Modern radiology has come a long way since its early origins more than 100 years ago with the discovery of X-rays. Today it is an integral part of medical practice, both in making diagnosis and in treatment. From those humble beginning of plain x-rays, we are now faced with a wide array of imaging methods using X-rays and a few non X-ray based methods eg. ultrasound, magnetic resonance imaging and nuclear medicine. The discovery of X-rays was also responsible for the birth of radiotherapy. We will look at how some of these have evolved.  

The discovery of X-rays was accidental. X-rays were discovered by a physics professor by the name of Wilhelm Conrad Roentgen on the 8^th of November 1895 while working on cathode ray tubes in his darkened laboratory. He noticed that some paper coated with a fluorescent material began to glow when the tubes were switched on which could only happen if the cathode ray tubes were emitting rays. Not knowing the properties of these rays, he called them X-rays. From further work, he learnt that these rays could penetrate most objects including his own hand. He then decided to use photographic plates to record the images. The world heard about this discovery in January 1896. Roentgen was awarded the first Nobel Prize in physics in 1901.

Radioactivity results from the inherent instability of some matters, which disintegrate, and in the process, emit radiation. Radioactivity was discovered soon after the announcement of X-rays. The intial discovery was made by Henry Becquerel (who was Professor of Physics at the Ecole Polytechnique as well as holding the Chair of Physics at the Museum in Paris) and this again was greatly accidental. The discovery was made known to the world in February 1896. The next major discovery was made by Marie and Pierre Curie who were responsible for extracting radium from ores. For all their contributions, Henri Becquerel and the Curies were awarded the Nobel Prize in Physics in 1903.

The next step was the synthesis of artificial radioactive materials where in 1920; E. Rutherford and J. Chadwick showed that the nuclei of light elements could be disrupted by alpha particles. IN  1933 to 1934, Irene Joliot-Curie (daughter of Marie Curie) together with her husband, Frederic discovered that some ordinary metals could be made radioactive when bombarded by alpha particles. For pioneering this work, they were awarded the Nobel Prize for Chemistry in 1935.

Very shortly after the discovery of X-rays, they were used to treat cancers. This area of specialty is called radiotherapy thought it is now often referred to as radiation oncology (which means the science of cancer). Different types of radiation other than X-rays have been used to treat cancer. The amount of energy deposited in the tissues is thousands of times greater than that used for taking routine X-ray pictures.  This intense radiation is able to kill the cancerous cells. Radiotherapy is also used to treat disease other than cancers.

Initially, the X-rays used were not very powerful and could not be used to selectively treat cancers deep within the body without causing extensive damage to the normal adjacent tissues. This situation has changed when more powerful radiation sources, eg betatron and cobalt-60 units, were developed after the Second World War. Presently radiation treatment is being provided by linear accelerators or “linacs”. Artificial radioactive materials have also been used to treat cancers. This is done by putting the radiation source directly in contact with the cancer. This method of treatment is called brachytherapy.

Radiology was introduced in the Malay Peninsula soon after the discovery of X-rays, i.e. February 1897, with the installation of the first x-ray machine in South East Asia. This occurred in Taiping, Perak. Unfortunately the first subject did not benefit very much from the event, since it was a Pomfret fish that was X-rayed. This demonstration was carried out by a Mr. Wray. This historic event took place even before availability of public lighting (first installed at the Kuala Lumpur Railway Station) or hydroelectric power (the first of which was constructed by a mining company in Raub). A complete X-ray machine was donated to the Government Hospital in Ipoh in October 1897 in commemoration of Queen Victoria’s Diamond Jubilee Celebration. There is documentary evidence of X-rays being presented at a meeting of the Malaysian branch of the British Medical Association in 1905. The General Hospital in Kuala Lumpur received its X-ray equipment on the 15^th of February 1910 followed by the Penang General Hospital in that same year.

In 1920, Dr Harold Mowat was appointed radiologist to the Federated Malay States but he was also responsible for both the electrotherapy and radiotherapy. Unfortunately, he died three years later following which Dr CF Constant was appointed radiologist. In 1924, the first dark room to process X-ray films was built at the Kuala Lumpur General Hospital (KLGH). Prior to this, the X-ray plates were developed by local photographers. By 1927, the General Hospital, European Hospital and the New Hospital Site at Circular Road (all in Kuala Lumpur), District Hospital Ipoh and Seremban Hospital had new x-ray equipment. The new hospital on Circular Road was originally called the Pauper’s Hospital. Currently, this is the site of the Hospital Kuala Lumpur. The then KL general Hospital was located at the site of the Tanglin Hospital. The first fluoroscopy machine was installed in 1927. Dr PTK Nayar was the first Malaysian to qualify with a Diploma in Medical Radiotherapy/Radiology and Electrotherapy (D.M.R.E.). In 1956, Dr YC Lian became the first radiologist in private practice. Dr Omar bin Din as the first Malaysian to be appointed Consultant Radiologist of Selangor & the Federated Malay States in 1957.

Mobile Mass Miniature Chest X-ray vehicles were used to take chest X-rays of people in the rural areas following the setting-up of National Tuberculosis Centre (NTBC) in 1960. Malaysia’s first school of radiography was set up in the KLGH in 1963. There were 14 students in that intake. Cerebral angiography was first performed in the same year at the KLGH while peripheral angiography was first performed in Penang General Hospital in 1966. Cardiac angiography was done in the University Hospital, Kuala Lumpur in 1967. The School of Radiotherapy started in 1969.

Mammographic services were started in KLGH in 1972 using a dedicated mammographic machine. Ultrasound came on the scene in 1974 when the Faculty of Medicine, University Kebangsaan Malaysia bought the first machine. 1977 saw the introduction of Computer Tomography when a scanner was installed in Institute of Radiotherapy and Oncology, KLGH. University Kebangsaan Malaysia started a training programme for radiologists in 1983 conferring a Masters of Radiology. MRI was installed in the KLGH in 1992.  

The first use of an X-ray apparatus for treatment purposes was in 1914 when it was used to treat some cases of skin cancers and other skin lesions. The first use of radioactive material i.e. radium for radiotherapy occurred in Singapore in 1926. Radiotherapy services probably started in Malaysia in 1949 with Dr Lynch as the first Radiotherapist in KLGH. From 1959 to 1960, the services were being provided by a Dr Lai from Singapore. Dr SK Dharmalingam was appointed the first Malaysian Consultant Radiotherapist at KLGH in 1960 while the first physicist appointed to work was MR George Phang. In 1968, a new Radiotherapy Department was built at the KLGH. The idea of a local School of Radiotherapy for radiographers was initiated in 1968 with the school actually starting at the KLGH the next year.

Nuclear Medicine facilities came on the local scene rather late with the first department of Nuclear Medicine starting as part of the Department of Radiotherapy in KLGH in 1964. The first Nuclear Medicine Technologist was Mr Anthony Ng. This was followed by the Nuclear Medicine Unit at the University Hospital, Kuala Lumpur. Presently there are six institutions, which provide Nuclear Medicine facilities, and these include the University Hospitals of University Kebangsaan Malaysia and the University Sains Malaysia among others.  

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Last Updated:
Thursday, 21 August, 2003