AJR 2000; 175:1507-1508
© American Roentgen Ray Society
Centennial Sounding Board |
Advancing Head and Neck Radiology into the 21st Century
Anton N. Hasso1
1
Department of Radiological Sciences, University of California Irvine Medical
Center, 101 The City Dr., Orange, CA 92868-3298.
Received August 15, 2000;
accepted after revision August 15, 2000.
Address correspondence to A. N. Hasso.
Prologue
As we approach the end of the first year of the new millennium or the
beginning of the new millennium (depending on who is counting), it seems
appropriate to reflect on the past century and to look forward to the future
century. The evolution of head and neck radiology is in many ways similar to
the evolution of other subspecialities in diagnostic radiology. Pioneers in
the field were often surgeons or clinicians who were intrigued by the
potential of X rays and tried to apply X-ray techniques to solve clinical
problems. As technology developed, new applications for imaging were added to
practice by radiologists. Now radiologists must learn about the clinical
issues to ensure proper and effective treatment of patients.
Maturation of Head and Neck Radiology
During most of the first half of the century, examinations consisted
primarily of barium studies (barium swallows, esophagrams) and radiographs
revealing foreign bodies, bony abnormalities, or calcifications. In the period
between the world wars, the complexity of procedures increased with the
development of techniques to image specific organs such as the larynx
(laryngography), salivary glands (sialography), and the lacrimal apparatus
(dacryocystography). Performance of these techniques required surgical skills,
and the field of head and neck radiology remained largely in the hands of
otolaryngologists, with input from diagnostic radiologists when the procedure
required fluoroscopy.
A major event leading to the maturation of the subspecialty was the
development of CT and complex-motion tomography. It is ironic that neither a
surgeon nor a radiologist discovered the most significant examination that
defined the field of head and neck radiology in its formative years. Ziedses
des Plantes, a neurologist from Holland, invented and developed tomography in
1931 [1]. It took nearly 30
years longer to develop complex-motion (hypocycloidal or trispiral)
tomography, which eventually led to detailed examination of the facial bones,
sinonasal cavities, temporal bones, and skull base.
Dissemination of the new imaging technologies into the field of head and
neck radiology evolved rapidly during the next 40 years. Selective catheter
angiography originated in Sweden and drifted to North America in the 1960s.
Selective vascular procedures heralded future developments in interventional
procedures in cerebral and extracerebral interventions. Single-photon emission
computed tomography (SPECT) in 1963, sonography in 1966, CT in 1973, MR
imaging in 1977, positron emission tomography in 1982, and MR angiography in
1990 became essential tools for head and neck imaging.
Progressive increases in the types and numbers of examinations made it
important to define the field and to determine the purpose and indications of
various procedures. The term "head and neck" originally
incorporated what is now referred to as neuroradiology. The classic two-volume
textbook authored by E. P. Pendergrass and J. P. Schaffer in the 1940s,
The Head and Neck in Roentgen Diagnosis, includes diseases of the
central nervous system [1,
2]. As recently as 1985, the
American College of Radiology published a syllabus for self-evaluation and
continuing education that used the term "disorders of the head and
neck" to describe the neural and nonneural structures in the head and
neck [3]. The subspecialty has
evolved to include imaging or interventional procedures that are needed to
treat patients who are cared for by otolaryngologists or head and neck
surgeons. An acceptable definition is the "subspecialty involved in
imaging or interventions of the non-neural structures of the head and
neck."
Problems and Solutions
Patients with head and neck disorders may present with conflicting signs
and symptoms. For example, symptoms of rhinorrhea and congestion are virtually
identical in patients with signusitis and in patients harboring sinonasal
tumors. This similarity may lead to a disconnection between a radiologist's
interpretation and clinical reality. To avoid such discrepancies, it is vital
that radiologists take advantage of learning opportunities such as head and
neck tumor boards. These specialized conferences are available in teaching
institutions and major hospitals. The interaction between surgeons, radiation
oncologists, medical oncologists, and radiologists is invaluable and leads to
better understanding of cancer detection and staging. Courses and seminars are
likewise vital opportunities to gain understanding of the nature and natural
history of head and neck illnesses.
To promote the field of head and neck radiology, the Executive Committee of
the American Society of Head and Neck Radiology has scheduled its annual
meetings in 2000 and 2001 with other specialty organizations. The importance
of education in the field of head and neck radiology continues to evolve. The
new draft of the Accreditation Council of Graduate Medical Education program
requirements for accreditation of neuroradiology training programs includes 4
weeks of dedicated training in head and neck radiology
[4]. The American Board of
Radiology has recognized the importance of head and neck imaging and has
incorporated case material into the examination for the certificate of added
qualification in neuroradiology.
Rewards and Opportunities
Head and neck radiology encompasses all aspects of imaging and many
critical interventional procedures, including placement of catheters,
dilatation devices, and stents into the drainage pathways of several organ
systems. Biopsies of superficial and deep lesions with various localization
methods are commonplace in most head and neck practices. Ablative techniques
are evolving that encompass thermal, cryogenic, and ultrasonic energies.
Functional procedures to detect nodal metastasis in both surgical and
nonsurgical patients require a knowledge and understanding of SPECT and
positron emission tomography techniques.
The diffuse nature of head and neck radiology has been instrumental in
preventing turf battles with head and neck surgeons or otolaryngologists. Such
opportunities are rare in current practice and require constant diligent
efforts by the radiologist to offer prompt, accurate service for optimal
patient care.
References
-
Pancoast HK, Pendergrass EP, Schaeffer JP, The head and
neck in roentgen diagnosis. Baltimore, MD: Thomas,
1940
-
Noyek AM. The history of otolaryngology/head and neck imaging in
North America. Laryngoscope
1997;107:298
-300[Medline]
-
American College of Radiology Professional Self Evaluation and
Continuing Education Committee. Disorders of the head and
neck, 3rd series. (syllabus) Chicago: American College of
Radiology, 1985:set21
-
Accreditation Council of Graduate Medical Education.
Program requirements for residency education in
neuroradiology. Chicago: Accreditation Council of Graduate
Medical Education. March 2000:revised draft
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Prologue
Maturation of Head and...
