the time of
 Maclntyre at this time.                                      Barclay's death in 1949 this equipment had been
    Russell Reynolds had commenced his experi-                retired as being of little practical use.
 ments in 1921 and reported these in 1927. He des-               Shortly afterwards the Nuffield Institute found a
 cribed his technique and equipment and succeeded             need for some cineradiographic equipment and an
in taking films of some joints and the chest with            inexpensive 35 mm equipment was developed (Ard-
exposure rates of up to 16 frames per second. The            ran and Tuckey, 1952) based on the use of an old
results were regarded as promising but it was                 35 mm cinematograph projector used as a camera.
appreciated by all that until the speed of the system        This produced films at 25 frames per second which
could be improved serious work was not possible.             were comparable with those produced by Janker
Russell Reynolds was a great champion of this                and when, in 1952, the equipment was fitted with a
technique in Great Britain and by the middle 1930s           specially designed Wray/0-75 lens, produced films
in conjunction with Messrs. Watsons, produced a              equal in quality to those produced anywhere else.
complete 16 mm cineradiographic equipment. This              Valuable results were obtained with this equipment.
had relatively limited use since the speed of the            A camera was designed and made for the Nuffield
system was still low (Reynolds, 1934).                       Institute by Messrs. Vinten incorporating the Wray
    F. Melville (1927) also produced films of joints        /0-75 lens modifying their HS300 frames per sec-
and the chest at 16 frames per second. He was very           ond camera to operate at 100 frames per second with
conscious of the radiation exposures used.                   a 90° shutter as was the case with the cinematograph
    In 1931 Janker in Germany started to report his          projector. The quality of films at 25 frames per
work in this field. He succeeded in obtaining 100            second with a 15x12 fluorescent screen was similar
images per second by the indirect method working             to those with the simpler equipment. Both these
with small laboratory animals such as cats and at            equipments in 1952 employed pulsed X-rays using
slower rates with human material. In subsequent             the first General Radiological constant potential
years he also obtained simultaneous sound record-            electronic generator. This was satisfactory at up to
ings and developed stereo cineradiography. Apart             75 frames per second: when used at 100 frames per
from other improvements Janker's success was                second, for animal experimental work, continuous
                                                                                                  OCTOBER 1973
 radiation was employed (Ardran, 1960a; 1960b).            motors to drive the camera so that the framing speed
   The situation was completely changed in 1953            could be synchronized to the mains impulses; for
when the first electron optical image intensifiers         speeds less than 25 frames per second with 50 cycle
became available and these, in conjunction with 35         mains, speeds could be chosen to record the image
mm and tandem optics, so improved the quality and          produced by the same number of mains impulses for
reduced the radiation exposures that cineradio-            each frame. Following this, many manufacturers
graphy finally became a relatively simple and more         produced cine pulse units to give individual identical
or less routine procedure. It rapidly became appa-         pulses per frame giving short exposures and no
rent that quantum mottle was a problem with image          radiation when the shutter was closed.
intensifier cineradiography as well as with conven-           In 1956 Ardran and Wyatt described a portable
tional radiography (Ardran and Crooks, 1954).              image intensifier cineradiographic camera: this
The tandem optics and the high speed films avail-          used a synchronous motor and a gear box so that
able at this time meant that there was no need for         films could be exposed at 25 or 50 frames per
faster optical systems, faster film or camera shutters     second with continuous or pulsed radiation or at
with an aperture greater than 180 deg.: for the best       one, two or four frames per second with pulsed
work when radiation exposure was not a critical            radiation if the X-ray generator could give individual
problem the optics needed to be stopped down. Some         exposures at this rate. The camera could be used
workers reduced the speed of the system and thereby        with self rectified portable equipment at 50 frames
obtained better results by using lower aperture            per second, each impulse exposing a single frame.
single lens optics. Others used fine grain film: they      At 25 frames per second, two impulses exposed each
did not always appreciate that their superior results      frame. The Field Emission Corporation's "Fexi-
were not due to the fineness of the film grain but         tron" cold cathode generators are pulsed at 1,000
merely to the slower speed of the film reducing            cycles per second and it is thus possible if the output
quantum mottle (Astley, 1955).                             is sufficient to pulse cine films at up to this rate,
   The original 5 in. diameter intensifiers were           though the maximum brightness build up time of
improved to give larger fields, e.g. 9 in. or 10 in. and   2 ms of most intensifiers would result in inefficiency.
the 12 in. Cinelix. These extended the use when a             Advances have been made in the use of cine-
large field was necessary but otherwise did not            radiography since it became possible to record
necessarily improve the quality. Some workers              simultaneously ECGs, pressures, flow, sound or
photographed the television monitor image: this            other physiological parameters. This might be done
could result in films taken with a lower radiation         by recording each cine frame on the physiological
exposure but because of the image of the television        recorder but has also been done by recording the
raster were not so good for detailed work as films         data simultaneously on the unexposed portion of
taken directly from the output phosphor. Stereo-           each cine frame.
scopic cineradiography and cineradiography with               Cine techniques have also been improved partic-
sound recordings were again adapted to the new             ularly for experimental work by the use of direct
method. Some workers, usually using 16 mm equip-           enlargement with fine focal spots. Two or three
ment, increased the framing speed up to 400 frames         times enlargement may be obtained with the 0*3 mm
per second; for most work in man this did not prove        focal spot and up to perhaps 20 times, using a focal
to be of great value.                                      spot of about 10/Lt such as can be obtained from the
   At first image intensifier cinefluorography was         Harwell El 2 micro focus generator. Of course the
carried out with a continuous radiation exposure,          output from these fine focal spots is relatively low
the camera shutter closing for about half the framing      and this may limit the size of the object radio-
cycle and covering the film while it was moved. This       graphed and may result in a return to continuous
meant that the radiation exposure was 30-50 per            rather than pulsed exposures.
cent more than was necessary. When the equipment              The basic technical problem of a slow speed
was used with fully rectified four-valve equipment         system with high radiation dose was solved by the
or with half-wave rectified equipment, the film            introduction of the image intensifier, and from then
showed variable exposures due to the framing speed         technical advance became of much less importance.
not being synchronous with the mains impulses.             The important problem now was to decide for what
Attempts were made to overcome this by the use             purpose cineradiography might be usefully em-
of very large condensers in the high tension circuit       ployed. Sooner or later every moving part of the
to give more constant potential current. This prob-        body was investigated and slowly it was used to
lem was better overcome by the use of synchronous          elucidate various physiological and clinical problems.
 VOL.   46, No. 550
                                               G. M. Ardran
  Sometimes when a problem had been elucidated           fluorography, as we now know it, will be com-
  there was no longer any further need for the method.   pletely obsolete.
  The principle clinical problems for which the                            REFERENCES
  method is used are angiocardiography, the mechan-      ARDRAN, G. M., MCLAREN, J. W., and SUTCLIFFE, J., 1950.
                                                           Radiographic studies of duodenum and jejunum in man.
 ism of swallowing, some speech defects and the            Journal of the Faculty of Radiologists, 2, 148-164.
 urinary outflow tract. Angiocardiography is usually     ARDRAN, G. M., and TUCKEY, M. S., 1952. The conversion
 carried out at between 25 and 100 frames per              of standard 35mm cine projectors into cine radiographic
                                                           cameras. British Journal of Radiology, 25, 33-34.
 second: for the mechanism of swallowing 25 frames       ARDRAN, G. M., and CROOKS, H. E., 1954. Some observa-
 per second is sufficient: the oesophagus can usually      tions on the graininess of radiographs. A.E.R.E. Report,
                                                           March 1954.
 be examined at four frames per second and the stomach   ARDRAN, G. M., and WYATT, D. G., 1956. A portable
 may only require one of two frames per second.            X-ray cinecamera. British Journal of Radiology, 30, 52-54.
 The urinary outflow tract seldom needs more than        ARDRAN, G. M., 1960a. Cineradiography. Research Film 3,
 four frames per second. These slower speeds may be           1960b. Cineradiography. Radiography, 26, 303-308.
 regarded as rapid serial radiography but the results    ASTLEY, R., 1955. Cineradiography with an image amplifier:
 are recorded on cine film and can be projected at         a practical technique. British Journal of Radiology, 28,
cine speeds or examined frame by frame. Most             BARCLAY, A. E., 1935. Direct X-ray cinematography with a
cineradiographic films are examined at the speed           preliminary note on the nature of the non-propulsive
at which they were taken, sometimes faster and             movements of the large intestine. British Journal of
                                                           Radiology, 8, 652-658.
sometimes slower, according to the nature of the         BARCLAY, A. E., FRANKLIN, K. J., and PRICHARD, M. M. L.,
problem, but full value is seldom obtained unless          1940. X-ray cinematography in research. British Journal
the relative portions are examined frame by frame.         of Radiology, 13, 227-234.
                                                         BARCLAY, A. E., and SEDDON, H. J., 1947. Cineradiography
 16 mm film is cheaper and more convenient but it          ofJoints (Blackwell Scientific Publications, Oxford).
has not produced results as good as may be obtained      BATTELLI, A., and GARBASSO, A., 1896. Sopra i raggi del
                                                           Roentgen. // Nuovo Cimento, 42, 40.
with 35 mm because the finer grain film required to      BLEYER, J. M., 1896. On the Bleyer photo-fluoroscope.
produce the same sized projected image is too slow.        Electrical Engineer, New York, 22,10.
                                                         JANKER, R., 1931. Zur Roentgenkinematographie. Fort-
    More recently, to examine the large bowel, a 12 in     schritte aufdeur Gebiete der Roentgen-Strahlen, 44, 658.
"Cinelix" equipment has been used, the film being        JARRE, H. A., 1933. Chapter 11 in The Science of Radiology,
exposed at one frame per minute for an hour or more.       Eds. Otto Glasser, pp.198-209. (Charles C. Thomas,
                                                           Springfield, Illinois).
This introduction of time lapse cinefluorography         LOMON, A., and COMANDON, J., 1911. La radiocinemato-
(Ritchie, Truelove and Ardran, 1968) has made it           graphie par la photographie des ecrans renforcateurs.
possible to study usefully the large bowel when other      Bulletins et Memoires de la Societe Medicale des Hopitaux
                                                           de Paris, 3,127.
methods over the years have failed (Barclay, 1935).      LOMON, A., and COMANDON, J., 1924. Radiographie cine-
    For some years now the advent of closed-circuit        matographique du cceur de l'homrae. Bulletin de
                                                           V Academie de Medecine (Paris), 91, 711.
television has enabled one to record the image on        MACINTYRE, J., 1897. X-ray records for the cinematograph.
video tape. This may be done with less radiation           Archives of Skiagraphy, 1.37
exposure than is required for cinefluorography. It       MACKAY, J. S., 1896. The new art of radiography. Elec-
                                                           trician, 36, 668.
suffers from the disadvantage that the quality of the    MACLEAN, A. B., 1927. Correspondence in British Journal
image is not as good as may be obtained with cine-         of Radiology, 23, 216.
radiography from the output phosphor of the inten-       MELVILLE, F., 1927. X-ray cinematography. British Journal
                                                           of Radiology, 23, 217-220.
sifier and it has proved difficult to view the image,    REYNOLDS, R. J., 1927. Some experiments on the produc-
frame by frame, or to readily select a particular          tion of rapid serial skiagrams from the screen image by
frame. If a single television scan is viewed for any       means of a cinematograph camera. British Journal of
                                                           Radiology. 22, 33-44.
length of time with the tape stationary, this rapidly         1934. Cineradiography. British Journal of Radiology, 7,
results in wear of the tape. However, improvement          415-424.
                                                              1935. Cineradiography. British Journal of Radiology, 8,
in electronic as distinct from photographic recording      135.
are to be expected.                                      RITCHIE, J. A., TRUELOVE, S. C , and ARDRAN, G. M., 1968.
                                                           Propulsion and retropulsion in the human colon demon-
    It is quite possible that in 75 years' time cine-      strated by time-lapse cinefluorography. Gut, 9, 735-736.

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