48TH YEAR, NO. 3, MAY-JUNE 1995 lOO years of radiological science X-rays 1895-1995 Radioactivity 1896-1996 ~ l ~ ~~tt~~- rf~ RLD W -~ THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION HEALTH Our cover illustrates the advances mode in TI-E MAGAZINEOf TI-E W01U0 t·EAHH0113ANIZATON radiological imoging over the last century. In this issue At the top, a radiograph taken by Rontgen in Editorial I 896 of the hand of his colleague, Professor Radiation medicine for all 3 von Kolliker. Centre, a computerized lOO years of tomography (CT) image of the abdomen -a Mou rice Tubiono &Gerold P. Honson radiological science technique firs t used on patients in 197 1. Radiology: a century of progress 4 Bottom, modern nuclear imoging using Pos itron Otho W. Linton &Jose ph Moro sea Emission To mograph y (PET) records the cerebral meta bolic rote of glucose in a patient with The discovery of radioactivity Alzheimer's disease. Mourice Tubiono WHO and radiation medicine 6 Gerold P. Hon son &Vlodimir Volodin Medical imaging in modern medicine 8 X· rays ~~~- 1w s Lenny K.A. Ton Radioactivily 1-"'6-1996 Profiles: Radiologists - the doctor's doctor 10 poge7 page 16 Radiographers today 10 The medical physicist 11 The basics of diagnostic imaging 12 \ .. Philip E. S. Polmer &Thure Holm Mammography: a woman's perspective 14 ~\ ~ Cori Borras ! High tech at low cost 15 Peter E. Peters &Hor st Lenzen Ultrasound imaging in developing countries 16 Hossen A. Ghorbi & M.W. Woch iro Nuclear medicine 18 Yosuhito Sosoki & Kiyoko Kusokobe Radiotheraphy: still young after almost a hundred years 20 Jeon{ loude Horiot &S uzon ne Noudy Quality assurance in radiotherapy 22 Hons Svensson &Bj orn Zockrisson Protection against radiation in medicine 24 Cesor F. Arias & Jorge J. Skvorco Radiology in the next hundred years 26 Alexander R. Morgulis The ethics of new technology 28 Sneh Bhorgovo Multidisciplinary research for health 30 Boutros G. Mo nsourion &Bruce MeA. Soyers World Health • 48th Year, No. 3, World Health is the official illustrated mogozine of the World Heolth Articles ond photographs thot ore not copyright moy be reproduced provided Moy-J une 1995 Orgonizonon. lt oppeors six nmes o yeor in English, french , Russian ond credit is given to the Wo rld Heolth Orgonizonon. Signed articles do not Spanish, ond four nmes oyeor in Arabic ond forsi . The Arabic edinon is necessorily reflect WHO's views. The designations employed ond the IXISSN 0043·8502 ovoiloble from WHO's Regional Office for the Eastern Med iterranea n, P0 Box presentonon of moteriol published in World Health do not imply the expression Correspondence shou ld be addressed to the Editor, World Heolth Mogozine, 1517, Alexondrio 21511, Egypt. The forsi edinon is obtoinoble from the of ony opinion whatsoever on the port of the Orgonizotion concerning the World Heolth Orgonizonon, CH-121 1 Genevo 27, Switzerland, or di recMy to Pub lic Heolth Committee, Iron University Press, 85 Pork Avenue, Teheran legol stotus of ony country, territory, city or oreo or of its outhorines, or authors, whose add resses ore given ot the end of eoch article. 15875·4748, Iron. The Russian edinon con be obtained from "Meditsino" concerning the delimitation of its frontiers or boundaries. for subsuipnons see order form on poge 31. Publishing House, Pettoverigski pe r. , 6/ 8, 101 000 Moscow, Russian federonon . World Health • 48th Yeor, No. 3, Moy-June 1995 3 Editorial Radiation medicine for all Maurice Tubiana &Gerald P. Hanson t the end of the 19th century WHO's policies and strategy. played a leading role in promoting all expectations for medical The issue of equity was clearly the rational use of radiodiagnostic Ainnovations were turned focused by radiologist Richard H. procedures, and has published rec­ towards microbiology and bio­ Chamberlain, in his seminal article ommendations on quality assurance, chemistry which were then in their "Basic radiology: a worldwide chal­ on radiation protection, and on the infancy, and no one could foresee lenge", published in 1970, which clinical indications for diagnostic new advances from physics. Yet, in pointed out that two-thirds of the imaging. The key elements for less than a decade after the discovery world's population had no access to improving equity and quality are of X-rays by Rontgen, radiology even the simplest X-ray procedures. having sufficient resources and mak­ added a new dimension to clinical When WHO adopted its strategy of ing rational and effective choices for examinations by making it possible Health for All, a remedy for this in­ their use, coupled with relevant to study hidden anatomical lesions in equity- the Basic Radiological education and training. live patients. System (BRS), now updated by the Medical imaging has achieved a Three dates stand out: in 1895, WHO Imaging System-Radiography technical level that was inconceiv­ Rontgen discovered X-rays while (WHIS-RAD)- was already being able 20 years ago, and this is only experimenting with cathode rays developed. Equity is also of the beginning. The future for radiol­ (the same week that the Lumiere paramount importance in radiation ogy is bright, with the promise of brothers introduced cinematography therapy; although over half of all computer-assistance for obtaining, in France). The reign of the image cancer patients live in the develop­ storing and transmitting images and had begun. The following year, ing world, the majority of the for the planning of radiation therapy. Becquerel in Paris di scovered developing countries do not have Telematics opens a new door to radioactivity and, in 1897, J.J. radiation therapy services. teleprocessing of images and Thomson di scovered the electron. Efforts to improve equity must telemedicine. Tomorrow any physi­ Within a decade, Rutherford, Planck not result in useless or even harmful cian, in any part of the world, will be and Einstein laid the foundations of medical procedures. WHO has able to seek on-line advice from the modern physics and its greatest specialists for applications. In retro­ the interpretation of a Science has no motherland, since human knowledge embraces the spect, one is filled with difficult image. Great "whole world.'' Louis Pasteur admiration for the cre­ hopes are now focused ative genius of these sci­ on molecular biology, entists and the rapidity biotechnology, computer with which these discov­ science and physics, and eries were made and their the world eagerly awaits applications were spread the fruits of multidisci­ throughout the world. plinary research. This issue of World By the year 2000, the Health provides an world's population is overview of today's expected to pass the technology in radiation 6000 million mark, and medicine, covering vari­ both WHO and its many ous aspects of diagnostic collaborators fervently imaging, radiation ther­ hope that vast segments apy and radiation pro­ of the population will tection. Fundamental have access to the most concepts of equity, qual­ Professor Mourice Tubiana, President, Or G. P. Hanson, Senior Scientist and essential elements of Centre Antoine Bee/ere, Paris , and Chief of Radiation Medicine, World ity and ethics are also former President of the International Health Organization. radiation medicine. • explored, as well as Society of Radiology. 4 World Health • 48th Year, No . 3, May- June 1995 Radiology: a century of progress Otha W. Linton & Joseph Marasco ithin weeks of the German physicist, Wilhelm Conrad WRontgen, discovering the X-ray and maiUng an image of the bones of his wife's hand, in 1895, such as pneumonias, skeletal malfor­ used intensive artificial magneti c doctors all over adopted the new mations and some problems of the fields to generate radio signals discovery as a giant step forward in nervous system. from patients' bodies. Again, com­ medical care. For the first time, a Refinements in equipment, puters analysed the information to doctor could see what was happening opaque contrast materials, higher create a sophisticated image. inside a patient. The location and energy X-ray therapy sources, The centennial of Rontgen's 1895 extent of a bone fracture, a stone in radium applicators for cancer and di scovery ofX-rays finds radiologi­ the IUdney or the presence of metal, improved clinical techniques made cal techniques firmly established as as shown on an X-ray film , helped to steady progress up to and after the an essential part of medical diagnosis guide the surgeon's knife. In a mat­ Second World War. and treatment. Today, physicians ter of months, other doctors were X-ray studies improved with the who specialize in radiological applying X-rays in efforts to cure a advent of photo-timing for sharper procedures are supported in their wide range of diseases including images and electronic image intensi­ clinical work by radiobiologists and some cancers, arthritis, lupus and a fication of fluoroscopic motion physicists, dosimetrists, engineers, variety of siU n conditions which studies. Special examinations such and computer scientists. • showed improvement after exposure as mammography for the detection to X-rays. During the same early of breast cancers gained rapid years, workers in this field realized acceptance. Mr Otha W Linton is Associate Executive Director of the American College of that their own repeated exposures In the earl y 1960s, ultrasound Radiology and Executive Director of caused inflammations and even devices modified from wartime sonar Radiology Centennial/ne., 1891 Preston White Drive, Res/on, VA 22091-4397, cancers in their bodies. and radar uses began to supplement USA Or joseph Marasco is Chief of Gradually, scientists and inven­ X-rays and isotopes for the study of Medical StaH of the Forbes Regional tors like Thomas A.Edison improved organ function. Since they did not Health Centre, 2570 Haymaker Rood, Monroeville, PA 15146, USA X-ray equipment, making it more in volve ionizing radiation they were powerful, more accurate and safer to particularly attractive for studies use.