Heritage Snapshot: Part 117

Mrs. Melvin Judkins describes her husband’s pioneering work in studying the blood vessels of the heart: “Enlisting the help of a staff necropsy pathologist, he obtained a plastic impregnated human heart. Equipped with a roll of stainless steel spring wire, pliers, and a wire cutter he spent countless hours fashioning shaping wires. When not scrubbed in his cath lab, he concentrated on bending shaping wires, using various pipes and faucets at the scrub sink to mold the wires. He would scrutinize the shape, place the wire over a chest radiograph on the view box, contemplate, and make changes. When a shape appeared workable, he threaded the proximal end of a catheter over the bending wire and immersed it in boiling water to set the new shape. When cooled and with the wire removed, the catheter assumed the new shape. Then he experimented with the “new” catheter on the heart specimen. When satisfied that he had achieved a workable shape, he began using the coronary catheters, making modifications as experience dictated…. He perfected ingenious configurations of left and right coronary catheters to accommodate for variations in aortic size and shape. He created sets of bending wires and then preshaped the catheters, customized to the patient’s anatomy.…” Melvin introduced “the Judkins Technique,” later identified by Dr. Charles T. Dotter as the “gold standard for anatomical coronary diagnosis,” by scientific exhibit and lecture, astonishing both radiologists and cardiologists. In late 1967, Radiology published details of his technique and examples of his outstanding coronary radiographic images. Soon, he had a well-trained angiography team who shared his dedication to obtaining the maximum amount of diagnostic information on which to base clinical management with minimum risk to the patient and minimum radiation exposure to the team. Together, they hosted a growing number of observers. Dr. Judkins became a diplomate of the American Board of Radiology in 1967. In 1968 a company in Miami, Florida, began fabricating preshaped Judkins coronary catheters. Another company in Portland, Oregon, began making sets of his shaping wires. In addition to his coronary and pigtail catheters, Dr. Judkins envisioned catheters with exaggerated curvatures that would consistently enter a target vessel when introduced and manipulated transfemorally. Dr. Judkins approached the X-ray evaluation of the blood vessels of the heart through the large femoral artery in the groin. In early 1969, David B. Hinshaw, Sr., MD, dean of the Loma Linda University School of Medicine and one of Melvin’s Class of 1947 classmates, invited Melvin to join his faculty. The invitation was disquieting to the Dr. and Mrs. Judkins. They were contented Oregonians. He was professor of radiology and director of cardiovascular radiology at the University of Oregon and presided over a new research laboratory. Nevertheless, the Judkins’ made the request a matter of prayer. Melvin P. Judkins, MD, accepted the challenge and became professor and chair of the department of radiation sciences and director of cardiovascular laboratories in Loma Linda in July 1969. The new University Hospital was two years old. For six months, while implementing his transition to Loma Linda, Dr. Judkins consulted with departmental staff, assessed needs, formulated plans, and worked with administration to implement changes. He joined the faculty full time on January 1, 1970. Until the end of his career, Dr. Judkins built and maintained a world-class academic department that would bring honor to God and Loma Linda. In so doing, he initiated departmental sponsorship of subspecialty training for selected staff. He added academically oriented radiologists to his faculty. He started an ongoing program to upgrade or replace existing equipment. He added diagnostic ultrasound, neuroradiology, and CT scanning with the most sophisticated equipment available, operated by radiologists with expertise in each modality. He strengthened postgraduate training by subspecialty rotations and expanded them to include fellowship programs in appropriate subspecialties. He developed a curriculum and offered a training program for radiologic technologists who sought to gain skills they would need in a cardiovascular laboratory. By November 1970, Dr. Judkins had designed and opened a new, state-of-the-art laboratory, trained a technical support team, and performed the first coronary angiogram in Loma Linda. Countless observers started pouring in from around the world to study Judkins’ exquisite radiographic films and to learn about equipment requirements to achieve quality images. Mrs. Judkins explains Dr. Judkins’ perspective: “Although a properly shaped catheter was the key to success, he always emphasized that his technique was not confined to the use of his catheters. The Judkins technique embraced a combination of professional skills…and manipulation of unique preshaped catheters, proper patient position for filming, and high quality radiographic hardware to produce and record optimum information while protecting patient and laboratory team from unnecessary radiation exposure. His was a constant advocacy for meticulous attention to all of the procedural details he outlined in his original and subsequent publications. However, the allure of technical excellence was never to subvert a compassionate focus on the patient himself. The well-being and safety of each patient was his lifelong passion.” Although Dr. Judkins carried a full patient load in addition to his administrative responsibilities, he generously shared both his technical expertise and his extensive knowledge about radiographic equipment. As a master teacher, he possessed a rare genius for explaining complex problems for experts and lay people alike. He shared his insights with peers and students and thoroughly explained the complexities of sophisticated angiographic equipment to several generations of angiographers.