The inception of Nuclear Medicine associated with Touro infirmary began with the recognition by Samuel B. Nadler, M.D. of the potential of radioactive tracers as a new and useful tool in patient management. This represented a new segment of scientific discipline and Dr. Nadler spent some time in 1948 at the Medical Division, Oak Ridge Institute for Nuclear Studies, Oak Ridge, Tennessee under the tutelage of the director, Marshall Brucer, M.D. This association led to the association with Robert T. Nieset, PhD, Director, Biophysics Program, Physics Department, Tulane University. This became a fruitful relationship between a physician with a strong interest in basic science and a scientist with a strong interest in biology and medicine. This was further enhanced by the interest of Hyman Mayerson, PhD, Director of the Department of Physiology, Tulane University The strength and skills of these three, presented with a vital opportunity, should and did produce the impetus and direction for a meaningful result.
As an important part of this foundation it should be noted that Mayerson, Nieset, Porter and others had collaborated on studies of circulating red cell and plasma volumes. In 1948, the definitive paper, "Determination of Circulating Red Blood Cell Volume with Radioactive Phosphorous", was published in American Journal of Physiology (155,226-231,1948) and in 1950, "Studies of Plasma Volume Using Human Serum Albumin Tagged with Radioactive Iodine 131" appeared in the Journal of Clinical Investigation (29, 513, 1950).
The state of the art, at this time, was essentially limited to the measurement of Thyroid uptake (I-131) and therapeutic application of I-131 to Thyrotoxicosis and P-32 to Polycythemia Rubra Vera and Chronic Mylegenous Leukemia.
In 1950, the program began with patients from Dr. Nadler's practice and the Touro Clinic. Thyroid uptake and therapy was offered. This was done under the Atomic Energy Commission (AEC) authorization of Dr. Nieset and the Biophysics Program.
Geiger counters, scalers and survey meters from the Biophysics Program were pressed into this service and the hallowed halls of physics took on the sometime appearance of a clinical facility. The arrival of an ambulance on campus never failed to cause some commotion.
It should be remembered that these were early days in Nuclear Medicine and ,the sole source of radioactive material was the government operated laboratory. The primary laboratory was the X-10 facility at Oak Ridge, operated by Union Carbide for the USAEC. This was the period before any radiopharmaceutical supplier was involved and the government laboratory would not provide guarantees o£ purity, strength, etc. It was necessary, therefore, that all shipments had to be subjected to a rigorous assay procedure and any secondary processing such as dilution or individual dosage preparations had to be carefully controlled in the user laboratory.
The arrangement for bringing patients to Tulane was not ideal for patient convenience and management and as the numbers increased it became apparent that the patient contact work should be moved into the hospital environment. Dr. Nadler presented the proposition to the administration at Touro Infirmary and it was accepted. Gestation was complete and Nuclear Medicine was about to see the light of day at Touro.
The Department of Biophysics was formed and Dr. Nadler was named to head the new Department. The initial acquisition of equipment consisted of:
- SCALER, Nuclear Instrument and Chemical Co., Model 263
- GM Probe, Bi cathode RIDL
- Monitor, Beckman, Model MX-2
In addition, a "folding-arm" from a discarded dental x-ray unit was contributed by an x-ray supplier and this was adapted and mounted on a base fabricated by the mechanical services at Touro. Total cash price for the above was $3,500.00. It is a little hard now to recognize that this was a precursor of our present brain scanning techniques.
It was in this period that the work of Dr. Reuben Flocks appeared in the literature in which he reported some success in treating carcinoma of the prostate with direct injection of radioactive gold colloid. This work captured the attention of one of our Urologists, Dr. Paul Getzoff. He visited Dr. Flocks to learn the procedure and in December this technique was introduced at Touro with the cooperation and participation of the Biophysics Department and Operating Suite personnel. This procedure presented same special new problems which required modification of existing operating room procedures to accommodate the special problems associated with radiation.
In the words of the OR supervisor, "You want to bring those dirty lead bricks and a garbage can into my operating room?" This was ameliorated by wrapping the bricks in clean paper and the use of a “special” garbage can painted a bright yellow with radiation warning insignia in magenta. The can was fitted with casters and a concrete liner for shielding. The purpose of this special can was that of a repository for radioactive waste.
The real problem in this procedure was the protection of the immediately attending personnel during the actual injection after surgical preparation and exposure of the sites of injection. This was solved by the design and fabrication of an elaborate syringe shield which featured one-half inch lead shielding for the ten cubic centimeter syringe and a screw-drive mechanism to operate the syringe.
In early 1951, the department was assigned space "back of the clinic" in a small room next to the service elevator. Part of the waiting area of the clinic was used for patient waiting.
The initial sequence of events began with the receipt of the radioisotope shipment in Biophysics at Tulane. The material was then assayed and prepared as individual diagnostic doses and standards of 50 microcuries each. These doses were prepared in liquid form in capped test tubes and transported to Touro in a lead-lined test tube carrying case on each Wednesday. The patients were assembled on B-2 and the doses were administered in the treatment room. The patients were then instructed to return the following day to the clinic area for counting. These tasks were performed as a part-time responsibility of the physicist, Mr. Hidalgo.
This Thyroid Uptake study and Radioiodine Therapy to the Thyroid were the only procedures offered at this time. The therapy doses were prescribed by Dr. Nadler and individually prepared, assayed and administered to the patient at Touro.
In 1956, Marshall Brucer's group, the Medical Division at ORINS developed an isotopic mixture, called "Mock Iodine" which simulated the gamma ray spectrum of I-131 and this provided the mechanism for one of Brucer's one-question projects, "What is the correct way to do a Thyroid Uptake?"
He developed a series of simulated patients (mannequins) with Mock Iodine and these were circulated around the world and laboratories were asked to measure the "uptake". The data was assembled and the consultants met. The results were quite varied and the discussions were very vigorous and animated. (The results from the Touro system of 1951 were correct).
Drs. Nadler and Bloch collaborated in preparation of the definite review paper "A Resume of Methodology an the Study of Thyroid Function", which appeared in the Southern Medical Journal in December of 1956.
The most significant event of 1959 was the acquisition of the Cliniscanner. This was one of the first practical, commercially available mechanical scanning devices. The unit was designed by J.R. Maxfield and others and was marketed by the Picker Corporation. Recollection is that the instrument cost about $2,800! Most of the current (1976) imaging machines range in cost from $70,000 to $180,000 but this is like comparing a Stanley Steamer with a current model Cadillac. However, this early machine gave us the capability of reasonable visualization of the distribution of radioactive iodine (I-131) in the Thyroid. This added a new and significant dimension to the diagnostic evaluation of the "Thyroid Patient".
It was also in this year that the efforts of Brucer's Thyroid Uptake Committee bore fruit and a reasonable basis for standardization now existed.
After leading the department for another fruitful nine years, in 1968, Dr. Nadler reduced his work commitments significantly and turned over the Departmental Leadership to Dr. Bloch. On November 28, 1969, Samuel B. Nadler, M.D., died. His skill as a clinician and teacher was virtually legendary in his time. His first training was that of a Biological Chemist (PhD, Harvard, 1930). He came to Tulane as an Instructor in 1930 and subsequently entered Medical School at Tulane, receiving his M.D. in 1936. His interests were diverse and intensively pursued. Among his many accomplishments was a Golden Gloves Championship while an undergraduate, a life master bridge player and a series of championships on the rifle range.
Ever the perfectionist, he was a gracious host and a formidable opponent in debate. His life was characterized by strong drives and motivations. Dr. Ted Bloch continued as Director of the Biophysics and Nuclear Medicine Department which was given the additional designation of the Samuel B. Nadler Memorial Department of Nuclear Medicine.
This content was gleaned from a paper by John U. Hidalgo.