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February 25, 2017
X-Ray Charles Dotter & Israel Steinberg

Charles Dotter (1920-1985) & Israel Steinberg (1902-1983)

Robb GP, Steinberg I. A practical method of visualization of the chambers of the heart, the pulmonary circulation, and the great vessels in man. J Clin Invest., 1938, 17, 507

Dotter CT, Steinberg I. Angiocardiography. Annals of Roentgenology, vol 20., New York, Paul B. Hoeber.1952


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Steinberg and Robb, physicians at Bellvue and New York University Hospital, described the technique of angicardiography for the first time in 1938. The procedure consisted of the radiologic examination of the cardiac chambers and thoracic great vessels during the opacification by an intravenously injected radio-opaque solution. This improved visualization of cardiovascular structures enabled cardiologists to diagnose a variety of congenital and acquired cardiac diseases with a greater precision. The opacification of esophagus with injection of barium sulphate was also performed to enhance the delineation of the borders of the cardiac chambers, particularly the left atrium.

In 1952, Dotter and Steinberg published their book entitled "Angiocardiography" which is the most authoritative work on that topic to date and still very informative.  The book is divided into 14 chapters with detailed description of imaging findings in patients with cardiovascular and pulmonary diseases.

A section of the chapter seven deals with angiocardiographic findings in patients with rheumatic valve disease, mostly mitral stenosis and regurgitation. Their studies demonstrated the anatomic changes responsible for the characteristic cardiac silhouette in mitral stenosis.

 Dotter and Steinberg observed that on lateral chest X-ray the prominence of the anterior heart border encroaching upon the retrosternal space was largely due to left atrial dilatation with anterior displacement of the superior vena cava and the right heart chambers. Prior to their study, this imaging finding was attributed to right ventricular dilatation and its pulmonary conus.

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 They also were able to show that the prominence in the left midcardiac border seen in frontal view was caused by the dilated left atrial appendage and dilated pulmonary artery and not the pulmonary conus.

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 They also showed several cases of valvular heart disease with characteristic findings in cinecardioangiography.


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The introduction of cardiac catheterization in 1940's and 50's combining imaging studies and hemodynamic measurements was a major advance in the precise diagnosis of valvular heart disease rendering the use of angiocardiography obsolete.


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Hugo Roesler


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