The inside view (1979)

[Music] this is an image of a human fetus a fetus just 12 weeks old and only 6 cm long this unique view of the development of an unborn child has been built up by high frequency sound waves it is one of many new techniques with which now we can look inside the living body in this film we will see many such inside views there are images built by computers images which will add to our understanding of how we work images that may affect the nature of medicine for the ability to see and understand our bodies is the foundation on which modern medicine is built 700 years ago human anatomy was based on the dissection of animals and Theological teaching medicine had little scientific basis remedies were often inappropriate and failed disease was seen as the wroth of God death a Horseman against whose arrows the only Shield was [Music] prayer with the Renaissance came the first challenge to such views man began to look closely at [Music] himself the great anatomists such as velus and D Vinci painstakingly and systematically dissected and Drew the structures of the body muscles ligaments and Bone these Exquisite drawings were the first major attempt to understand the workings of the human body in them lie the beginnings of scientific medicine an investigation carried out with the naked eye which continues today but now we look without having to dissect for we can see inside the living [Music] body this is the human heart at work seen with radioactivity okay could have the eyes I don't know the technique developed at the Royal Edinburgh infirmary uses a minute injection of a radioactive substance G I'm making the injection now flush now please as this short-lived radioactive liquid passes through the heart the radiation is detected by a special camera above the patient's chest all right [Applause] Mr to the electrical pulses set off inside the camera are organized by the hospital computer into an image of the heart at work the rapidly moving yellow patch on the right is the left ventricle the part of the heart that pumps the blood around the body but this man has a heart disorder you have lots to tell them when you get back here's a normal heart that yellow patch on the right contracts to almost nothing showing that a good volume of blood is being pumped to the body here's the patient's heart again it's not pumping nearly as well but just how inefficient is it okay you know we'll just run it down there the image itself provides the answer that's seum quite clearly Mark there we'll come down there first a line is drawn around the left ventricle around bottom Ed and that's quite nice there okay and up there exactly how much that yellow area changes with every heartbeat can now be calculated okay that's it it's a measure of the ventricles efficiency as a pump the result is plotted out an image of the efficiency of the heart at work okay but under exercise the heart must work much harder how's it going pain good are you're not short of breath at all no excellent no pain no pain excellent the demands of the Body for more oxygen mean that more blood must be pumped through it will the patient's heart meet these demands you're not getting fine on this bite the heart beats faster but that yellow patch is almost constant even less blood is being pumped out you won't feel a thing at all you'll hear us talking and you'll hear the machines chattering but don't worry about it at all so they' try a drug which could help the heart to work more efficiently and the effect can be seen within a few minutes the yellow patch almost disappears on each heartbeat it means that once again the heart is working well you feeling quite comfortable the patient has been lying here chatting to the nurse for a little over an hour but in that time his heart has been observed at rest during exercise and under therapy that's while this new technique teaches doctors more about this most vital organ it's also improving treatment such images are becoming common but it's easy to forget there a recent Innovation it's less than 100 years since this man villm brkin invented the X-ray tube with which he took the first inside view a shadowy picture of the bones of the human [Music] hand in fact it was the hand of his wife the technique was rapidly taken up its impact on medicine has been enormous and today exists in a form that the inventor would barely recognize now x-ray tubes scan rapidly back and forth collecting millions of bits of information information which is synthesized into a cross-section of a patient's chest far more than a shadow this image shows a cancerous growth which is marked with a light pen an image as precise as this allows a new computer system to design a course of therapy with equal Precision the growth will be destroyed by radiation but first the operator traces out the left lung and then the right lung these are healthy tissues and must not be damaged by the beams of radiation other sensitive areas like the spinal cord are also marked now three radiation beams are superimposed on the image where the three meet the there will be sufficient radiation to burn out the cancer the computer then draws a contour map showing the intensities of the radiation the red lines indicate the areas receiving a high dosage but here the spine is included as well as the cancer and there is a dangerous hot spot on the chest wall so this plan is rejected and a subtle alteration is made to the beams again the contour map is plotted the spine is now in the clear and that hot spot has been reduced to a safe level only the cancer will receive a lethal dose the computer prints out a copy of this plan without this system it would take at least a day to plan the therapy but in half an hour exact beam angles and intensities of been calculated the results are passed to the radiotherapist who puts the plan into effect the destructive rays will now cross at exactly the right point the result of a clear inside view little more than 80 years after that first [Music] Shadow and this colorful wrist is another sort of Latter-day x-ray okay Phil let's try a short exposure this time it is enabling these physicists at leads infirmary for the first time not only to look but to measure the progress of diseases inside bone this aome the technique uses a small radioactive Source rather than an x-ray tube away we go interesting to see what the picture qualiity is like with this exposure time it's the shortest we've tried so far during the exposure time particles from The Source pass through the subject's forearm and instead of falling onto a photographic plate pass into a steel chamber containing a rare gas here the radiation causes minute electrical discharges which can be detected millions of tiny signals are passed to the computer signals which can then be organized into an image but it's an image from which measurements can be taken the colors show how the density of the bone varies and it's bone density that changes in many crippling diseases the progress of such diseases can now be monitored any area of the image can be selected for investigation then the total weight of bone within the box is calculated effectively they're weighing the bones precise measurements from an image which reveals a process within the human body this vital aspect is common to many of the new Imaging [Music] techniques this image of a young child is a picture of heat the areas of differing temperatures are displayed as different colors ice L the iced Lolly looks black because it's so cold is it nice the cooler edges of the body are green the yellow areas are the warmest can I have it a minute mom have a little bit thermography as the technique is called is totally non-invasive as it uses the body's own heat radiation can you stand up and heat radiation from the body reveals processes taking place within for example a hand is normally quite warm there's a lot of yellow but watch what happens when a drug is taken after only a few Puffs the effects of nicotine can be seen the fingers once yellow soon change to purple they're getting much cooler probably due to a reduced blood supply at the Royal arthritis Hospital in B they're using this system not just to watch but to measure bring your knee round Mr Edmonds thank you that's it arthritis is a disease of the joints which causes inflammation and an inflamed knee emits heat just how much can be measured by comparing the knee to a black disc of known temperature ready a thermogram is now taken as the heat radiation from the knee passes into the eye of the sensing [Music] camera the large amount of red shows the knee is very inflamed a number of anti-inflammatory drugs are available and thermography is being used to provide an objective assess assessment of how effective these drugs are a drug is administered and a day or so later another thermogram taken the red area is considerably reduced compare this thermogram with the previous one by allowing us to measure information a process within the body these colorful heat images are giving us the first objective test of a range of different drugs elsewhere thermography is now in regular use in this London Hospital it's being used to screen patients after surgery such patients risk having deep vein thrombosis a blood clot in the leg which can prove fatal but a thermogram can detect the danger then we should be able to see exactly what we want to see on the screen the red area shows clots are probably forming and treatment is needed so thermography is not just pretty pictures but a valuable clinical technique it shows the body in a completely different way it reveals the changes taking place [Music] within and as our eyes are extended by techniques like this it's not only our understanding of how our bodies work that will alter our concepts of what we are may be transformed in the 17th century man's view of himself was changed because suddenly he could look more closely the revolution of the microscope with it the Italian scientist Mal pigi was able to see the fine blood vessels in the human body previously invisible and completed the theory of the circulation of the blood the workings of the human body were slowly being revealed man started to look upon himself that at least in part as a machine controlled by the brain Robert hook saw that certain materials were made up of discrete units he called them cells and cells are now known to be the building blocks of life the machines within the [Applause] [Music] machine a revolution in our thinking brought about by a new way of looking the new techniques now being developed May mean our Concepts will have to change again this is an image of human cells produced with ultrasound ultrasound pictures are created using pulses of very high frequency sound pulses like these seen with the help of a laser if a barrier is placed in the sounds path part of the pulse is reflected these Reflections can be used to build up an image it's an advanced form of this technique that allows us to picture the Restless activity of an unborn child [Music] and now the same method is being used in a totally different way to look for disease at the Royal maen [Music] Hospital this is a sort of ultrasound microscope a transducer the source of the ultrasound pulses is swept across the patient's stomach the reflections build up a picture of the major structures of that part of the body then they select a single point of the image consisting perhaps of just 100 cells the arm carrying the transducer is adjusted so the beam will cross this selected Point as the transducer sweeps to and fro in its new position the ultrasound beam always passes is through that point under examination all the reflections are produced from the one cluster of cells but as the transducer arcs to and fro the reflections change in strength these variations are plotted out and searched for hidden patterns when all the dots are connected up a series of Peaks and troughs emerges a signature of one tiny point in the [Music] body these signatures appear to show the difference between diseased and healthy tissue they are images of the first signs of cancer deep within the body they're not the sort of images we're used to but their significance is that they show the body as it's never been seen before like the microscope or the X-ray before them now we've got a CP scale here Chosen and this image does the same it's an image which in the future may give doctors a totally new understanding of disease it's a cross-section of the whole body built up by a technique developed at Nottingham University the image is actually a map of the concentration of water water contains a lot of hydrogen the H in H2O and hydrogen can be detected the bottle is plac placed at the center of a strong magnetic field a radio transmitter is switched on the highfrequency radio waves cause the hydrogen atoms to ring like bells or more correctly it is the nucleus of the hydrogen atom that Rings the nucleus is like a spinning bar magnet and in a strong magnetic field it moves in a strange way like a spinning top knocked off balance but in living tissue there is a lot of water and that means a lot of hydrogen nuclei all doing the same thing sending in a radio pulse will knock the nuclei into different positions but as they fall back they give out a radio signal this radio signal can be detected here is the signal from Pure Water just like the single chime of a bell slowly dying away but in the body the concentration of water and hydrogen varies a radio pulse triggers a complex mixture of returning [Music] signals but a great deal of computation will separate these signals and produce a map of the water concentrations the researchers studied their first living subject and all that complex Theory produces a picture of reassuring familiarity a section through the orange produced without cutting it the peel shows up as green the wet juicy fruit is red so from fruit to animals this is a cross-section through the body of a mouse showing the spine the back muscles the stomach wall the intestines the white areas are fatty tissue and then from mice to men Dr Mansfield the leader of a second group in the same Department in the best traditions of Medical Science is experimenting on himself first he puts on the receiver coil the coil that picks up the signals returning from the body the ringing of the hydrogen nuclei he then climbs into a specially constructed giant magnet it must be pointed out that this is the development model and any production models in the future would pay more attention to Patient comfort once he's inside the magnet Dr Mansfield's assistants fit the coils that will transmit the radio signals into his body hold it hold it when these experiments were started it had been suggested by an American scientist that the intensity of the magnetic field could interfere with the heart however Mansfield's mathematics disagreed and he trusted in his own calculations he can you get the receiver called I think once bolted into the apparatus the receiver coil is connected okay fine let's go fine and the process of building up a picture can start the radio pulses are injected their frequency slowly Alters to gain more information from the body inside the magnet the process takes about 30 minutes but the workers here are confident that it'll soon be reduced to a matter of seconds General this is one of their first pictures of the human body and this is looking from the rear this is the stomach region which hasn't come out very well at all but you can see these little convolutions here which are probably intestines or something showing through here the obvious feature here of course is the liver Li yeah which is coming out really rather bright red and this is we believe the left handle L the liver just showing through here and there's a the higher proton region just underneath it what what's that here well this blue demarcation I think uh shows the spleen area and in fact there's a region here which is water is the most common substance in the human body this map of water concentration may seem crude but what it shows could have an enormous impact on medicine and the images will improve remember that just over 80 years ago the X-ray looked like this and today we can see the beating heart but will these techniques become as familiar as the X-ray we are now beginning to understand that the best medicine is not always the most technologically advanced some of these techniques may become quite widely used in the future others may be confined to specific diseases others still May remain research tools to look to measure revealing more about processes inside our bodies as we see more we will come to consider our bodies in a different way perhaps as a dynamic system rather than a static one and as our understanding changes our concepts of what what we are will be changed just as they were changed by the first men who looked The first explorers of the human body [Music]