Radiologist Earl R. Miller, M.D.

This is a rewrite of pages 52, 53,and 54 of report on an interview of Dr. Miller by Ann Berge and Gregg Herken for the Archives of the Lawrence Radiation Laboratory.

Berge: What do you see as the results of your work over the past 40, 50 years, in terms of what you were able to produce with your research?

Miller: I introduced body section radiography (laminography) to the UC Department of Radiology in 1937. My interest in this kind of radiography lasted till 1973 when I developed a method for obtaining an infinite number of laminagrams from a finite number of films.

Dr. Mary Olney and I introduced angiocardiography for the study of congenital heart - disease in babies in 1944. Dr. Ed Boldrey and I introduced cerebral angiography in the study of Brain disease and cerebro-vascular disease in 1946. These interests lasted till 1953.

Dr. Soley and I introduced the use of Radioiodine at UC for the diagnosis and treatment of thyroid disease in 1948. This was a major interest until 1959.

Jacob Yerushalmy (statistician) and L Henry Garland led a group of us that started a study of error in interpretation of chest radiographs in 1952. My own interest in error of any kind continues to the present day. It led to my final studies of seeing in the interpretation of a scene. The word "seeing" has two definitions both of which must be met in order properly to know the meaning in the scene. The first is to gather information through the eyes and the second is to "see" or to understand the meaning of the scene. The interest embraced not only error but also how one made a correct decision. Search patterns, viewing distance, training, the quality and size of the image, the amount of contrast and contrast gradient, the center of interest, the size and shape of the zones of confusion of the every part of the imaging system. the amount of movement and its rate were only some of things that entered into consideration. All of these aspects enter into the need for survival.

The Bratt Bored was made in 1952

I would like particularly to call attention to reprint # 85 entitled "Patient exposure during fluoroscopy" published in Radiology Vol. 80 No 3. Pages 477 to 485 March 1963.

In this paper I invented a new unit for the measurement of radiation exposure of patients.

The unit was cm²R and is pronounced square centimeter roentgens. The unit was nicknamed SCIMMERS. To my knowledge this is the first unit which takes into account the flux of radiation and the area to which the patient is exposed simultaneously.

It is reasonable to suppose that the injury to a patient caused by exposure to ionizing radiation is proportional to both the area exposed and to the flux of radiation. This unit can be expressed also in Gram rads of absorbed radiation.

It was shown that experienced examiners using a 5" image intensifier subjected patients to only one fourth to one fifth as much radiation as did less experienced examiners using a conventional Fluoroscopic screen during examinations of the viscera in the abdomen.

Dr. Frank Hinman first awakened my interest in the physiology of voiding in 1954. My interest in X-ray cinematography began about the same time. It was apparent that it one was to understand the physiology of an organ system, one needed to know what happened to it as a function of time. The best way to do it was to use X-ray movies to display the anatomical changes continuously and to display, simultaneously, those physiological parameters of importance to the working of a system.

Developing the apparatus and the procedures to provide such information about the lower urinary tract at rest, during normal voiding, during strain, and during incontinence; the mouth and pharynx during speech and swallowing; and the esophagus during swallowing occupied the major effort of the Radiological Research Laboratory until 1973.

I was given the Laboratory in 1958 by President Robert Gordon Sproul and directed its activities until I retired in 1974. With the help of Ed McCurry EE, (inventive guy), and Bernard Hruska (super technician) we developed the most sophisticated means of making these studies in use at that time. The final apparatus employed a Vidicon TV camera to record the physiologic data, and an image orthicon TV camera to record the x-ray image The images from these cameras were presented side by side on a video screen and on every frame of the movie film.

For example, in the study of the lower urinary tract in women, on every frame of an xray movie, and on every frame of a video tape showing the contrast filled urinary bladder and later, the urethra, there were 8 channels of physiological data.

The latter showed absolute pressures in the bladder and urethra, the absolute pressures in the colon (abdomen) and the rectum and the differences in these pressures with respect to one another, plus the amount and rate of voiding, during rest, during strain, and during "holding" urine. The patients had either incontinence, had difficulty in initiating voiding or had recurring infections in the bladder due to incomplete voiding or reflux of the urine into the ureter. The sound track recorded the commands to the patient and the movie and the video image showed the response of the patient while all this was happening. Study of these data allowed us to understand the abnormal physiology in these patients.

In studies of the esophagus, the x-ray image showed the passage of Barium and the data showed the pressure gradients throughout the esophagus during swallowing.

The late Dr. Lucie Lawson got me interested in the studies of patients with abnormal speech due mainly to cleft palates. The x-ray movie showed a lateral view of the mouth and pharynx during speech and swallowing. The sound track recorded the sound of the speech. The data from a sound spectrograph recorded the frequency components of the sound on each frame of the movie. Dr. John Q. Owsley was the Plastic Surgeon most interested in these patients. He and we developed a very clear picture of the way the soft palate worked in patients with nasal sounding speech. Through this understanding, Dr. Owsley was able to develop the most effective surgical techniques for the alleviation of these patient's abnormality.

Al these studies were made in line with the fundamental drive of acquiring the greatest amount of data about a patient with the least radiation exposure.

We became interested in image manipulation in 1970. We used one vidicon TV camera and sometimes two simultaneously to look at x-ray and other images. Any single line of the TV raster could be isolated and the variation in its brightness presented on the viewing screen of an oscilloscope. The brightness and contrast gradients were presented instantaneously across the width of the image. The optical quality of the image could thus be determined instantaneously and be recorded objectively.

This type of analysis was applied to images that were subtracted from one another, both isotropically and anisotropically and in those in which edge enhancements were introduced. The effects of defocusing the image on these parameters became a major aspect of the studies of pattern recognition