Orthodontics in 3 millennia. Chapter 8: The cephalometer takes its place in the orthodontic armamentarium.

After World War II, cephalometric radiography came into widespread use, enabling orthodontists to measure changes in tooth and jaw positions produced by growth and treatment. Cephalometrics revealed that many malocclusions resulted from faulty jaw relationships, not just malposed teeth, and made it possible to see that jaw growth could be altered by orthodontic treatment. Since 1931, a multitude of analyses have been developed, whereby the face is inscribed in triangles, rectangles, and polygons, permitting the orthodontist to dissect the profile into an array of angular and distance measurements. Those who embraced too quickly these measurements as a panacea soon learned that they are best taken with a grain of good judgment.

[Conventional roentgen diagnosis of the temporal bone. A historical review]. / Konventionelle Röntgendiagnostik des Schläfenbeins. Ein historischer Rückblick.

The Viennese Medical School played an important role in the development of radiological examinations and signs of the temporal bone with conventional X-rays. Famous pioneers include E.G. Mayer (1893-1969) and L. Psenner (1910-1986). Nowadays conventional X-rays and tomography have lost their important role in diagnostic radiology of the temporal bone, but the basic principles established in those early years of radiology are still used now. This statement is correct not only for conventional X-rays, but particularly for "poly"-tomography in comparison with CT.

[The history of tomography]. / De historiek van de tomografie.

It is easily forgotten that not yet a hundred years ago the only way to look into the patients' body was via invasive procedures. Within the year of the discovery of X-rays by Conrad Röntgen the need for three dimensional imaging had been voiced. The driving force behind this development was undoubtedly clinical motivation. Planar X-radiographs were not satisfactory to the clinicians who urged the radiologists to provide them with tomographic images. Between 1910 and 1940, classical tomography has been the product of individuals rather than collective groups. It is only in the mid thirties that scientists found out about each other and started to correspond vigorously. Mayer was the first to suggest in 1914 the idea of tomography. Bocage, Grossman and Vallebona all developed the idea further and built their own equipment. In 1931 Ziedses des Plantes published the most extensive and thorough study on tomography. In the forties and fifties a stagnation is noticed, only further refinements to the existing equipment are carried out. Although Frank and Takahashi published the basic principles of axial tomography in the mid forties, we had to wait for the necessary developments in electronics before Hounsfield was able to develop and commercialize the first axial computer tomography in 1972 (EMI-Scanner). At the time all the big radiology companies rushed into the field and soon, second, third and fourth generation CT scanners became available. Only a few years later a new way of generating images without using ionizing radiation was introduced. Lauterbur and Damadian produced the first low quality images with magnetic resonance, a technique called zeugmatography by its inventors. In 1974 the first images of a living subject were published and initial scepticism was replaced by euphoria. This resulted in the spectacular evolution in Magnetic Resonance that we are now observing. While it is impossible to predict the future, the development of networks, the increase in data acquisition and storage will spread a new light on our specialty. A closer cooperation between radiologists, pathologists and clinicians will undoubtedly be necessary, as well as a partial redefinition of the radiologists task.

Historical experiments predating commercially available computed tomography.

Computed tomography (CT) was a revolution in radiology. Commercially available CT scanners appeared in 1972, a joint effort between the EMI Company, Atkinson Morley's Hospital, London and the Department of Health and Social Security (DHSS). The name of Sir Godfrey Hounsfield will always be associated with these developments. Like most developments in science the breakthrough came by standing on the shoulders of giants and many experiments can, with the curious wisdom of hindsight, be considered precursors to CT. Gabriel Frank's patent in 1940 showed apparatus for back-projection CT and Takahashi developed equipment in the 1940s for reconstructing from a sinogram; in both cases using an optical "computer". A medical CT scanner was reportedly constructed in 1957 in Kiev. Transmission CT was performed by Kuhl in 1965. Cormack built an experimental scanner in 1963. Oldendorf identified what was needed for successful CT as early as 1960. Throughout the 1960s a host of independent workers were busy on the mathematical problems of reconstructing from projections with both medical scanning and non-medical applications in mind. Experiments in early emission tomography influenced the development of CT. With imagination one can even see how close "classical" tomography, as started even before 1920, came to the realization of CT. The pioneering British radiographer Watson stands out from a galaxy of inventors. The lecture at Radiology and Oncology '91 in Brighton was a thumbnail sketch of the origins of radiological CT. A fuller story is told elsewhere (Webb, 1990).