Heritage Snapshot: Part 116

A family practice opportunity on the Sacramento River Delta in Antioch, California, with access to two open-staff hospitals, led Dr. and Mrs. Melvin Judkins to open a new practice in a rented facility in the light manufacturing and farming town. Soon Melvin started planning and searching for a strategic building site for a medical office that would accommodate two or three physicians. His dream became a beautiful reality; a healthcare facility equipped for a full complement of diagnostic and therapeutic services. His support staff included four RNs, a laboratory and X-ray technologist, a part time physical therapist, receptionist, and bookkeeper, in addition to his wife, Eileen. He always had a physician partner, who was sometimes an internist. Having backup gave Dr. and Mrs. Judkins time to explore the many miles of inland waterways in their inboard motorboat, often cruising to Stockton. They sometimes towed their boat to Clearlake for water-skiing. Melvin also bought an airplane and earned his pilot’s license to accommodate business trips and attendance at medical meetings. But as patient volume increased, so did work hours. Dr. Judkins continued taking office films to the hospital where he anticipated daily interpretation “lessons” from a radiologist, an interesting prelude to his eventually becoming chair of the department of radiation sciences and director of cardiovascular laboratories at Loma Linda University Medical Center in July 1969 In the late 1950s, threatened by burnout, Dr. and Mrs. Judkins sought council from an enthusiastic former family practitioner who had recently completed a residency in radiology. After many months of soul searching and agonizing over the possibility of making a major mid-life career change, the almost 49-year-old Melvin Judkins decided to specialize in radiology. The Mayo Clinic rejected him because of his age. (Years later, much to his satisfaction, the Mayo Clinic invited him to present a lecture series on his world-recognized technique of coronary arteriography!) Of the residencies available to him, Melvin chose to attend the University of Oregon in Portland, starting in January 1961. The decision was a major disappointment to his staff and patients. According to Mrs. Judkins, “The intense loyalty of his patients reflected his integrity and compassion and respect for their needs.” In Oregon, Melvin studied under Charles T. Dotter, MD, professor and chair of the department of radiology, already a well-known angiographer and innovator of vascular techniques and tools. Under the influence of Dotter, P.E. Billimoria, MBBS, and others, Melvin developed a special interest in diagnostic and investigational laboratory procedures, and accepted a fourth-year fellowship. During this year, Judkins and Dotter published landmark research on the development and introduction of percutaneous transluminal dilation of narrowed peripheral arteries. Although initially scorned, it became the forerunner of today’s transluminal angioplasty techniques. Because coronary arteriography was not being performed at the University of Oregon, Melvin went to the Cleveland Clinic to learn the Sones brachial artery cut down approach in order to start the procedure at the University of Oregon. In 1965 the National Institutes of Health awarded Dr. Judkins, now captivated by a career in academic cardiovascular radiology, a grant for a research fellowship at the University of Lund, Sweden. During that time, Sweden was the Mecca of radiology, particularly selective angiography. During the year, Melvin studied under several pioneering radiologists, an experience which laid the groundwork for him becoming a pioneer in his own right. Mrs. Judkins elaborates: “Commercially manufactured [heart] catheters did not exist. Catheters were fabricated in the laboratory at the time of each examination from roll tubing in various diameters with inherent moldable properties. Pre-procedure radiographs were the key to selection of tubing of suitable size and length as well as of proper configuration of the catheter. The catheter, often encasing a stainless steel wire, was bent to conform to the anticipated anatomy and then heated. When the assembly cooled and the wire was withdrawn, the catheter retained its heat-formed shape. A flexible guide wire inserted in the preshaped catheter straightened it for percutaneous insertion.” Melvin Judkins not only collaborated in the development and introduction of the “hooktail” (U-shaped) catheter for percutaneous selective cardio angiography, he also visited the departments of radiology in other Swedish medical centers as well as several in Denmark and Norway, where as an eager seeker he studied, observed, and absorbed a vast store of information. Catheter techniques and imaging equipment used for X-ray studies of the heart and coronary circulation particularly interested him. When he returned to Oregon, Dr. Judkins was appointed associate professor of radiology and director of a new laboratory, complete with the first commercially manufactured imaging equipment specifically designed for angiography. In addition to developing Teflon coated safety guide wires, which prevent catheter “cling,” and increase guide maneuverability, he began a quest for a method of consistent selective coronary catheterization, and thus made a major contribution to world medicine. Dr. Judkins developed catheters that enable selective injection of radio-opaque contrast medium into the left and right coronary arteries and the technique angiographers use today to manipulate these catheters from the femoral artery. X-rays will not penetrate the radio-opaque contrast medium. Therefore, after injection, the size and shape of the inside of a blood vessel can be visualized. If it has narrowed, physicians can see how much and exactly where. Dr. Judkins Technique increased the ease and confidence with which angiographers could place catheters in the coronary artery. While he will be remembered as much more than just a designer of angiographic catheters, according to colleagues, that accomplishment alone is enough to secure his place in history. Critics had maintained the impossibility of manipulating a 100 cm catheter from a femoral artery in the groin into a coronary artery.