Ben Cassen and the D e v e l o p m e n t of the Rectilinear Scanner

William H. Blahd

The development of the rectilinear scanner by Bone- defining event in the evolution of clinical nuclear
dict Cassen was preceded by his successful fabrication medicine. In 1956, Kuhi and his colleagues developed a
of a directional scintillation detector probe. In 1950, photographic attachment for the Cassen scanner that
Cassen assembled the first automated scanning sys- improved its sensitivity and resolution. With the devel-
tern that was comprised of a motor driven scintillation opment of organ-specific radiopharmaceuticals, a com-
detector coupled t o a relay printer. The scanner was mercial model of this system was widely used during
used to image thyroid glands after the administration the late 1950s until the early 1970s to scan the major
of radioiodine. Initial studies that were performed at body organs. The decline of the rectilinear photoscan-
the West Los Angeles Veterans Administration Medi- ner began in 1973 with the advent of computed axial
cal Center led to the extensive use of the scanning tomography.
system for thyroid imaging during the early 1950s. Copyright 9 1996 by W.B. Saunders Company
Cassen's development of the rectilinear scanner was s

T HEdevelopment
SEMINAL EVENT leading to the vised a wide-angle scintillation detector also by
of the rectilinear scanner cementing calcium tungstate crystals on the
was the discovery in the early part of this tube-end window (Fig 2). The sensitivity was so
century by Rutherford and others that crystals high that 24-hour thyroid uptakes could be
of high density and transparency would absorb obtained with administered doses as low as 1
~/photons, producing light flashes called scintil- p.Ci (37 kBq). G-M systems required doses of
lations. In 1947, Kallmann 1 devised a scintilla- 100 to 200 p~Ci (3.7 to 7.4 MBq).
tion detector by attaching organic crystals of Because the UCLA Hospital and Medical
naphthalene to the face of a photomultiplier School were not in operation at the time of
tube that was able to amplify and transform these developments, a collaboration was devel-
crystal scintillations into electrical pulses. This oped with the Radioisotope Service at the West
detector proved to be much more efficient in the Los Angeles Veterans Administration Hospital.
detection of ~/ rays than the Geiger-Mueller The opportunity to explore the use of the
(G-M) counter, the only existing device at that scintillation detector was seized upon by Dr
time capable of detecting radioactivity. Herbert Allen, Jr, the first Chief of the Radioiso-
The first scintillation detector especially de- tope Service, who helped to initiate the coopera-
signed for the detection and localization of tive program. One of the first applications of the
radioactivity in biological systems was con- detector was an attempt by manual scanning to
structed by Cassen et al 2'3 in 1949 at the Atomic delineate the morphology of the thyroid gland.
Energy Commission's University of California The detector was attached to a stand projecting
at Los Angeles Atomic Energy Project. It was a over the thyroid gland. After the administration
directional scintillation probe consisting of cal- of 100 to 200 IxCi of 131I (3.7 to 7.4 MBq),
cium tungstate crystals optically coupled to a point-by-point counts were taken over a lucite
side-window RCA photomultiplier tube. An grid defining 400 counting positions that was
efficiency of 25.8% detection of iodine-131 ~/ placed over the patient's thyroid gland (Figs 3
rays was obtained in the first trials. With a and 4). 4 It took 1 to 2 hours to make a complete
single-channel lead collimator, tests showed mapping of the thyroid gland. This procedure
that a resolution of approximately 0.25 in. could
be obtained (Fig 1). The excellent performance
From the Nuclear Medicine Service, West Los Angeles
of the detector arrangement suggested its poten- Veterans Administration Medical Center, and the University of
tial for biological and medical applications. California at Los Angeles School of Medicine, Los Angeles,
Early tests showed that rabbit thyroid glands CA.
could be located easily and rapidly after the Address reprint requests to William H. Blahd, MD, Chief,
Nuclear Medicine Service (115), West Los Angeles VA Medical
administration of a 10-1xCi (370-kBq) tracer Center, 11301 Wilshire BIvd, Los Angeles, CA 90073.
dose of 131I. Later, with the advent of the Copyright 9 1996 by W.B. Saunders Company
end-window photomultiplier tube, Cassen de- 0001-2998/96/2603-000455.00/0

Seminars in Nuclear Medicine, Vol XXVI, No 3 (July), 1996: pp 165-170 165

166 WILLIAM H. BLAHD

~ l,:~ll:,.~ ,.r;.L . 2 ,

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,,:'-Removobl, , ,
i, Ii1i
~wod [ "2"aD. bro~
le~d pl~g Golclum tung~o~ tuae
cryBtol#

Fig 1. Side-window directional ~-ray detector. (Repro-

duced by permission of the copyright holder. 3)

Fig 3. Dr Herbert Allen mapping a thyroid gland with the

directional scintillation detector circa 1949. The detector could
was so tedious and labor-intensive that efforts be moved manually in two directions by means of two cranks.
were soon made to automate the system, lead- Radioactivity was recorded over the lined horizontal and
ing ultimately to the development of the auto- vertical rectangular coordinates of a lucite grid. (Reprinted
with permission. 14)
mated rectilinear scanner.
THE AUTOMATED RECTILINEAR SCANNER sively for more than 31A years, primarily for
The first automated rectilinear scanner was thyroid-gland imaging.
built at the U C L A Atomic Energy Project in Because the ribbon-tapper mechanism was
1950 by Cassen, Curtis, and Reed (Fig 5). 5,6 It subject to jamming, it was replaced in 1952 by a
was a simple device composed of a dual motor- system composed of thermal-sensitive teledel-
driven collimated scintillation detector and an tos paper that had been developed by Western
automated readout system controlled by a scaler Union for photo transmission and an electri-
that was mounted on an ancient x-ray tube cally activated metal stylus. Electric current
stand (Fig 6). Cassen coupled a stationary relay reflecting the count rate observed by the scintil-
printer to the moving scintillation detector with lation detector caused the stylus to heat, thereby
a tapper. When events were detected, electrical producing an imprint on the surface of the
impulses were generated that caused the tapper teledeltos paper. Images could be obtained
to strike a typewriter-type ribbon and imprint more rapidly and were of better quality than
the events on a sheet of paper in correct spatial
relationship to the position of the detector (Fig
7). The scanner was taken to the West Los
Angeles VA Hospital where it was used exten-

Fig 2. Wide-angle scintillation detector. Calcium tungstate Fig 4. Grid pattern of a nontoxic hyperplastic thyroid
crystals are cemented to the end-window photomultiplier adenoma (note increased counts at left lower pole). (Repro-
tube. (Reprinted with permission, e) duced by permission of the copyright holder. TM)
DEVELOPMENT OF THE RECTILINEAR SCANNER 167

Fig 5. (A) Schematic diagram and (B) first model of Cas-

sen's automated rectilinear scanner. (Reprinted with permis-
sion from Bauer, et al: Visual delineation of thyroid glands in
vivo. Journal of Laboratory & Clinical Medicine, vol 39, pp
153-158, 1952. TM)

those obtained with the original relay printer

system. Fig 6. Benedict Cassen and the first automated rectilinear
scanner circa 1950 (scanner is in the Smithsonian Institution
In 1950, Curtis and Reed, who were em- National Museum of History and Technology, Washington, DC).
ployed at the UCLA Atomic Energy Project,
left to establish the RC Scientific Instrument for the purpose of treating hyperthyroidism
Company (Playa Del Ray, CA) that would make with individually calculated doses of 1311.79 In
and sell scintillation detection instruments, in- addition, efforts were made to scan other or-
cluding rectilinear scanners. The first scanners gans, particularly the liver, using colloidal gold
used calcium tungstate crystals and single-
channel collimators, but, with the advent in
1951 of hermetically sealed thallium-activated
sodium iodide crystals available from Harshaw
Chemical Company (Solon, OH), sodium iodide
crystals rapidly replaced calcium tungstate in
commercial scanners. The first commercial thy-
roid scanner was an adaptation of an over-the-
bed hospital tray (Fig 8). Scanner models be-
came more sophisticated in the next few years
(Fig 9).
Scanning techniques were primarily limited
to the thyroid gland in the early 1950s. Numer-
ous articles were published using scanning tech-
nology to delinate abnormal thyroid gland mor-
phology and to determine thyroid gland weight Fig 7. Early automated rectilinear scan of the thyroid gland.
168 WILLIAM H. BLAHD

198 (Fig 10). 1~ However, the quality of these

images was of marginal clinical value.

THE PHOTOSCANNER
A major turning point in rectilinear scanning
took place in 1956 when David Kuhl, then a
resident in Radiology at the University of Penn-
sylvania, and his colleagues developed a modifi-
cation of the Cassen scanner that substantially
improved its sensitivity and resolution (Fig 11). 11
It used a glow lamp as a variable light source
that was focused on an x-ray film in a light-proof
box. The glow lamp was actuated by the scintil-
lation detector output and moved in register
with it. The advantage of this system was its
capability of producing multiple shades of gray
on x-ray film because of the varying intensity of
the light from the glow lamp. This development
subsequently led to a vastly expanded role for
Fig 8. The first commercial automated rectilinear scanner the rectilinear scanner in body-organ imaging.
manufactured by the RC Scientific Instrument Company. With the subsequent development in 1952 of

Fig 9. Advanced model of the

rectilinear scanner manufactured
by the RC Scientific Instrument
Company.
DEVELOPMENT OF THE RECTILINEAR SCANNER 169

Fig 12. Photoscanner circa 1958 manufactured by Picker

X-ray Corporation.

Fig 10. Hepatic rectilinear scan of a patient with metastatic

adanocarcinoma involving the right lobe of the liver obtained ing boxes. They seemed to convey more informa-
with colloidal radiogold mAU, (Reprinted with permission tion than the former dot scan printed on opaque
from Stlrrett at al: Clinical applications of hepatic radioactivity
surveys. American Journal of Gastroenterology, vol 21, pp paper. With the development of organ-specific
310-317, 1954.1~) radiopharmaceuticals, photoscan images of ma-
jor body organs, eg, brain, liver, kidneys, and
a multihole-focused collimator by Newell et a112 lungs, were readily obtained (Figs 13 and 14).
and the availability of 3-in sodium iodide crys- The advent of the rectilinear photoscanner
tals from Harshaw Chemical Company, the resulted in the rapid growth of clinical nuclear
Cassen scanner with its Kuhl modification be- medicine. Photoscanners were produced by mul-
came the commercial Picker photoscanner tiple manufacturers and were sold to hospitals,
(Picker International Corporation, Highland clinics, and physicians in private practice. The
Heights, OH) (Fig 12) and was soon used for nuclear medicine scan soon took its place as an
body-organ imaging throughout the industrial important contributor to the diagnostic process.
world in the late 1950s and early 1960s. The The development of rectilinear scanners reached
photoscanner appealed to nuclear medicine its peak in 1973 when more than 2.5 million
physicians and radiologists because the scans
were printed on standard-size x-ray film and
could be examined on conventional x-ray view-

Fig 11. Kuht's homemade photo recorder circa 1954. (Cour- Fig 13. Photoscan of the brain in a patient with a grade III
tesy of David E. Kuhl, MD) astrocytoma, Note "doughnut sign."
170 WILLIAM H. BLAHD

e a r scanning. I n t h e late 1970s, t h e r e c t i l i n e a r

s c a n n e r u l t i m a t e l y gave w a y to t h e scintillation
c a m e r a t h a t h a d b e e n d e v i s e d by C a s s e n ' s
f r i e n d a n d c o l l e a g u e , H a l A n g e r , w o r k i n g at t h e
U n i v e r s i t y o f C a l i f o r n i a D o n n e r L a b o r a t o r y in
Berkeley.
T h e d e v e l o p m e n t of t h e r e c t i l i n e a r s c a n n e r
was a defining e v e n t in t h e e v o l v e m e n t o f
n u c l e a r m e d i c i n e , a n d was t h e h a r b i n g e r of t h e
e m e r g i n g clinical discipline. C a s s e n was o n e o f
those rare human beings whose genius and
creativity t r a n s c e n d t h e i r e a r t h l y time. H i s con-
t r i b u t i o n s have h a d a m a j o r effect on o u r lives as
Fig 14. Photoscan of the liver with multiple large meta-
practitioners of nuclear medicine and on the
static lesions in a patient with adenocarcinoma of the colon. h e a l t h a n d w e l f a r e o f o u r p a t i e n t s . It is a p p r o p r i -
ate t h a t he t a k e his rightful p l a c e in t h e history
a n d e v o l u t i o n o f o u r discipline as t h e F a t h e r of
diagnostic scanning procedures were per- Clinical N u c l e a r M e d i c i n e .
f o r m e d . 13 M o r e t h a n 6 2 % o f t h e s c a n n i n g p r o c e -
d u r e s involved t h e brain. H o w e v e r , c o m p u t e d
axial t o m o g r a p h y , which was d e v e l o p e d in t h e ACKNOWLEDGMENT
e a r l y 1970s, s o o n r e p l a c e d t h e r e c t i l i n e a r b r a i n The author acknowledges the valuable assistance of Mrs
scan, l e a d i n g to a n i n e v i t a b l e d e c l i n e in rectilin- Kazuko Endow in preparing the manuscript.

REFERENCES
1. Kallmann H: Natur and Technik. July, 1947 with individually calculated doses of 1-131. Arch Intern Med
2. Cassen B, Curtis L, Reed C: A sensitive directional 99:194-201, 1957
gamma ray detector. UCLA Report 49, 1949 10. Stirrett LA, Yuhl ET, Cassen B: Clinical applications
3. Cassen B, Curtis L, Reed CW: A sensitive directional Of hepatic radioactivity surveys. Am J Gastroentero121:310-
gamma-ray detector. Nucleonics 6:78-80, 1950 317, 1954
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in clinical studies of human thyroid physiology using 1-131. J contrast photographic recorder for scintillation counter
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glands with an automatically scanning recorder. UCLA mators for gamma scanning with scintillation counters.
Report 130, 1951 Nucleonics 10:36-40, 1952
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1-131 use in medical studies. Nucleonics 9:46-50, 1951 rectilinear scanner: Nuclear medicine instrumentation 1970-
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