Gone but Not Completely Forgotten: Pictorial Review of “Antiquated” Radiologic Procedures

Abstract

The field of diagnostic and therapeutic radiology has always been characterized by constant innovation and creativity to evolve to its current form. There are numerous imaging techniques that were once prevalent but have become outdated and were replaced by the current examinations and modalities, which improve diagnostic accuracy and patient outcomes. Many of these outdated examinations were first described in the journal Radiology during its first 100 years of existence and were subsequently able to be disseminated across its vast readership to become the standard of care across the nation and the world. These earlier techniques, such as pneumoencephalography as it applies to neuroimaging and neurosurgery; kymography, a predecessor of cardiac imaging; contrast agents such as Thorotrast; and miscellaneous cultural tools, such as the shoe-fitting fluoroscope, left lasting impressions on the current practice of radiology and reflect a small subset of the imaging examinations of our predecessors. Knowledge of historic radiologic examinations and procedures is important to understand how we have arrived at the current practice of radiology we embrace today and how our field can continue to evolve to improve our diagnostic and therapeutic abilities to fit the changing needs of our patients.

Pneumoencephalography in the workup of neuropsychiatric illnesses: a historical perspective

“…7 Air was typically introduced through puncture of an open fontanel or via a bur hole. 9,18,33 Soon after the development of ventriculography, Dandy realized that air from ventriculograms often escaped onto the surface of the brain. Using this observation, he developed the pneumoencephalogram in 1919.…”

A Review of Medical Imaging Innovations that Impacted Patient Care in Recent Decades as Link to Future Trends

“…These diagnostic tools have expanded further to include positron emission tomography (PET), single photon emission CT, and additional innovations in ultrasound such as M-mode and Doppler imaging [1]. In some obsolete imaging procedures and modalities, patient experience was gruesome, time of study was measured in multiples of hours and radiation exposure was significantly high [2].…”

“…The fields of diagnostic neuroradiography, pneumoencephalography, myelography, lymphangiography, conventional tomography and arthrography, radionuclide brain scanning, and bronchography benefited immensely from the introduction of cross-sectional imaging, especially computed tomography (CT) and magnetic resonance imaging (MRI). Computed tomography and ultrasound have replaced Cholecystography and retroperitoneal air insufflation [2]. Lower limb angiography has successfully been replaced by Doppler ultrasound with the advantages of not just being real time but offers manipulations that improve diagnosis, such as compression, respiratory phasicity, Valsalva manoeuvre, augmentation [11], and estimation of degree and length of arterial stenosis.…”