Collective Fluorography

TWO methods of x-ray analysis have been available for the thoracic survey of large groups of individuals. One, radiography, is expensive and impractical, while the other, fluoroscopy, requires the services of a considerable number of skilled specialists (about 150 per million examinations per annum). The method of fluorography or fluoroscopic screen photography, or indirect radiography, which has also been called roentgen photography, does, however, permit practical chest surveys of large groups effectively and at a low cost. Indirect radiocinematography, an expensive method, is still in the experimental stage and may eventually be useful for certain types of research and teaching, but it is not to be confused with the method of roentgen photography utilized by the writer for tuberculosis prophylactic surveys. Though fluorography was attempted long ago by many workers, the early results were unsatisfactory. Blyer (1896), MacIntyre, Porcher, Köhler, Lomon and Comandon, Cole, and others experimented with the method. In 1918, and later, in 1924, we attacked this problem diligently but were unable to obtain decisive or practical results. Then most of the work was directed exclusively to the solution of the problem of radiocinematography. More recently this has been accomplished by Reynolds, Djean, and Janker. We inaugurated the first installation of fluorographic apparatus for the purpose of carrying out a collective thoracic survey at the German Hospital of Rio de Janeiro, in 1936; thus our priority cannot be contested. In 1937 three additional centers were operating, one in the Public Health Department of Rio de Janeiro, one in the Navy Hospital, and one in the Public Health Department of Victoria. At present,2 due to the great interest aroused by this work, we have 25 installations in Brazil and many others in Argentina, Chile, Uruguay, Germany, France, etc. The method has also been carried to the United States by Dr. D. O. N. Lindberg, of Decatur, Illinois, who, after his visit to us late in 1937, introduced fluorography in his sanitarium. Our attempts, in 1937, to interest American manufacturers in the construction of this apparatus were unsuccessful. To-day, three years after the first practical results were achieved, collective fluorography is universally accepted. At the beginning of this work, there were many roentgenologists who expressed themselves in opposition to the procedure but have since become convinced as to its practicability. The objections with which we had to contend at the beginning were principally that since the initial roentgenological indications of tuberculosis are frequently very vague, fluorography would not show sufficient detail to demonstrate early tuberculosis, and that fluoroscopy in various planes was essential to diagnosis. Also, the wear and tear on x-ray tubes from the exposures on a large scale would make the procedure expensive.