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Pushing the Boundaries with Angiography

Pushing the Boundaries with Angiography

Johns Hopkins’ imaging heritage includes many things that are today just footnotes. The development of angiography took long and steady work as radiologists, technologists, nurses, physicists and engineers pushed the boundaries of image clarity while always keeping in mind patient care and safety.

In the 1950s, intracerebral vessel imaging used to be done through direct carotid artery injections with steel needles. The two types of needles were Seldinger and Cournand, and they both had pointed stylets. Placement would be based on palpation, and then the stylet would be removed, arterial flow observed and the connection to short tubing with stopcock done. A saline flush followed, with a manual test injection of 2–3 cubic cm of iodine contrast with a test film. This was without fluoroscopy, so the film was developed with either hand development or seven-minute automatic processing.

During the automatic processing, a saline flush was necessary to prevent clot formation at the needle tip. If the test injection showed good placement, then the diagnostic injection of 10–12 cubic cm of contrast could be done with filming. The contrast medium was usually methylglucamine diatrizoate.

Aortoiliac vessel with femoral runoff angiography was done with a translumbar approach. This could be quite anxiety-provoking, as there was no post-needle withdrawal compression, but the retroperitoneal connective tissues stopped blood flow. The noncatheter needle placement would be done without fluoroscopy and used a 7-inch-long, 17 g Dos Santos needle, which had two side holes near the tip, with a pointed, closed tip to avoid an intramural injection.

As a note, syringes in the 1950s were glass. The smallest syringe with the desired volume was favored, as it could provide more pressure and a faster injection. Sometimes, if the radiologist was very strong, these glass syringes would break. At Johns Hopkins, the machine shop made a stainless steel syringe, now on historical display on the third floor of the Johns Hopkins Outpatient Center.

The equipment and techniques that were once relied on so heavily are now long obsolete. Johns Hopkins’ new Interventional Radiology Residency Program shows the breadth of new, precise procedure options available to patients. Still, even in 2019, with the department spread across eight locations with state-of-the-art imaging modalities and full radiochemistry and cyclotron facilities, it is important to remember that the department continues to build on the achievements started in the 1950s.

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