Pediatric X-Ray Diagnosis

Although x-rays were used in the diagnostic study of infants and children within a few weeks after Roentgen announced his discovery, the roentgen method has never been, and is not now being fully utilized in pediatrics. As early as 1898 Escherich commented that roentgen examinations were not being made as frequently in infants and children as in adults. In the United States prior to the first World War, roentgen facilities were non-existent in many large pediatric clinics; and, with few exceptions, both pediatricians and roentgenologists were then unfamiliar with the diagnostic value of the roentgen investigation of young patients. Notwithstanding these adverse circumstances, roentgenology made early and substantial contributions to both the clinical and experimental investigation of the skeletal lesions of rickets, scurvy, and syphilis, and a number of other pediatric diseases. During the 1920's the great value of roentgen examination in the congenital obstructive lesions of the alimentary tract became manifest when their successful surgical treatment was demonstrated, largely owing to the pioneer efforts of Ladd of Boston. The diagnostic roentgen features of congenital hypertrophy of the pyloric muscle were reported in accurate detail for the first time by Meuwissen and Sloof of Holland in 1932. Reynolds of Detroit, in 1925, first described the roentgen changes in the skeletons of children suffering from Cooley's anemia; the skeletal lesion was one of the principal features which led to the recognition of Cooley's disease as a separate entity. During the 1930's excretory urography was introduced into the United States and it became clear immediately that this roentgen technic would greatly ameliorate the study of chronic pyuria, long a difficult and important pediatric problem. The roentgen method was also being gradually utilized more frequently in general pediatric diagnosis in a variety of ways ; in the study of pulmonary diseases, infantile hydrocephalus, and many of the diseases of skeletal growth. In comparison with adult roentgenology, however, pediatric roentgenology was still a comparatively and seriously neglected subject. Infants and younger children were often incompletely examined or examined not at all, owing both to their inability to cooperate and to their actual resistance to roentgen examination. Most roentgenologists, busy with more pressing problems in adult medicine, had relatively little time to devote to the special diagnostic features and technical problems of pediatrics. During the last decade pediatric roentgenology has expanded rapidly owing to several factors. Better roentgen images of infants and children are now more easily obtained with the faster exposures which can be made with the newer roentgen machines; now there are actually no serious difficulties in the examination of very young—even uncooperative—children and newly born infants.