February 25, 2019

Early Days of Body Computerized Tomography

by Ronald D. Harris, MD, FACR, FSAR, FSUR

Being among the pioneers of body CT was a fascinating and exciting learning opportunity for those of us who were privileged to participate in those early days. We were constantly learning, making exciting discoveries and providing major aid in patient diagnosis and assistance to referring physicians.

We were also allowed to make contributions to physician education through numerous scientific publications and presentations at major radiology meetings. Our CT scanner at Scripps Clinic and Research Institute in La Jolla, CA, was a gift from Dr. Cecil Green (the founder of Texas Instruments) in return for life-saving care he received from us in the radiology faculty.

Occasionally our new-found diagnostic capability got us into hot water with our referring doctors. Our referral base was actually worldwide but we specifically had a large number of physicians from the Los Angeles area who would refer patients who liked to vacation in La Jolla.

One particular case is notable and received quite a bit of notoriety at the time. A well-known personality in the Los Angeles area was sent to us for a work-up of a somewhat painful left-flank mass previously “diagnosed” as a renal cell carcinoma by IVP in an L.A. hospital and sent to us by his urologist from L.A.

I started with a non-contrast abdominal CT followed by a scan using IV contrast. Our EMI scanner was an 18-second rotational CT, and we anxiously awaited for images to be displayed. Low and behold there appeared a smoothly rounded 7-cm mass extending from the lower pole of the left kidney. To my amazement it had all of the characteristics of an angiomyolipoma on the CT images.

I telephoned his urologist and explained what I had found. The urologist became quite belligerent and told me to do an angiogram to prove that it was a renal cell carcinoma and not the foolish thing I was purporting. So, I got the patient’s consent, prepped and did a left-lower renal artery angiogram injection. I had done a few previous angiograms on angiomyolipomas, and the films on this one looked identical to the others.

In my excitement, I told the patient that he did not need to worry since he did not have a carcinoma, but instead, he had a benign lesion. I called the urologist again and told him that the angiogram had confirmed my conclusion that we were dealing with an angiomyolipoma rather than a renal cell cancer. I released the patient who returned to his urologist in L.A. a few days later.

A day later I received a phone page that a urologist from L.A. was calling and he sounded very angry. I answered the call and was quickly “chewed out” in no uncertain terms. He claimed that I was negligent in telling the patient that he had a benign lesion rather than a cancer, that I should be “brought up before the medical board”, and he slammed the phone down to disconnect the conversation.

A couple of weeks after that experience, I was notified that I had another call from the urologist from L.A. I was expecting the worst at that point in time. However, the urologist rather sheepishly told me that he had operated and removed the left kidney on his assumption that he was doing proper cancer surgery. To his surprise the lesion was pathologically an angiomyolipoma. He said he was sorry for being so arrogant with me on our prior phone call and congratulated me on my diagnostic acumen, saying that he looked forward to sending more patients to me in the future.

I hastily wrote up the case for publication as the ‘first’ CT-diagnosed angiomyolipoma. I also presented the images at several scientific radiology conferences and teaching courses.

Needless to say, this was not the only case of CT diagnosis that flew in the face of the clinical presentation, but I was getting used to angry physicians (including a very famous heart surgeon from Houston) calling to tell me how dumb I must be and only later calling to apologize for their rudeness in learning that the CT diagnosis was correct after all.

Those were extremely exciting days to be on the forefront of learning and unveiling of the power of CT scanners, which constantly increased our knowledge and teaching ability and resulted in better and more accurate patient care.