Dr.William OldendorfBy:

SHAWETA KHOSA

William H. Oldendorf, M.D. Biography (1925-1992)

• He was born in Schenectady, N.Y., on March 27, 1925

• He was the youngest of four children, graduating from high school at age 15

• attended Union College in N.Y. and finished it in three years.

• He earned his medical degree from Albany Medical College in 1947.

The true Father of Neuroimaging

• He completed his residency in psychiatry at the New York State Department of Mental Health residency training program.

• He then went on to serve in the US Navy as a medical officer at the US Naval Hospital in Newport, Rhode Island for 2 years.

• After leaving the US Navy: he entered a fellowship in neurology at the University of Minnesota in Minneapolis and was subsequently certified by the American Board of Psychiatry and Neurology as a diplomate in both specialties.

William Oldendorf (1925-1992)

– Dr William Oldendorf the first designer of the Axial tomography which led to development of CT Scanner

– While being an active member of UCLA’s academic community, where his scientific, clinical, and teaching abilities were highly admired from the outset. During this period, Oldendorf resurrected the idea of tomography and innovated on it.

– After performing numerous cerebral angiographies and PEGs, Oldendorf, frustrated by the gross inadequacy, and concerned about the hazards, morbidity, and mortality associated with these procedures, approached the scanning problem in the 1950’s.

– Bill's mind was Einstein's universe, finite, but boundless. Always reaching into spheres you wouldn't imagine." These are the words of L. Jolyon West, MD, Chairman of Psychiatry at UCLA

– In 1959, Oldendorf declared his goal “to scan a head through a transmitted beam of X-rays, and to reconstruct the radio density patterns of a plane through the head.

• He wrote: “I developed a distaste for these procedures. During the waiting periods between films, I began to imagine how one might do away with these traumatic, arduous, tedious tests, which provided only limited and indirect information about the brain. Broad, William J. Riddle of the Nobel Debate. Science 1980; 207; 37.

Continue introduction:

• Oldendorf (1980) in his book “The Quest for an image of brain” cites William Morton’s 1896 work titled The X Ray as the first published skull radiograph.

• Despite numerous advances in X ray technology, no direct images of brain were generated till the 1970s.

• Only indirect assessments based on skull asymmetry, lesions or pathologies like neoplasm's causing opacities like calcification were visualized.

• He is the author of more than 250 scientific publications, including 3 textbooks.

• He also received many honorary degrees and awards, including the President's Award for Distinguished Federal Civilian Service,

• He was on several editorial boards and was a Fellow of the American Academy of Arts and Sciences and many other organizations. In 1992, he was the first neurologist in the 20th century to be elected to the National Academy of Sciences.

• In 1956, Oldendorf joined the University of California Los Angeles (UCLA) faculty and the neurology staff of the nearby UCLA-affiliated West Los Angeles Veterans Administration Medical Center (VAMC).

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• He quickly became an active member of UCLA’s academic community, where his scientific, clinical, and teaching abilities were highly admired from the outset. During this period, Old- endorf resurrected the idea of tomography and innovated on it.

In addition to his wife stella, Dr. Oldendorf is survived by three sons: Eric Oldendorf, of Los Angeles, Mark Oldendorf, of Albany, and William Oldendorf Jr., of Sherman Oaks, Calif.; two sisters, Florence Karlen, of Schenectady, and Dorothy Brown, of

Duanesburg, N.Y., and three grandchildren.

• Dr. William died of complications of heart disease,. in a Los Angeles hospital on Dec. 14 1992.

• He was 67 years old at time of his death and lived in Los Angeles.

Concept of Axial Tomography

• First brought forth as “Planigraphy”

• by a Dutch neurologist/radiologist, B.G. Ziedses Des Plantes

• Prof Radiology at University of Amsterdam

– Idea: 1921, Yr. I Med Student

– Tomograms 1931

• He envisioned moving an X-ray tube and radiographic plate in a controlled manner, such that all the visualized structures excluding those within a single plane were blurred.

• A number of other European physicists were involved in the 1930s in the developing this concept, before it finally reached UK and the USA.

• The concept finally gave way to the biggest breakthrough in Neuroimaging, “The CAT Scanner”.

BG Ziedses Des Plantes

William Oldendorf & the CAT Scanner

• William Oldendorf was a well known Neurologist and psychiatrist at the VA West LA and UCLA.

• I have had the unique pleasure of knowing him personally as My teacher when I was resident at UCLA.

• Oldendorf was influential in evolving the concept of CAT Scanner.

William Oldendorf

• He aimed to produce a radiographic cross-section that would delineate the distribution of tissue structures based on regional radio density.

– Inspired by a young engineer’s attempts to use X-rays to detect dehydrated regions in frostbitten oranges, Oldendorf developed a model using domestic materials such ranging from a frying pan to his son’s discarded train set

• In 1961, Oldendorf wrote his first paper on radiographic tomography.

– In 1963 he patented his model for a “Radiant Energy Apparatus for investigating selected areas of the interior of objects obscured by dense material”.

Oldendorf’s early struggle:

– Oldendorf’s concept was revolutionary, but such a machine had a probable cost of $250,000, and major X-ray manufacturers unwilling to risk the capital, denied his request for backing,

– Industry Rejection of CT Concept

– Neurological Disinterest

– Hounsfield Scoop

William Oldendorf & the CAT Scanner

In his prototype, a gamma ray source and detector were placed opposite to each other with a simulated head in the middle, the source and detector arrangement was capable of revolving 360 degrees around the head. A capacitance circuit was then used to imitate these internal points.

William Oldendorf & the CAT Scanner

A sketch from Oldendorf’s patent demonstrating the principle of his device. Changes in intensities of gamma rays are observed as they pass through regions of varying radiodensity, these changes in intensity are plotted against time in the graphs (3A). The changes become more apparent when the object rotates on an axis within itself (3B, 3C). Furthermore, as the penetrating beam looks continuously at the axis of rotation, the graphs provide lateral translation of the axis through the object. In other words discrete regions within the object defined by the intersection of the beam with the axis of rotation are isolated, while all other regions within the object are rejected by virtue of their transverse motion across the beam.

William Oldendorf & the CAT Scanner

• Having isolated one such internal point or a discrete region of the simulated head, other regions can be successively observed by providing a relative linear movement between the simulated head and the axis of rotation.

• Thus a line through the simulated head is observed, and when plurality of such lines parallel to each other are taken, the entire interior of the head can be effectively observed

• Oldendorf’s concept was though revolutionary, it was never recognized by the Nobel Committee.

CAT Scanner

– In 1963, Allan McLeod Cormack a American physicist, came up with a similar concept for Axial Tomography as Oldendorf but with a more detailed mathematical explanation.

– Finally, in 1970 Godfrey Newbold Hounsfield a computer engineer from England, was able to put to production a device for Axial Tomography Scan similar concept for Axial Tomography as Oldendorf.

– In 1979 Cormack and Hounsfield received the Nobel Prize in Physiology and Medicine for “Computer Assisted Tomography”

Godfrey Newbold Hounsfield

Allan McLeod Cormack

Awards And prizes

– In 1974, he was awarded the first Ziedses des Plantes Medal by the German Society of Neuroradiology and the Medical Physics Society of Wurzburg in recognition of his pioneering study.

– In 1975, he was awarded the prestigious Albert and Mary Lasker Award "for his original concept of the principles which demonstrated the feasibility of computerized tomographic scanning.".

– Aebersold Award of Society of Nuclear Medicine 1978

– William S. Middleton Award from VA 1976

A) Oldendorf and Hounsfield receiving the 1975 Lasker Award; (B) Oldendorf’s prototype.1

Awards Continue….

– U.S. Presidential Award for Distinguished Service 1981

– Gold Metal Award of German Neuroradiological Society1974

– Wartenberg and Cotzias Lectures, Amer Acad Neurology

– Election to National Academy of Science

– Hounsfield’s Acknowledgement

Creditionals Continue….

– Oldendorf was also

– Fellow of the Institute of Electrical and Electronic Engineers (1986),

– Distinguished Founder of the American Board of Nuclear Medicine Science,

– Honorary Doctorate of Science (1982) from Albany Medical College and Union College,

– Honorary Doctorate of Science (1986) from St. Louis University, and

– Keynote Speaker at the annual meeting of the Japanese Society of Neuroradiology in Tokyo in February, 1990

American society of Neuroimaging

– William H. Oldendorf, MDASN President 1978-1979

– 1978

– Annual meeting held in Hilton Head, South Carolina

– The first examination by a national organization in the field of neuroimaging given. Organized by Dr. William Kinkel - 100 physicians took the exam

– Neurosonology voted in by Board to be a part of the Society

– Number of CT scanners in the US exceeds 800

The Politics surrounding the 1979 Nobel Prize

– Rosalind Yalow, a Nobel laureate in physiology and medicine in 1977, went on to nominate Oldendorf for the prize and was upset that he did not get it.

– The history of the Nobel Prize in Physiology or Medicine, demonstrates relentless discrimination against the physician-clinician from the basic science faction of the Nobel Assembly.

• In 1979, although Oldendorf, Hounsfield, and Cormack all deserved the prize, a deadlock persisted in the Assembly.

• According to the code of statutes for the Nobel Foundation, and the will of Alfred Nobel, “the prize may in no case be divided between more than three persons.” .

• However, the probable elimination of a third name (William Oldendorf’s) led the Karolinska Institute to announce the winners on October 11, 1979 an hour late, and solely in the Swedish language

• The Nobel Assembly claimed that “the problem was basically a mathematical one.”

• Cormack and Hounsfield used mathematics to produce a visual representation of a cross-section of the human body.

• Though Oldendorf simulated the same model without mathematical basis before Cormack and Hounsfield’s efforts, he failed to receive the award.

• The intention of the Nobel Prize in Physiology or Medicine is to award based on “the greatest benefit to mankind and discovery.”

• The phrase “greatest benefit to mankind” is more applicable to a clinical setting, a setting that the Nobel Assembly routinely ignores.

• Oldendorf, who aimed to eliminate invasive and painful procedures such as PEG and cerebral angiography, certainly had the benefit of mankind in mind.

• While “discovery”, meaning a sudden increase in new knowledge or a scientific breakthrough of high originality, is easier to define in the basic sciences, it is evident that Oldendorf’s model, created from everyday sources, was a discovery of high originality

What this history means for us today

– Technology should never be limited to the domain of a certain specialty, particularly when patient care is on the line.

– Today, diagnostic scanning is an integral part of neurologic practice and diagnosis, and is a natural extension of any neurologist’s duties.

– Erosion of a neurologist’s imaging privileges and amplification of a neuroradiologist’s domain affects the speed and effectiveness of image interpretation and ultimately leads to unacceptable patient care.

• Such historical territories have led to a sense of entitlement for radiologists, though specialty physicians and neurologists who have seen cases for years are clearly more competent and effective in interpreting diagnostic scans.

• In his President’s Message for the November 2007 American Society for Neuroradiology (ASNR) E-News, David M. Yousem urges neuroradiologists to engage in “strategic maneuvers” for promoting rejection of nonradiologists out of neuroradiology fellowship programs.

• He further goes on to suggest objection to manufacturers that sell MR/CT equipment to nonradiologists, and denial of scanning privileges to hospitals that allow nonradiology interpretations of neuroimaging studies.

• Yousem’s proposals represent a sad abuse of authority over scanning devices, which have ironically come about from neuroscientific research mostly performed by neurologists and Neuroscientists and not radiologists.

Summary

– Clearly, the mission of all physicians : should override issues of income or domain and ultimately focus on effective patient care.

– The desirable goals of neuroradiologists and neurologists alike are exemplified in the words of Alfred Nobel in his criterion for the Nobel Prize in Physiology or Medicine. “benefit ailing mankind”.

– The dedication of the father of neuroimaging, Dr. William Oldendorf : legacy can even today be honored by ending the neuroimaging turf battle with the neuroradiologists and neurologists working in unison for the betterment of science and our patients.

Thank You

"Bill's mind was Einstein's universe, finite, but boundless. Always reaching into spheres you wouldn't imagine." These are the words of L. Jolyon West, MD, Chairman of Psychiatry at UCLA

The fields of both neuroradiology and neurology are indebted to Oldendorf for his propulsion of diagnostic neuroimaging beyond research and into clinical practice.