Radiology History: Lessons in and of Radiology

Published in Radiology Update - 2022

Since its inception, teaching has been an integral part of The Johns Hopkins Hospital and the Department of Radiology has in turn reflected that foundational value. While the leaders of the field were forced to break ground and learn from first-hand experience, by the end of the 1930s, they argued for the creation of formal training programs and certification. John Pierson, chief of the Johns Hopkins Hospital radiology section, started the first radiology residency in 1934 as a two-year program structured to expose residents to all areas of diagnostic radiology with a separate unit to cover radiation therapy.

Within weeks, residents were expected to interpret x-ray exams and perform fluoroscopies. Residents would gather in the reading room and dictate for all the films from the previous day, except for cases that were particularly interesting or puzzling. That’s when Pierson would step in. He also reviewed all the fluoroscopic films, but would first ask residents to read from their own notes before viewing. If a resident missed the pathology, Pierson would offer another chance on the spot. Despite receiving emeritus status in 1949, he continued to visit once a day, between 11 a.m. and noon, until suffering a stroke in 1956.

As the department and residency program expanded, the morning conference before each working day became a staple in the nuclear medicine division. All the staff, fellows, graduate students, technologists, other scientists and visitors would attend to review the presentation of scans from the previous day. Henry Wagner, chief of the nuclear medicine division, would lead discussion whenever in town. He would often be diverted into spontaneous lectures about other studies and possible diagnoses, which were appreciated by the participants as being useful and interesting, occasionally leading into research project proposals. However, these impromptu discussions could stretch the morning conference into the early afternoon, which caused a pile-up of patients and research timelines as staff and fellows were unable to break away from their chief. In addition to daily film-reading sessions and lively discussion, outside experts were frequently invited as visiting professors to Johns Hopkins. One early notable in 1951 was Merrill Sosman, the Harvard professor of radiology and chief at the Peter Bent Brigham Hospital. He was known to be a superb diagnostician as well as a practical joker. Occasionally, when presenting obscure cases at his hospital’s Grand Rounds, he would coach the hospital barber on the diagnosis so the barber could step in when the clinicians have failed.

Knowing that, Russell Morgan, then chairman of the department, and Daniel Torrance Jr., a Johns Hopkins radiology resident, planned a prank during Sosman’s visit in which they dug up a particularly difficult case and dressed Torrance as a janitor. When Sosman was invited to review this case, which took some time, Torrance entered the room sweeping vigorously before taking a glance at the view box and muttering the diagnosis. Sosman asked a question of this “janitor,” received a medically detailed answer in return, and burst out in laughter, almost as much as he did at his own pranks. Radiology is a field that started with self-taught experts and inventors who were eager to pass on their knowledge and collaborate on ideas to better refine and build up this valuable capability to image the human body. The dedication at Johns Hopkins Radiology to not just continue this tradition but to excel and prioritize it has been recognized globally, and is demonstrated by the over 1,100 applications for its four residency programs, submitted by those from all over the world who are interested in joining and furthering the Johns Hopkins mission for excellence.