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A Brief History

 

The Department of Radiology has been characterized by enterprise, stability, and achievements.

Achievement came early, although unrecognized at the time. In 1890, five years before Roentgen announced his discovery of the rays that made the field of radiology possible, a University of Pennsylvania physics professor and a photographer inadvertently exposed two coins to a photographic plate and produced an X-ray. Not understanding the accident, however, they filed the film, only to recall it and realize what they had done when Roentgen's work became public.

Clearly, Penn was poised to take advantage of the new technology. The first X-rays (called "skiagraphs") were taken of extremities. By June of 1896, the chief of surgery used a skiagraph to locate a toy jack that a child had swallowed. Within months, several hospital departments were using roentgen rays for diagnosis, surgical planning, and follow-up.

In 1898, Charles Lester Leonard, M.D., was put in charge, effectively becoming the first chairman. Leonard was the first roentgenologist to use a skiagraph to identify kidney stones, and he made other advances, but at the price of his life. X-rays gave him burns and induced cancer, which claimed him in 1913.

Henry K. Pancoast, M.D., was an anesthetist at the hospital when he succeeded Leonard in 1902. Eventually appointed the country's first professor of roentgenology, he gained national recognition for X-ray therapy, especially on inoperable cancer s, for examination of the gastrointestinal tract, and for the improvement of chest X-rays in occupational health.

Pancoast insisted on a staff of professional caliber. Early on, the department began to train residents, whose memoirs testify to the cooperative and educational atmosphere.

Under Eugene P Pendergrass, M.D., who succeeded Pancoast in 1939, radiology emerged from the Department of Surgery and became an independent department, increasing in size, expertise, and machines. The entire field was changed by the experience with atomic energy during World War II and afterward. Procedures were adjusted and equipment and space built to specifications that took cognizance of atomic power.

Fundamental research, booming in every biomedical area during the postwar years, became a departmental staple, especially in the investigation of radioisotopes. Nuclear medicine tapped the imagination and energy of David A. Kuhl, M.D., who built his first scanner as a first-year medical student at Penn. During his residency here, in the 1960s, he conceived of and constructed a device that represented the first true computed axial tomographic imaging system. As a member of the faculty, Kuhl went on to develop the procedure known as single photon emission computed tomography (SPECT) and the principles of positron emission tomography (PET).

In their own postwar evolution, the programs for residents and fellows became more structures and substantial. Trainees had major responsibility for making decisions. Funding for fellows was begun. The department offered electives to medical students. Conferences often included advanced radiologists, so the level of review was impressive and enthusiasm high. Relations between radiologists and other HUP physicians were regularized, paving the way for interdepartmental exchanges and collaboration, a continuing feature of the department.

Richard H. Chamberlain, M.D., succeeded Pendergrass as Chairman in 1960. Subspecialties grew; the Neuroradiology Section was the first in the country to perform all of a hospital's neuroradiological procedures. The resident training program was extended to four years.

In 1975, Stanley Baum, M.D., one of the first vascular radiologists, became chairman. Diagnostic radiology was organized into the sections. Radiation oncology, historically a departmental strength, was made a separate department.

R. Nick Bryan, M.D., PhD., a neuroradiologist who pioneered applications of MR imaging to the nervous system, succeeded Dr. Baum in 1999. Under Dr. Bryan’s stewardship, the Department has continued to evolve. Most recently, the Department has undertaken numerous, concurrent capital projects to upgrade the clinical and research infrastructure.

The University of Pennsylvania Department of Radiology has become an international leader in virtually all of the sections represented, as well as in techniques previously pioneered here. Among other major activities is a continuing medical education program attended by radiologists worldwide. The department currently performs more than 1,045,000 procedures annually: 319,000 of them at HUP, 83,000 at the Penn-Presbyterian Medical Center, 472,000 through our Community Radiology subsidiaries, and 171,000 at the Children's Hospital of Philadelphia.

For some 15 years, the department has been one of the leaders in grant support from the National Institutes of Health. Our faculty contains not only distinguished basic scientists and clinicians, but also clinicians with peer-reviewed grants; indeed, we lead the country in the number of clinical radiologists who conduct research.

Looking to the future, the University of Pennsylvania Health System will continue to make history, and the Department of Radiology will be part of it. Currently under construction is the new Raymond and Rita Perelman Center for Advanced Medicine, scheduled to open in July 2008. Allocated some 40,000 sq. ft. on the ground floor of the site, the Department is making plans to expand its services, while still offering the best and latest in patient care.

An Historical Timeline

 

1890 - The world's first X-ray image was produced by Arthur W. Goodspeed and W.N. Jennings on February 22, 1890 at PENN. Not knowing the significance, they never published it. Roentgen published his seminal paper five years later.

1896 - The first medical X-ray image at HUP was obtained, only three months after Roentgen's discovery. - Later the same year, the "skiagraph" was used by the chief of surgery to locate a foreign body in the abdomen. - Goodspeed and Charles Lester Leonard wrote the first analytical paper on the various systematic applications of Roentgen rays to medicine.

1897 - The Division of Roentgenology Services officially opened at HUP, believed to be the first radiology department in the United States. There was one x-ray unit for clinical work and one for research.

1898 - Charles Lester Leonard used X-rays as a method to identify urinary stones. He also wrote the first paper on the hazards of X-rays.

1905 - Henry Pancoast described the utility of bismuth and then barium for contrast in radiology studies. Among many other contributions, he is known for his description of Pancoast's tumor. He also later described the relationship of prolonged irradiation and the development of leukemia.and the use of X-rays in the treatment of Hodgkin's disease and leukemias.

1911 - Henry Pancoast was appointed as the first Professor of Radiology (roentgenology) in the United States.

1928 - Although residents were appointed to the radiology service as early as 1898, a formal residency training program was established this year at HUP.

1932 - Eugene P. Pendergrass became the first chairman of education in the American College of Radiology.

1934 - Henry Pancoast became the founding president of the American Board of Radiology.

1940 - The University's Eldridge Reeves Johnson Foundation for Medical Physics started experiments with ultrasound and pioneered the first biomedical applications of this new discovery.

1949 - Britton Chance became director of the Johnson Foundation for Medical Physics. He is a pioneer in biophysics and its applications to medicine. He trained generations of eminent scholars and researchers in the radiological sciences throughout the country. He and his associates later developed the technique of Optical Imaging.

1954 - David E. Kuhl invented the first photorecording radionuclide scanner. This invention helped the acquisition of images in nuclear medicine.

1958 - A new building named William H. Donner Center for Radiology was added to HUP. - Mortimer Mendelsohn opened the Radiation Biology Laboratory.

1959 - The world's first transverse section emission tomographic image was obtained at HUP by David Kuhl and Roy Edwards on August 21.

1960s - Radiologist Stanley Baum and surgeon Moreye Nusbaum pioneered the field to be known as interventional radiology. Stanley Baum later became chairman of radiology at the University of Pennsylvania from 1975-1996.

1964 - David E. Kuhl and Roy Edwards developed the Mark II emission tomographic scanner, starting the field of cross-sectional tomographic imaging. Kuhl went to develop the technique of Single Photon Emission Computed Tomography (SPECT) and the principles of Positron Emission Tomography (PET). - HUP obtained its first linear accelerator.

1966 - The first transmission construction tomography image of man was produced at HUP by David Kuhl. This technique led to the development of CT scanning. - Stanley Baum and associates used selective intrarterial catheter vasopressin infusions for the treatment of gastrointestinal bleeding.

1972 - Stanley Baum became the founding president of the Society of Cardiovascular and Interventional Radiology (SCVIR).

1975 - Stanley Baum became chairman of radiology at the University of Pennsylvania.

1975 - The first in-vivo absolute measurement of local cerebral blood volume in animals and man was performed at HUP.

1976 - The world's first fluorodeoxyglucose PET image was obtained at HUP, starting an ongoing new era in functional imaging.

1977 - Abass Alavi and associates developed the gastrointestinal bleeding scan. Alavi is currently chief of nuclear medicine at HUP. - PACS technology was initiated at HUP by Arenson, London and Morton. Ronald Arenson is currently chairman of radiology at UCSF.

1978 - Hans Herlinger developed the technique of methylcellulose double contrast small bowel study (Enteroclysis).

1981 - Coincident system based scintillation camera detectors were developed at HUP. - The medical image processing group was formed. Among many other achievements, they helped develop and advance the mathematical basis for tomography and 3D imaging.

1982 - The country's first hospital based MRI became operational at HUP. - The Eugene P. Pendergrass Lab for Radiology Research was inaugurated.

1984 - The David Devon MRI Building opened at HUP.

1986-1987 - Penn Radiology Chairman Stanley Baum, MD, serves as President Society of Chairmen of Academic Radiology Departments.

1995 - Presbyterian Hospital joins Penn Health System.

1996 - Reuben Mezrich, MD was appointed Interim Chairman of Radiology by the University Administration at the University of Pennsylvania

1997-1999 - Penn Radiology Chairman Stanley Baum, MD, serves as President Academy of Radiology Research.

1998 - Wallace T. Miller Sr., MD awarded RSNA Gold Medal.

1998 - Penn Radiology Chairman Stanley Baum, MD, receives Gold Medal, Society of Cardiovascular and Interventional Radiology.

1999 - R. Nick Bryan, MD Ph.D. became chairman of radiology at the University of Pennsylvania.

2001- Penn Radiology Chairman Stanley Baum, MD, receives Gold Medal, American Roentgen Ray Society.

2002 - Establishment of the Stanley Baum Professorship in the Department of Radiology, University of Pennsylvania.

2002 - Penn Radiology Chairman R. Nick Bryan, MD Ph.D. serves as RSNA president.

2002 - Penn Tower Outpatient Radiology Center opens.

2003 - Stanley Baum, MD, Penn Radiology chairman emeritus and editor of Academic Radiology was awarded the 2003 Gold Medal by the Association of University Radiologists.

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Thematic History of the Radiology Department*

 

Radiology at Penn began even before the beginning. In late 1895, German physicist Wilhelm Conrad Roentgen announced his seminal discovery of x-rays. Almost immediately, Penn Physics Professor Arthur Willis Goodspeed realized he had produced x-rays almost six years before, and had the physical plates to prove it. But rather than looking backward, Goodspeed looked forward instead. He quickly teamed with Penn surgeons J. William White and Charles Lester Leonard to produce, on February 4, 1896, one of the first recorded patient exposures using x-rays. That spring, Leonard was named the University Hospital´s first "skiagrapher," and arguably the first academic department of radiology in the United States and, perhaps, the world was born. Looking forward became the Department´s hallmark from the outset.

These early adventures in science, scholarship, and patient care foreshadowed much of the history of this pre-eminent Department over the next century. The journey has been marked by a continuous quest for the very best people, programs, and resources. The Department´s academic leadership has been internationally distinguished and stable. Only six individuals have held the permanent Chairmanship since 1896: Charles Leonard (1896-1902), Henry K. Pancoast (1902- 1939), Eugene P. Pendergrass (1939-1961), Richard H. Chamberlain (1961-1975), Stanley Baum (1975-1996), and R. Nick Bryan (1999-present). In addition, George Edward Pfahler, a "towering figure in radiology for more than half a century,"* served as Vice Dean of Radiology at Penn´s Graduate School of Medicine from 1916 to 1946.

The Department´s scholarly and patient care missions have dictated its organizational evolution. The initial interest of surgeons in using x-rays to facilitate their work helped keep Radiology within the Department of Surgery until 1939, when Radiology was made an independent department. Later, as science and medicine progressed, the Department reassessed whether its dual focus on diagnosis and therapy had become too broad, leading to the establishment of a separate Department of Radiation Oncology in 1977. At about the same time, increasing subspecialization within the radiology discipline led to the restructuring of the Department in the 1970´s to reflect the discipline´s changing realities. This reorganization was accompanied by the seminal change agreed to in 1975, when the Department ceased to be the private proprietorship of the Chair and all Department faculty became full-time academic faculty of Penn and the medical staff of the Hospital of the University of Pennsylvania (HUP).

Scholarship in the Department has been robust and wide-ranging, and centered on the major issues in the field. A key focus has been on translational medicine – adopting the latest advances in both basic science and clinical research to the benefit of patients. From the beginning, for example, the discipline was concerned with developing better -- and safer -- x-ray equipment, and Penn researchers have contributed heavily in these areas, particularly Goodspeed, Leonard and Pfahler in the early years, and later David Kuhl (radioisotope scanner design) and Chamberlain (radiation safety and measurement). Mortimer Mendelsohn, a radiobiologist who was the Department´s first dedicated research scientist in 1958, contributed significantly to studies of human cancer treatments. In recent years, Department faculty have achieved international reputations for developments in computed tomography (CT), positron emission tomography (PET), and especially magnetic resonance imaging (MRI) modalities.

For over a hundred years, the Department has been characterized by the strength of its academic leadership, the continuing effort to advance the educational, research, and clinical frontiers of the radiology discipline, and on-going organizational evolution and resource development to ensure that it is optimally structured and equipped to meet present and future medical and scientific challenges.

* For an excellent and detailed history of the Department, please see Otha W. Linton, MSJ, A Century of Radiology at the University of Pennsylvania, The Department of Radiology, University of Pennsylvania, 1999.

THE DEPARTMENT TODAY – AN OVERVIEW

 

The Department of Radiology at the University of Pennsylvania Health System and School of Medicine today stands at the pinnacle of academic radiology in the United States and abroad. Led by a world-renowned faculty, the Department offers a wide array of outstanding education, research, and clinical service programs with a deep commitment to developing and disseminating subspecialty expertise. The Department consists of two main Divisions: the traditional Academic Program clinically centered at the Hospital of the University of Pennsylvania, Presbyterian Medical Center, Children's Hospital of Philadelphia and the Veterans Administration Medical Center; and Community Radiology covering Pennsylvania Hospital, Phoenixville Hospital, Chester County Hospital and eight outpatient imaging centers.

People -- The Department´s strengths begin with its people – faculty and staff. As 2002 begins, 97 full-time faculty make Penn´s Department their academic home -- 13 are in the Tenure Track, 68 in the Clinician-Educator Track, and 16 in the Research Track. All full-time faculty participate in educational activities and most in research programs, but there is a degree of specialization within the group – three-quarters of the faculty (72) provide clinical care and one quarter (25) are dedicated to research. Radiology´s most prestigious professional organizations and associations have repeatedly recognized the quality of Department faculty by electing them to positions of leadership and conferring upon them the discipline´s major awards and honors.

Department faculty work closely with 213 members of the support staff. Of this number, the great majority participate in the provision of clinical services to patients, with others filling a wide range of professional research, educational, and administrative support roles. The strength of the faculty rests upon the vitality of those who work with them.

Programs -- The Department´s strong programs begin with its responsibility for education and training. Faculty participate in all aspects of Curriculum 2000., the medical school´s pioneering undergraduate medical education course of study. Almost 30 faculty teach the highly popular and well-regarded elective Clinical Clerkship in Radiology (RA300), which annually attracts over 80 percent of each medical school class. The Department´s residency program -- with 34 housestaff -- is among the nation´s best, as measured by its perennial ability to fill all of its advertised slots with outstanding applicants, many of whom eventually pursue academic careers. The residency curriculum is diverse, offering rotations in sixteen subspecialties, with opportunities for electives in research, community radiology, and teaching. The Department also offers clinical fellowship opportunities, such as in magnetic resonance imaging, neuroradiology, and interventional radiology – the Department now has 36 clinical fellows. Post-doctoral research programs, with 25 research fellows now participating, are also attractive, and the MRI program is particularly sought after. In addition, Department faculty in several basic science disciplines help train graduate (Ph.D.) students -- now numbering eight --under the auspices of the University´s Biomedical Graduate Studies Program. Finally, the Department´s continuing medical education symposia in Philadelphia and elsewhere are attended annually by more than 1,000 radiologists from around the country.

The research program in the Department is one of the world´s best. Its overall strength derives from its multidisciplinary focus and the close integration between disease-oriented and basic science and technology programs. The Department has maintained the top NIH research funding position among American radiology departments for the past ten years. In FY 2001, the Department was awarded $18.0 million in research grants from all sources, including $15.0 million from the NIH. Department research programs cross a wide disciplinary spectrum, with considerable strength in cancer research (particularly breast and animal models, as well as studies at the cellular level), cardiovascular, musculoskeletal, neurofunctional (positron emission tomography/magnetic resonance), and method development (magnetic resonance imaging techniques, imaging agents, image processing, and optical imaging). Research in magnetic resonance imaging, computerized imaging, molecular imaging, and translational medicine research is widely respected.

The Department´s clinical programs are equally robust. On an annual basis, the Academic Department´s faculty and staff at HUP and PMC perform about 350,000 patient examinations per year, giving patients access to a wide spectrum of imaging modalities. The addition of dedicated imaging facilities in the Penn Tower – to be completed in 2002 -- will increase the availability of the Department´s clinical services to outpatients and result in improved patient satisfaction. An additional 200,000 patient examinations per year are performed at CHOP and the VA, invaluable components of the academic program.

With primarily a clinical care mission, Community Radiology covers 3 hospitals and 8 outpatient facilities with 20 radiologists at its suburban sites and 14 at PaH. Approximately 350,000 exams a year are performed. The Community Radiology Practice is appropriately coordinated with that of the Academic Program, allowing maximum utilization of subspecialty expertise. A separate general radiology residency is offered at PaH with electives available at other Community Radiology sites and HUP.

Resources -- The Department´s outstanding people and programs require complementary resources. The Department´s $47 million annual professional budget and $20 million annual Hospital of the University of Pennsylvania (HUP) operating budget fund the substantial education, research, and clinical service programs for which the Department is recognized. The budget also supports major imaging equipment which permit faculty and staff to bring state-ofthe- art imaging modalities to patients and which also provide a strong platform for research on imaging technologies and disease processes. The Department maintains 114,000 net square feet (nsf) of space, of which 30,000 nsf is devoted to research and education, 80,000 nsf to clinical care, and 4,000 to administration.

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