The work to obtain higher-quality images quickly, reliably and safely is a never-ending journey, with steady progress being made by radiologists, technologists, medical physicists and supporting staff members. It can be easy to forget that the X-ray department at Johns Hopkins started with fragile emulsion-coated glass plates — strongly preferred by radiology pioneer Frederick Baetjer (whose hands were badly scarred due to radiation injury) — before being replaced with pliable X-ray films.

These X-ray films came with their own set of challenges, in part thanks to the rapid rise in patient volume for radiology. Wet films could take several hours to dry in the summer humidity, and completed patient films rapidly filled up the first small film room.

Patient films were collected into “jackets,” with some patients collecting jackets that weighed more than 10 pounds. As additional storage locations were acquired, film clerks struggled with the unwieldy layout of film vault rows and conflicting demands from radiologists who wanted to read patient cases, house staff who wanted to show film to attending physicians, and referring physicians who wanted to take away the films.

Film clerks also had to contend with the transition process: The on-site film holding area held images up to month, then the radiology subbasement film vault held records for two to three years, then an off-site storage area met the seven-year film retention requirement. In the meantime, physical films would often be lost around clinical areas. One particular film clerk, Theresa Dannenfelser, gained a reputation for sleuthing out missing films under the beds, mattresses, and around various nooks and crannies of her unit.

In 1965, there was a flood in the Brady Building subbasement film vault. When the film dried, the emulsions stuck together, making it impossible to separate the films. The chief technologist at the time, John Bright, arranged for the use of a large fish tank in the pediatric area. Students from the Schools of Medical Imaging brought the film out to the fish tank, dumped them in so they could stay wet and dried film individually by processing them through the three automatic processors available.

It wasn’t until 1996 that the first electronic imaging system was implemented for ultrasound. In 2000, the opening of a new Johns Hopkins Kimmel Cancer Center building (the Harry and Jeanette Weinberg Building) included a picture archive and communication system (PACS) unit that covered all modes of imaging. Over the next few years, most other sections of the department were converted to digital imaging and PACS programs.

At the turn of the century, the Johns Hopkins Department of Radiology and Radiological Science imaging workload surpassed 300,000 annual procedures. In 2020, some 1,034,174 procedures were interpreted, with 27 million images every month stored in 12.5 terabytes. The Medical Imaging Information Technology (MIIT) team, led by Ryan Fallon, director of MIIT, has become the steward of this vast electronic data. Fallon comments on the growth and future of imaging records, stating: “It is a very exciting moment in radiology where digital tools have allowed our department to expand its size and scope of increasingly specialized services. Technology continues to evolve, and we are already trying to ditch the discs used for image management today toward a future where we leverage cloud-based solutions that can support innovations, like AI, and more.”