Excerpted with permission from This House of Noble Deeds: The Mount Sinai Hospital, 1852-2002 by Arthur H. Aufses, Jr., and Barbara J. Niss, (NYU Press, 2002), pages 342-350

Department of Radiology

THE ORIGINS OF the Department of Radiology provide us with a prime example of Mount Sinai’s perpetual need for more space. When the Hospital purchased its first x-ray machine in 1900, it was set up in the synagogue, a portion of which had already been converted to an op­erating room. There, the staff could use the machine as long as there were no religious services in progress. Eugene H. Eising, who was House Surgeon at the time, took the first x-ray plate. The resulting picture revealed a fracture of the upper thigh in a male patient. Eising and Walter Brickner were the first radiographers appointed to the Hospital. The initial success of the two radiographers was reflected in the Annual Report for 1901, which concluded that “All cases that have been studied on the operating or post-mortem table have verified our x-ray findings…and of the very large number of cases submitted to x-ray exam, not one has to our knowledge suffered the slightest burn.” Unfortunately, like many of the early experimenters with x-rays, Eising and Brickner were not so lucky. Both men acquired severe burns from repeatedly testing the machine by placing their left hand in front of the tube.

In fact, as early as 1905, Brickner brought the matter of the safety of x-rays for the medical staff before the Medical Board: The frightful, even fatal skin injuries that have been suffered by several x-ray workers are quite familiar through the medical and lay press. That frequent exposure to the x-rays is also capable of effecting deeper injuries is just being discovered. Several members of the board are already familiar with the damages that the x-ray work have inflicted upon my person. . . . The employment of shields and screens, therefore even if altogether practical in active diagnostic work, does not give sufficient promise of protection.

 Following Brickner’s recommendations, the Board adopted proposals to distribute the x-ray work between the x-ray staff and the rest of the physician staff so that the x-ray workers would be exposed to less radiation. However, it was another thirty-five years before routine measurements of the stray radiation received by hospital employees were conducted by the Physics Department.

Brickner served as Chief of the Department of Roentgenology until 1908, when he was appointed Assistant Attending Surgeon, and Leopold Jaches replaced him. Jaches emigrated to the United States from Latvia in 1892. He studied law and was admitted to the New York Bar in 1898, having become an American citizen the previous year. Later, he studied medicine, graduating from medical school in 1903, and became one of the pioneers of x-ray in America. During World War I, he was in charge of the X-ray Division of the United States Army in France. As Chief at Mount Sinai, Jaches would develop the Department “from small beginnings. into a large diagnostic and therapeutic institute.” By 1909, the rest of the Hospital was beginning to realize the importance and utility of radiology. According to the Annual Report for 1909, “The services of this department have been utilized to a much larger degree by the surgeons and physicians of the hospital, and by the profession, and this department is gaining in importance, as the value of this service and its practical application in the practice of surgery and medicine are more largely recognized.” As a reflection of this growing importance, the Department moved into larger quarters in the basement of the medical building the following year. By 1920, the total operating costs of the Department were $20,119, up from $3,370 in 1910, and the number of examinations increased from 1,724 to 10,777 in the same period. As the number of patients examined continued to climb, the Department decided in 1930 to begin using full-time lay technicians for diagnostic work, which up until then had been performed by interns.

The 1920s were marked by a series of scientific achievements by members of the Department. Since radiography was fast becoming an important tool for many of the medical specialties, members of the Department were integrally involved in advances occurring throughout the Hospital. In 1923, Jaches and Harry Wessler published Clinical Roentgenology of Diseases of the Chest, which was long considered the standard American work on the subject. In 1926, an x-ray unit was installed in the operating room to permit visualization of the kidneys during the removal of kidney stones. Three years later, Mount Sinai’s own Moses Swick formulated Uroselectan, which permitted the visualization and examination of the urinary tract without cystoscopy.

This compound led the way for later advances in the visualization of the heart, vascular system, and brain. Jaches frequently collaborated with Swick in the roentgen diagnosis of urinary diseases. Also in the 1920s, the radiologist Arthur Bendick assisted Isidor C. Rubin, of the Department of Gynecology, with his pioneer work in the visualization of the uterus and the fallopian tubes. In 1937, the internship in radiology at Mount Sinai was recognized as part of the course required for the degree of Doctor in Medical Sciences in Radiology at Columbia University.

Jaches died in 1939, after more than thirty years as Chief of Radiology; Marcy L. Sussman succeeded him. That same year, Sussman performed the first angiocardiogram at Mount Sinai. This led to his becoming the head of the Cardiovascular Research Group, a collaborative effort that included cardiologists, radiologists, pediatricians, and thoracic surgeons. Achievements of the group include the first angiographic demonstration of a coarctation of the aorta and the development of one of the first rapid film changers for use in angiography. By 1950, two thousand angiograms had been performed. Sussman served as Chief for ten years and was responsible for training several of the outstanding radiologists of the future, including Bernard S. Wolf, who would succeed Sussman when Sussman resigned his position in 1949.

Under the leadership of Wolf, the Department attained international recognition. Trained in physics and radiation therapy, Wolf entered the United States Army during World War II as a captain and was assigned to the Manhattan Project, working on the development of the atomic bomb. He was one of the first physicians to enter Hiroshima at the end of the war to measure residual radioactivity. Returning to Mount Sinai, Wolf was appointed Associate Radiotherapist and simultaneously served as Director of the Atomic Energy Commission in its New York City office from 1947 until he took up his position as Director of the Department of Radiology in 1949. At the time the Department was relatively small, consisting at most of three to five Attending Radiologists. Wolf was able to attract a group of individuals whose productivity as both full-time and voluntary staff radiologists became the envy of many far larger radiology departments. In addition, Wolf fostered a passion for teaching that has been inherited by every member of the Department for the past half century.

Wolf was a prolific writer, publishing more than two hundred articles on a wide range of radiologic subjects. One of the great leaders in the world of radiology, Wolf was a prodigious worker and a perennial

Radiology, 1940s. Joan J. Lipsay, M. D., at right.

student. An inspiration to all who came in contact with him, he was a constant source of support for his staff. Through his work, he helped define the radiographic anatomy of the esophagus, including hiatus hernia, and the esophagogastric junction. He introduced the use of the barium pill (sometimes referred to as “Wolf pills”) to detect minimal esophageal strictures. Wolf’s collaborations, over a period of many years, with Richard Marshak and Mansho Khilnani on the physiologic and anatomic details of the esophagus and gastrointestinal tract and on the various aspects of inflammatory bowel disease were unique. Much of what we take for granted today was first articulated during this era by these three men.

A dominant figure in radiology for more than thirty years, Richard H. Marshak belongs to a group of Mount Sinai physicians who are remembered equally for their scientific achievements and for their colorful personalities. After completing residencies in pathology and radiology, Marshak was invited by Burrill Crobn to join his private practice as a consulting radiologist. Consequently, Marshak saw hundreds of patients with gastrointestinal disorders.

Bernard Wolf, M.D., Chairman of the Dept. of Radiology (1949—1977) presenting the Jacobi Medallion of the Alumni Association to Richard Marshak, M.D., 1972.

This experience, coupled with his amazing abilities as a teacher and a writer, would lead him and his colleagues to their groundbreaking work on the radiologic descriptions of regional enteritis and would inspire further studies on small bowel and colonic radiology. They would go on to describe the radiologic manifestations of sprue, malabsorption, protein-losing enteropathy, parasitic small bowel infection, vascular disease of the small bowel, lymphoma and other small bowel tumors, segmental colitis, toxic megacolon, and numerous other disorders. Marshak’s seminal work in this field during the 1950s and 1960s would help to “elevate the small bowel from an untouchable area in diagnostic radiology to a status equal in importance to the remainder of the G.I. tract.”

Marshak’s remarkable scientific accomplishments and innate intellectual gifts produced a man with a powerful ego. Almost everyone, however, would agree that he was entitled to it. He was known as a radiological evangelist and an indefatigable lecturer, “who could literally caress the film and feel the diagnosis.” Unfortunately, this would turn out to be a necessary skill when the ravages of diabetes resulted in Marshak’s almost complete loss of vision. However, with the assistance of his long-time associate Daniel Maklansky, himself a gifted radiologist and teacher, Marshak continued to give lectures, describing in detail slides he could barely see.

One of the unsung heroes of the Department was Mansho Khilnani, a superb diagnostic radiologist with a keen analytic mind. He attended medical school at Calcutta University and worked in refugee camps on the India-Pakistan border before coming to the United States in 1951. To review films with Khilnani was to get a lesson in anatomy, pathology, and x-ray diagnosis. An unassuming individual, Khilnani never received the national and international recognition due him. Yet, those who worked with him recognized him as a giant in the field of radiology.

Maklansky has characterized Wolf, Marshak, and Khilnani as follows: “Although they had different personalities, they all shared a passion for excellence, a remarkable dedication to their work, and intellectual and mental energy to allow them to pursue their goals relentlessly until achieved.”

John E. Moseley served Mount Sinai for four decades (1943—1983) as its first pediatric radiologist. Internationally recognized for his expertise in bone radiology, he was often requested by anthropologists to study x-rays of ancient bones. Invited to Peru for the opening of the Museum of Paleopathology, he had the opportunity to review x-rays of Peruvian mummies; his report became part of a conference on Human Paleopathology, sponsored by the National Academy of Sciences in 1965. Moseley’s conferences with radiologists and pediatricians were amalgamated into the textbook Bone Changes in Hematologic Disorders.’ He also provided the original description of the “spinnaker sail” sign, indicating a pneumomediastinum in the newborn,’ and was a co-author of the first publication to depict the changes of the lateral spine in Trisomy­21.20 A warm individual with a fine sense of humor, Moseley became in­volved in many of his community’s projects, including the Harlem Cancer Committee and the local Sickle Cell Anemia Association.

For decades, Charles Newman and Claude Bloch, associates in practice, were invaluable members of the Department. Bloch edited “Radiologic Notes” in the Mount Sinai journals for a number of years; Newman, who would endow a Professorial Chair in the Department, was another superb teacher of students and residents.

Yun Peng Huang joined the Department after completing neuro­surgery training at Mount Sinai in 1961. His contributions to neuroradiology over the next thirty-five years were remarkable. In collabora­tion with Wolf, he provided the first anatomic delineation of the venous drainage system of the posterior fossa, a noteworthy achievement. His insightful observations guaranteed his reputation as a world-class neuroanatomist.

A most productive member of the Department from 1970 to 1986 was Murray Baron, the first interventional radiologist to perform intra­arterial angiographic studies at Mount Sinai. His angiographic­anatomic correlation of the changes that occur with endocardial cushion abnormalities was a major accomplishment. Harold Mitty, the current Chief of Interventional Radiology and Urologic Radiology, has spent his entire career at Mount Sinai. A founding member of the Society of Cardiovascular Radiology, he also served as President of the New York Roentgen Society and serves on numerous radiologic journal editorial boards. The author or co-author of more than 150 publications, Mitty runs a fellowship program that is highly sought after by budding interventional radiologists. From the earliest days of ultrasound imaging, Hsu-Chong Yeh has provided outstanding diagnostic services, and in his writings he has made significant contributions to the field.

Recruited to Mount Sinai by Wolf in 1961, Jack Rabinowitz left after five years on the staff to become Chief of Radiology at Brooklyn-Cumberland Medical Center, Kings County Hospital, and then Chairman of the Department at the University of Tennessee. He returned “home” in 1978 to become Chairman at Mount Sinai, succeeding his mentor. During Rabinowitz’s tenure, the Department assumed responsibility for radiologic care at City Hospital Center at Elmhurst, Queens Hospital Cen­ter, and the Bronx Veterans Administration Medical Center. The resi­dency training program, which included rotations to all of the institutions as well as Mount Sinai, increased to more than forty Residents. There was also a concomitant increase in faculty. Many of the graduating Residents have remained on the faculty: Kathleen Halton is now in charge of the Resident training program; David Mendelson, in addition to his expertise in chest and body imaging, has played a major role in the Medical Center’s efforts to upgrade computer technology. Karen Norton, the pediatric radiologist, and Robert Shapiro, in ultrasound, among others, have joined Peter Som, an acknowledged expert in head and neck radiology, and George Hermann, whose clinical activities include mammography and bone imaging. Rhona Keller has provided stellar gastrointestinal radiologic services for many years.

Rabinowitz occupied many prestigious positions during his sixteen years as Chairman. He served as President of the New York Roentgen Society and was Editor-in-Chief of Radiology Today during its entire existence, as well as a reviewer for the American Journal of Radiology. For twenty-five years he was an examiner for the oral examinations for the American Board of Radiology and was Chief Proctor for the written boards. Rabinowitz is the author of two books and fourteen chapters, as well as more than 125 papers. His initial description of the roentgen sig­nificance of the pulmonary ligament was an important contribution to the radiologic literature.

During Rabinowitz’s tenure, efforts commenced to enlarge and modernize the Department of Radiology. With the opening of the state-of-the-art Radiology Imaging Center in the summer of 1994, Mount Sinai became New York City’s preeminent source for ambulatory, comprehensive radiologic services. Offering a full range of technologically advanced diagnostic capabilities in a single location, the Center has enhanced the delivery of patient care, as well as providing the requisite tools to train tomorrow’s radiologists and facilitating imaging research.

In 1995, Burton P. Drayer was appointed the Dr. Charles M. and Marilyn Newman Professor and Chairman of the Department. A nationally recognized authority on the use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) for the diagnosis of neurological disorders, Drayer came to Mount Sinai from the Barrow Neurological Institute in Phoenix, where he was Chairman of the Division of Neuroimaging and Director of MRI. His clinical research interests focus on the normal aging brain and on the use of innovative imaging techniques for the early detection of Alzheimer’s disease, Parkinson’s disease, and brain infarction. The author of nearly two hundred publications, he has written extensively on improving diagnostic specificity in multiple sclerosis and primary brain tumors. Drayer played a leading role or was the initiator of a variety of techniques that are routinely utilized in animal models and patients for applying functional concepts to anatomic CT and MR imaging: intrathecally enhanced CT Cisternog­raphy, xenon-enhanced CT scanning for regional cerebral blood flow, brain iron detection using standard MRI, and carotid and intracranial MR Angiography.

Drayer holds leadership positions in several radiologic associations; he is Chairman of the Task Force on Appropriateness Criteria for Neuroradiology of the American College of Radiology, Editor of Neuroimaging Clinics of North America, and Chairman of the Public Relations Committee of the Radiological Society of North America. In 2000, he served as President of the American Society of Neuroradiology (ASNR). He was the founder of the Research Foundation of the ASNR and served as Chairman of the Foundation’s Board from 1995 to 2001. Drayer is currently (2002) President-Elect of the New York Roentgen Ray Society.

Drayer is developing programs to build a service-oriented, user-friendly Radiology Department of the future. The goals of this “Radiology 2000” initiative include radically altering the Radiology inpatient physical plant and equipment to match the quality of the Radiology Imaging Center; transforming Radiology into a digital filmless image and information management department that pursues clinical excellence; providing a resource of data management and clinical expertise for the entire Health System; expanding basic science and research ac­tivities; and reevaluating the education of physicians-in-training to prepare them for the changing world of healthcare.