RANZCR Trailblazers

Remarkable Careers

We continue our RANZCR Trailblazers series with more excerpts from the oral history interviews made in 2016 by the then College archivist, Ms Eva Stokes- Blake. In this edition, read on for more insights and recollections from Professor Lesley Cala and past president Dr George Klempfner.

In these excerpts we see where a career in radiology or radiation oncology can take you and the breadth of life experience and practice opportunities offered. Many and varied interactions with colleagues, fellow researchers, patients are recounted as particularly life-enhancing.

We see where these trailblazers have seized opportunities, dealt with setbacks including the experience of being both doctor and patient, and sometimes made their own luck. We see also the sheer range of clinical advancements over the years and the advances in teaching and examining.

As Dr George Klempfner puts it, “To my non-medical friends who play golf, I say, I don’t need to play golf, I can stick needles in things and enjoy the accuracy with which I can do that. I think that’s far more useful than and just as enjoyable as playing golf.”

We thank Eva Stokes-Blake for her invaluable work in amassing oral histories for future generations of radiologists and radiation oncologists. We would also like to invite your expressions of interest to actively participate in clinician-to-clinician interviews of RANZCR Trailblazers (of your nomination), more details are available via editor@ranzcr.edu.au. Interviews can be made face-to-face at RANZCR2022 ASM or now in your home city or via an online meeting.

Access the full recordings from the three interviewees for much more detailed history of the professions and the College here: www.webcast.ranzcr.com/ Mediasite/Showcase

We hear first from Professor Lesley Cala on a few of the clinical advancements that benefited patients and clinicians.

Professor Lesley Cala

Professor Lesley Cala

You have the honour of being the first radiologist in Australia to perform spinal angiograms and orbital venograms. Could you please share your memories from these days?

The first orbital venogram was performed in 1971 at St John of God Hospital (STGH), in Belmont, which is a suburb of Perth, and published with additional cases in Australasian Radiology March 1972. My radiographer was a very enthusiastic nun who was thrilled to be involved with the case.

She was later put in charge of radiography at St John of God in Bunbury. I taught other radiologists the technique, including the late John Kennedy at Princess Margaret Hospital for Children and Trevor Apsimon at RPH, during 1971. It was very useful to show a surgeon pre-op the full extent of venous malformations in order to decide if the operation had anything to offer, without damaging the optic nerve.

Spinal angiograms were learned in Paris from René Djindjian at the Hôpital Lariboisière and performed by me at Sir Charles Gairdner Hospital in 1973. The patient had a vascular malformation around the spinal cord which was causing backache and he was troubled also with infertility. Safe corrective surgery to the malformation was then possible because the surgeon could identify the feeding arteries and draining veins pre-op and plan accordingly.

Would you like to share any other memories specifically regarding the development of radiology equipment and technologies?

My initial carotid angiograms in 1966 were by direct puncture of the artery in the neck and the films were handpulled through a cassette holder. It was essential to have good co-operation between the radiographer and myself because only four films could be taken. The radiologist had to call ‘shoot’ which coincided with the injection of 10 mls of contrast and the first film of four being taken. After that the radiologist had to call ‘pull” three times for the radiographer to first take an exposure and then remove the cassette to leave the next one ready to be exposed.

If both carotid arteries had to be examined, one pressed on the first one to achieve haemostasis and then went ahead and punctured the other side. One was always on the look out for the first side starting to bleed while the needle was still in the second side, or after an anaesthetist had removed the endotracheal tube!

With the development of image intensifiers and the Elema Schönander automatic film changer in 1962, it meant that more than four films could be taken and the machine took over “calling” the orders. Also at that time, RPH commenced to use the Seldinger method (started in Sweden in 1956) which consisted of introducing an arterial catheter in the groin, instead of puncturing the neck, and following it up to the aortic arch to catheterize carotid and vertebral arteries.

Air encephalograms and myodil ventriculography had been accomplished with difficulty prior to the use of image intensifiers in 1964. However, the major advance for both procedures was when STGH purchased a MIMER 3 ensemble in 1973. This had a chair attachment to the table, with an open back to allow the lumbar puncture with the patient sitting upright and then it was possible to rotate the patient, still strapped safely into the chair, forward and back to fill selective parts of the ventricular system.

It was a horrible procedure giving the patient a severe headache and they might vomit for a few days. Within one week of seeing what the CT scanner could show in 1975, this procedure was not ever done again by me.

Dr George Klempfner

Dr George Klempfner

On mentors

I don’t know if you have a lot on Professor Hare in your archives but there is this story about him that he, I think, topped his year in medicine. He then developed tuberculosis and he was close to death and one of the first people treated with streptomycin which had just come in as a treatment for TB. So his life was saved but he had a lot of problems from, for instance, a fused shoulder, because he had tuberculosis of the shoulder, and when he recovered his doctor said ‘look, you’ll have to lead an easy life, you can’t become a physician as you wanted to or a surgeon, you can either become a dermatologist, a pathologist or a radiologist’ at that time, a radiologist was a rather boring profession, and in his words, he thought ‘I may as well shoot myself’. Anyway, it was not so at all and he started in a profession which has really blossomed and became one of the most interesting parts of medicine.

I regard him as one of the most important mentors in my life and I admired him very much.

On luck

In this life you have to be lucky and I’d just like to say I feel that in my life I have been lucky but also you have to take the chance to make your luck.

On the benefits of a career in radiology: the people, places and opportunities

I realised that as a wealthy country we had resources here which we should try and make available to the people in the South Pacific; places like Fiji, Western Samoa, Tonga and even smaller places like Niue and so on, so we set this committee up and we arranged that people from radiology and radiography, cause some of these islands are so small they don’t have a radiologist, would come to our College meeting, we also arranged for radiologist to come to departments to further their education, we also brought education resources to the island. That was something I felt we really helped people and I really enjoyed the interaction between us and them.

I was sent (to Samoa) as a result of my involvement with the ISR because it was a project I was sent on with World Health, so I did a report for World Health on Western Samoan radiology. My wife came with me and we were housed at a hotel called Aggie Greys, Aggie Greys is the only hotel virtually on the island and it’s quite famous in fact it features in a book by Somerset Maugham in a very famous short story called Rain, which I had read. When I arrived there, I realised there was only one radiologist on the island, Veni Siva, and when he was away no radiology got performed, there was nobody else to take over from him. He did all the reporting, he didn’t have a dictaphone, he handwrote his reports. And there was another strange system there where an X-ray cost very little, just a few dollars, but the system was, you could have as many X-rays as you wanted. So when a patient was referred for an X-ray of the chest, the referring doctor would say, ‘oh and X-ray his skull, he’s had some headaches as well’ and things like that.

I think the companionship one gets as a councillor was great, you know, I have been on a lot of committees before and since and there is a sought of comradery and unity of purpose that I found amongst most of the councillors and I can’t really remember really very many angry words at any stage and I was on council a long time and I really enjoyed the companionship, the comradery, the unity of purpose. With the presidency I felt very privileged to be the president and feel very lucky as I was president in the year of the Roentgen centenary and so not only was it being the president and having the annual meeting it was also part of the centenary which made it a very exciting year, so I enjoyed that. I also enjoyed all the friendships I made as a result of being part for just going to the meetings and part because of my position in the College. I have a lot of very good overseas and Australian friends who I have made as part of having had that position.

On continual learning

Initially I was an examiner in physics, and then I moved on to became an examiner for the second part. I found being an examiner was in fact incredibly invaluable because you give something to the College in all of this but you learn an awful lot, when you have to examine in something, you do your research and that you know that subject well so I found that it was educational to me.

As well as nuclear medicine, I was the director of a few places, I took great interest in mammography. I was the director of mammography at Cabrini hospital where I spent most of my time. In an effort to really excel in this, I had to join BreastScreen for a while and found that really valuable too. Because when you report to BreastScreen you get an assessment of your performance. Each case you see is recorded and any false positives or false negative you make is recorded against your name so you can quantitatively assess your performance, I found that interesting and very valuable.

So really my career in radiology, like everything else, I must be a really positive person, I have really enjoyed it but it was continual learning. So one graduates, one does nuclear medicine, one does ultrasound, one learns CT. I decided MRI was one thing too many, you can cast yourself too far so while I understand the principals in MRI, I never tried to become an expert in MRI but then I performed and enjoyed mammography and also some of the more simple interventional work. I had done a bit of angiography when I worked as a register, but thought this was too specialised, you either did it full on or you didn’t. But there are other interventional procedures that the general radiologist can do safely with skill and I think I enjoyed those as much as anything else I did in radiology.