Blog by Michael Jackson, Chair British Society for the History of Radiology (BSHR), and Arpan K Banerjee, Chair International Society for the History of Radiology (ISHRAD)
This year, 2023, saw the passing of acclaimed movie director William Friedkin, whose films include The French Connection (1971), and Sorcerer (1977), and To live and die in LA (1985).
However, he is best remembered for his 1973 horror movie, The Exorcist which is re-released in November to celebrate its 50th anniversary, along with a sequel The Exorcist: Believer (David Gordon Green, 2023). Many will be familiar with the vomit-soaked, head twisting spectacle of this classic, but perhaps the most terrifying scene contains no demonic possession or supernatural elements. The scene depicts a carotid angiogram in the X-ray room of the New York University Centre. Imposing radiographic equipment moves around a 12-year-old girl, Regan (Linda Blair), in a threatening fashion with neither family members nor hospital staff supporting her, accompanied by loud, unpleasant noises. Whatever blood-curdling terror the devil can conjure, high tech investigations, it appears, can be equally frightening.
While the scene has drawn some praise for its realistic depiction of an invasive radiology procedure, there is no doubt that the cinematography, editing, and sound design are carefully engineered to exert maximum audience impact. Over the last fifty years numerous films and television series have depicted a trip to the X-ray department as a similarly frightening, disturbing or frankly perilous experience.
In The Theory of Everything (James Marsh, 2014) Stephen Hawking (Eddie Redmayne) undergoes a series of plain x-rays in a harsh, austere looking room while investigating his motor neurone disease in the early 1960s. He is shown in a similar position to his first collapse in a Cambridge college quadrangle, helpless and extremely uncomfortable. The surroundings look more like a military facility than a place conducive to recovery.
Bleak, unfriendly hospital décor also appears in The Killing of a Sacred Deer (Yorgos Lanthimos, 2017). A child (Sunny Suljic) is investigated for mysterious symptoms in a similarly austere, characterless hospital. An ultrasound scan is conducted in an extremely bare, white room, with camera angles also adding to a disturbing, unsettling atmosphere. No sign of wall art, ambient lighting, or stickers, typically found in a paediatric imaging department. Indeed, the harsh bright lighting used cannot be viewed as a minor inaccuracy (ultrasounds are typically performed in a dimly lit room to improve visibility of the image) but a deliberate device to add to the menacing mood.
Likewise, lighting design is used for artistic purposes in The Sixth Commandment (Saul Dibb, 2023), a recent BBC TV drama based on the real-life murders of Peter Farquhar and Ann Moore-Martin in 2015. Farquhar (Timothy Spall) is shown undergoing a CT scan. Unlike ultrasounds, CTs are performed in well illuminated scan rooms. However, here the lighting is of an atmospheric, low intensity blue which helps make the red laser crosshairs, used to assist positioning, shine vividly. Again, the lighting is utilised for mood rather than accuracy, with the crosshairs manipulated to mimic a crucifix (a recurring visual motif) projected over Farquhar’s head. The scan is not portrayed as a particularly distressing experience, but the unusual lighting scheme reflects Farquhar’s bewilderment and confusion, and the religious symbolism adds to the theme of impending doom.
By contrast, a character’s ordeal at having an MRI scan is all too apparent in another BBC drama Undercover (James Hawes, UK, 2016). Maya (Sophie Okonedo) a successful barrister has a distressing panic attack during her scan in claustrophobic surroundings.
Non-human creatures also pay a visit to the Imaging department in “Smith and Jones”, an episode of Doctor Who (Charles Palmer, 2007). A villainous alien posing as a patient (Anne Reid) attempts to destroy half of the earth by modifying an MRI scanner within a London Hospital that has been relocated to the moon. While we do not see any patients being scanned, the concept of a diagnostic scanner being repurposed as a weapon of mass destruction conveys a menacing use of medical technology. In the same episode The Doctor himself (David Tennant) modifies an X-ray tube, creating a laser gun to see off some other alien baddies, again weaponizing imaging technology.
The above examples represent diverse genres, but they all have a connecting thread. The X-ray department is depicted as being at best unfriendly or austere and at worse a highly dangerous environment. As radiologists, we recognise that filmmakers do embellish kernels of truth. Hospitals, and imaging departments in particular, can be unfamiliar, potentially threatening environments for patients. MRI scanners can trigger claustrophobia and do make unpleasant loud noises. Serious and life-threatening diseases including cancers and complex trauma are diagnosed by imaging, so the association of a foreboding atmosphere will ring true for some patients and their families.
Even scans which eventually offer reassurance can cause significant anxiety prior to receiving their results. In Hannah and Her Sisters (Woody Allen, 1986); Woody Allen plays Mickey (characteristically riddled with anxiety and existential angst) who has a CT head for hearing loss and tinnitus. Scanning is realistically depicted and is not physically uncomfortable. However, Allen’s fears are laid out through multiple worst-case-scenario internal monologues, culminating in a scene where his doctor reports he has an inoperable brain tumour. We then realise that this is an imagined scene, with an identically staged subsequent (“real life”) scene in which he is given a clean bill of health. Allen’s runaway hypochondria is played for comedic effect, but the cycle of pre-and post-scan anxiety is rooted in genuine patient experience.
Filmmakers should legitimately explore these fears and concerns. However, the pervasive negative portrayal of imaging is typically misleading and has become a cliché. Radiology examinations will inevitably deliver some unfavourable diagnoses, but in most cases, imaging will guide appropriate treatments or intervention, and many scans will of course deliver good news for patients. Furthermore, all who work within medical imaging departments strive to make patient experience as comfortable as possible. We plead to moviemakers to reconsider their portrayal of radiology departments, not only to refrain from portraying tired tropes, but also to help reduce radiology-phobia amongst the public at large.
Dr Michael Jackson is a Consultant Paediatric Radiologist based at the Royal Hospital for Children and Young People in Edinburgh. He is currently Chair of the British Society for the History of Radiology and his book, Imagining Imagining, explores the relationship between art and medical imaging.
Dr Arpan K Banerjee MBBS(LOND)FRCP FRCR FBIR is a retired Consultant Radiologist from Birmingham and current Chair of the International Society for the History of Radiology (ISHRAD). He is author/ co-author of numerous articles and essays on clinical, radiological, and medical historical topics and seven books including Classic Papers in Modern Diagnostic Radiology 2005 and ‘The History of Radiology’ OUP 2013.