Detection and identification of intracardiac calcifications.

During the past 15 to 20 years the detection in vivo of intracardiac calcifications and their identification has become a fairly common accomplishment in the hands of careful, painstaking roentgenologists. No individual has contributed more toward stimulating his confreres in detecting these lesions than has Merrill Sosman, of B o ~ t o n . ~ # ~ . l ~ Among technical advances which have greatly aided in the visualization and identification of these lesions might be mentioned the more brilliantly fluorescent screens now commonly employed, the use of high-speed radiographic techniques (faster than 1/10 second), and the application of kyrnography. One must not fail a t this point to emphasize the value of fluoroscopy both for detection and identification of many of these calcifications. The new Westinghouse fluoroscopic image amplifier or the Moon scanning tube, when perfected and available for general use by fluoroscopists, may render visible the more minute calcifications which are today revealed only with difficulty or not a t all. I am, nevertheless, thoroughly convinced that to reduce the errors of omission and to aid in matters of differential diagnosis and exact localization, with present-day equipment, we do need high-speed, multiple, aimed, "spot" roentgenograms. Not only will calcification associated with coronary arteriosclerosis be much more frequently revealed, but occasionally other intracardiac calcifications, particularly the less marked degrees of valvular and annulus calcifications which cannot be visualized on roentgenoscopy, will be demonstrated. We have been using multiple, "spot," aimed, high-speed roentgenograms for study of the heart substance routinely for approximately five years, during which time the incidence of cases of calcification due to coronary arteriosclerosis exceeds that of valvular, myocardial, and pericardial calcifications combined. Our patients are for the most part of middle age or older. Many of those examined are highly intelligent private patients who want exact guidance as to their future physical and mental activities. Others are in the group who may