In 1895, Roentgen WC found X-ray, which was soon applied to medical clinics. In early 20th century, X-ray films combined with fluoroscopy were used in the diagnosis of cardiovascular diseases, mainly in the anatomy analysis on heart and great vessels (local) at that time.

Based on Forsman’s (1929) right heart catheterization and thenceforth in-vivo cardiac hemodynamics, X-ray can in certain degree analyze heart beating and the change of pulmonary hemodynamics. From1930s to mid-1940s, X-ray has been effectively applied to the diagnosis of non- and congenital heart diseases. In early 1950s, X-ray was extensively applied in clinics, becoming Roentgenology of the Heart, which was reflect in JB’s Clinical Roentgenology of the Heart in 1946. (Its Chinese version was published in 1954)

At the early stage of right heart catheterization, the “trial” angiography has been conducted. Combined with the research and application of fast film changer and low toxic contrast agent, during 1938-1939 the intravenous angiocardiography (IV-ACG) developed by Robb and Steinberg has been in form. But practices showed that the dilution of contrast agent by re-cycle caused the limitation in observing and analyzing left cardiac cavity and aortic system, which is the disadvantage and limitation of IV-ACG.

Since 1950, the selective vessel and cardiac cavity imaging experiments and clinical application developed rapidly: in 1950 the development of clinical application of right heart catheterization (Zimmerman); in 1953 Seldinger developed percutaneous galactography; in 1959 Sones conducted coronary arteriography in elbow artery open treatment; the percutaneous coronary arteriography by Reketts & Abrams in 1962 and by Judking in 1967 is still widely used in clinics. The above development and progress of selective heart cavity/coronary arteriography promote the development of cardiovascular surgery including coronary artery bypass grafting (CABG) and lay foundation for intervention treatment.

From early 1970s to mid-1970s, X-ray diagnosis combined with selective angiographyhas formed the cardiovascular radiology.

Since 1972, the development and applicatin of CT has entered into a new stage based on tomosynthesis and computer image reconstruction. Radioisotope and ultrasound diagnosis has developed toward computer imaging trend – nuclide and ultrasound imaging. In early 1980s, Magnetic resonance imaging (MRI), the new imaging technology with high contrast issue resolution and no ray, was rapidly used in clinics with its unigue advantages, followed by Digital Subtraction Angiography (DSA) and digital X-ray imaging technologies such as DR/CR.

The applications of the above new non-/minimum invasive technologies triggered revolutionary changes of imaging diagnostic level and progress and with X-ray and selective imaging consists of modern cardiovascular imaging system. China (developed areas, educational/ the third level hospitals) and developed countries has respectively formed modern medical imaging system (including cardiovascular imaging) in mid-1990s and mid-1980s. The development ove the past 110 years, every single important achievement is benefit from new imaging equipments, devices, technologies and the development of clinical and basic research. And the last 30 years’ development is inseperable with the cross- and coordinated research of modern computer technologies, electronics and biomedical engineering. Theses ex[eriences and lessons implies the future development trend.

Medical science including imaging, as the component of life/biological science, will develop toward the “big environment” direction, for example, promoting medicine (including imaging) toward combination of micro/intelligent and macro direction.

Molecular/genetic medicine has appeared, and molecular imaging is also in the transitional stage from lab research to clinic. Micro MR/CT, nuclear medicine, optical imaging are all ite main components, automation and robot application have also developed.

Meanwhile, the psychology, ecology, environment and other factors have important meaning to human health and disease prevention, such as the breakout, prevention and control of SARS, bird flu in recent years. Gene/hereditary factors has been paid more and more attention as nosogenesis. And air pollution, smoking and other enviromental factors and bad conventions should also be considered.

The integration of natural science and social science is another important trend of life/medical science development. Medical work and its object of research is “human being” who have both biological and social characteristics.

Swizerland Lausanne International Competitiveness Report proposed thress stages for the development of science and technology: First stage, introduction and copy; Second stage, adoption absoption and introduction; Third stage, innovation. This is related with a country’s social and economic development and its investment on science and technology, such as R&D/GDP. R&D ocuppies <1%, >1% and <2% of the GDP respectively at the first, second and third stages. China’s R&D percentage in 2005 is 1.34%, in the second stage, and China’s medical development including imaging is also in the corresponding stage.

The establishment and development of modern medical imaging: Modern medical imaging (including radiology/intervention, ultrasound and nuclear medicince) has been paid great attention from the industry in China as the basic construction of clinical department for diagnosis and treatment. The traditional concept and methods of radiology department application/referral system should be changed and should directly involves in the cilinical diagnosis and treatment.

Further imprvong the medical imaging and research level: For China, clinical diagnosis and treatmetn and the related application research are advantages, but mainly focusing on case review and analysis. The forward-looking, both-blind and multi-center standardization research should be promoted. The basic and experimental research need to be improved and the imaging basic/experimental reseach system should be established/improved, such as molecular imaging, interventaional gene treatment and etc. It is recommended to explore and promot coordinative research between multi-discipline (medical, scientific, engineering, molecular/genetic science), and to be innovative, enhance the establishment of mechanism and system.

Some suggestions on how to optimize cardiovascular imaging: To emphasize the comprehensive diagnosis/optimized application of several imaging technologies; according to benefit / proce ratio, equipment / general application, proposing the “three axles (ultrasound, CT, MR)- two wings (X-ray and imaging & nuclear medicines)-one center (patient)” procedure and method; Meanwhile, following new literature progress and improving acknowleddge and diagnosis level; strengthening high quality comprehensive professionals, for example, senior physicians shoul have one specialty and many skills, i.e., they should expand knowledge range including clinics, basics and social science.

New findings, new knowledge and new technology generate and form modern medical imaging including cardiovascular imaging, which makes great contribution to the improve the acknowledge and disease control capacity. Cross multiple disciplines and coordinative research is the future direction of medical work and research. The cultivation of inter-disciplinary talent, especially young talent, is the fundemental for sustainable development of cardiovascular imaging.

(The main content of this article was presented in the 1st Radiology Yong Physician Seminar & the 3rd Molecular Imaging Seminar, on June 15, 2007, at Shenyang, China)