One of the Best of a Rare Breed
Melvin Paul Judkins
A Pioneer in Coronary Arteriography
October 2007-January 2008
Melvin Paul Judkins was born May 3, 1922. He grew up in a sparsely
populated area near Los Angeles raising chickens, goats and cows. He
showed an early affinity for all things mechanical and electrical,
building crystal sets, learning Morse code and earning a first class radio
operators license. His college aptitude scores were high in engineering
and medicine. To pay for his own education at two private church
academies, he delivered papers, worked in construction and drove a truck.
Later, during WWII, he worked in the Kaiser Shipyards in Long Beach, CA,
wiring Liberty ships. His premedical education was at Loma Linda
University College of Arts and Sciences in Riverside, CA, where he
received a BS in 1945.
He chose a career in medicine and enrolled in an accelerated premedical
program at La Sierra College, working as a laboratory assistant to cover
school expenses. He was later accepted into an accelerated program at the
College of Medical Evangelists. While attending school, he continued to
work in the shipyards during school vacations. Like many other medical
students at this time, he was eventually inducted into the Army.
Dr. Judkins married Loma Linda student nurse Eileen Cobb (1946). A
one-year internship at Loma Linda Hospital (1946-1947) was followed by
special training in urology and an appointment to the staff. He graduated
from Loma Linda University School of Medicine in 1947.
After a war-time appointment to the Urology Section of the 28th General
Hospital in Osaka, Japan, he and Eileen moved to Sumas, WA, a rural town
near the Canadian border, where he started a family practice. Eileen was
physician's assistant, laboratory and x-ray technician, receptionist and
bookkeeper. Their first patient was a dog, treated at no charge. When the
antiquated examining table jackknifed and collapsed onto a patient, new
equipment got top priority. It wasn't long before Dr. Judkins had full
surgical and obstetric privileges at three area hospitals. The twenty-four
hour demands of a solo practice caused both to reevaluate their plans to
continue in Sumas. Eventually they returned to California to begin a new
family practice in Antioch, CA.
In the late 1950's, at nearly 40 years of age, Dr. Judkins decided to make
a career change as burnout threatened. Though he had established a family
practice with a support staff of four nurses, a laboratory and an x-ray
technologist, a physical therapist, a receptionist and a bookkeeper, the
patient volume continued to grow. With the encouragement of a former
family practitioner turned radiologist, Melvin decided to search for a
residency program that would accept someone of his age.
After being turned down by the Mayo Clinic, he chose to come to Portland
to attend the University of Oregon Medical School as a resident in
radiology under P.E. Billimoria, MD and Dr. Charles Dotter, who was
already a well known angiographer and innovator of vascular techniques and
tools. That year, Dr. Judkins collaborated with Dr. Dotter in the
development and introduction of percutaneous transluminal dilatation of
narrowed peripheral arteries, subsequently published in a milestone
article. Originally scorned by colleagues in the U.S., the technique was
the forerunner of today's transluminal angioplasty techniques.
Dr. Charles T. Dotter
is considered the Father of Interventional Radiology. He was the Chair of
the Department of Diagnostic Radiology at the University of Oregon Medical
School for 33 years. "Eclectic on the lecture platform, sociable with his
friends, and an absolute terror to many of his peers and unprepared
Like Mel Judkins, Dotter was a workaholic and cared deeply for his
patients. But unlike Judkins, Dr. Dotter was expansive, and had many
interests outside of work, while Judkins preferred to stay in the
laboratory or to work on projects at home. Dotter, also like Judkins, died
At this time, coronary arteriography was not being done at UOMS. Dr.
Judkins went to the Cleveland Clinic to learn the Sones brachial artery
cut-down approach. He returned to UOMS and began to use this procedure of
introducing the catheter via a surgical opening of the brachial artery in
the arm. This technique required surgery and general anesthesia. Dr.
Judkins began to develop a technique that would require neither, and would
reduce radiation exposure for technician, physician and patient alike.
Melvin Judkins and F. Mason Sones:
co-founders of the Society for Cardiac Angiography now
named the Society
of Cardiovascular Angiography and Interventions.
In 1977, the Cardiac Catheterization and Angiography Study Group met to
discuss the establishment of a professional society. The first meeting of
the society was held in 1978, with Sones and Judkins as co-chairs. Sones
became first president of the society and Judkins was second president.
The Society was open only to individuals who had become experts in the
broad field of catheterization and angiography.
In 1965, Dr. Judkins received a National Institutes of Health grant to
study at the University of Lund in Sweden, then known as the premier
center of selective radiology. Preformed commercial catheters had not yet
become available. Catheters were formed at the time of examination from
tubing in various diameters. Utilizing preprocedure radiographs to select
a suitable size, length and configuration, the stainless steel wire was
inserted in the tubing, bent to conform to the anatomy of the patient and
then heated. When the assembly cooled, the wire was withdrawn, and the
catheter retained its form. A guide wire was introduced into the catheter,
which straightened the catheter for percutaneous insertion. It was at Lund
that he collaborated in the development and introduction of the "hooktail"
(U-shaped) catheter for percutaneous selective cardiography.
Lateral: One of three positions used
for High Resolution Serial Radiography
Dr. Judkins returned to Portland in 1966, after a new laboratory had been
created with the installation of the first commercially manufactured
imaging equipment specifically designed for angiography. Melvin was
appointed Director of Cardiovascular Radiology for the UOMS Hospitals and
Clinics as well as Professor of Radiology in the Medical School. He held
both positions until 1970, when he returned to Loma Linda. While at UOMS,
he introduced the Judkins Technique of selective percutaneous transfemoral
coronary arteriography, a technique which has been used worldwide. He and
his colleagues developed safety and safety-J guidewires and pioneered the
application of a thin Teflon coating to the guidesprings. Designed with a
flexible and broadly rounded leading end, the safety-J guidespring has a
small, strong internal safety wire that prevents loss of the guide tip if
breakage should occur. Teflon coating prevents catheter cling, increases
maneuverability and minimizes thrombogenicity.
The Picker Room at UOMS radiology laboratory. Equipment
was donated by GE and the James Picker Foundation.
James Picker (1882-1963), a Russian Immigrant, established the Picker
X-ray Corporation in 1921, manufacturers of x-ray equipment.
This image shows the procedure room and the Picker Control Console at the
University of Oregon Medical School, Department of Radiology.
In the 1960's Dotter established a first-rate laboratory for
interventional radiology with the latest x-ray equipment and cine, having
convinced GE and Picker to donate the equipment.
Oregon cardiac surgeon Albert Starr had begun to request that all valve
replacement patients over 50 years of age receive routine preoperative
coronary arteriography. Dr. Judkins took the challenge to develop a method
of consistent selective coronary catheterization, inserting a 100 cm
catheter into a coronary artery from a femoral artery, finding that
conventionally shaped catheter curvature did not work for coronary
Dr. Judkins obtained a plastinated human heart and would spend hours
molding his own guide wires, with a roll of wire, a wire-cutter, and
pliers, using various pipes and faucets at the scrub sink. "He would
scrutinize the shape, place the wire over a chest radiograph on the view
box, contemplate, and make changes." If a shape seemed workable, he would
thread a catheter over the shaping wire, immerse it in boiling water to
set the shape, and experiment on the heart specimen.
Original drawing of a human heart by UOMS medical
illustrator Clarice Ashworth Francone
Soon Dr. Judkins was using his new catheters on patients, creating
preshaped catheters customized to each patient's anatomy. His ability to
conceptualize the anatomical relationship of the aorta and the coronary
ostia coupled with his knowledge about catheter materials and mechanics,
and his proficiency in manipulation of the Teflon-coated safety-J wires,
lead to the development of the Judkins Percutaneous Transfemoral Technique
for Selective Coronary arteriography. Details of his new technique and the
outstanding radiographic images it produced were published in Radiology in
1967. In 1968, commercially manufactured preshaped Judkins coronary
catheters and shaping wire sets became available.
Melvin Judkins with his
left and right coronary catheters and pigtail catheter.
Before commercially preformed Cordis catheters were available, Judkins
catheters before each examination bending them to conform to the
Radiologists and cardiologists were astonished by the Judkins technique.
UOMS was the site of exhibits and demonstrations. He assembled a trained
angiography team dedicated to gaining the maximum amount of diagnostic
information with a minimum risk to patients and minimum radiation exposure
to the team.
Final exhibit panel
introducing Judkins Superselective Visceral Angiography, using the cobra
catheter. Billing was shared with Gerald S. Green, William Hebard, P. E.
Billimoria and Charles T. Dotter.
In 1968, Cordis Corporation of Miami began fabricating preshaped Judkins
coronary catheters and a Portland company began making sets of his shaping
Besides his coronary and pigtail catheters he envisioned catheters with
exaggerated curvatures that would consistently enter a target vessel when
introduced and manipulated via a transfemoral approach. He created unique
catheters for selective femoral cerebral arteriography, small branch
visceral catheterization, internal mammary and coronary bypass graft
arteriography, and left atrial catheterization, which are now commercially
"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," Mrs. Judkins explains. "The Judkins technique embraced a
combination of professional skill in transfemoral access 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
Dr. Judkins suffered a stroke in 1978. Accepting his limitations
gracefully, he and Mrs. Judkins worked as a team to author several
scientific publications and continue other nonclinical professional
activities. Dr. Judkins died in 1985, ending their partnership of 39
"He charted a course followed by radiologists and cardiologists, a tacit
tribute to his preeminence in both fields," Mrs. Judkins writes. "He never
sought to patent nor did he ever receive any monetary rewards for any of
the cardiovascular tools or devices he developed. When asked once why he
did not patent his devices, he replied that he wanted to make safe
coronary arteriography available to as many patients as possible. The fact
that most catheterization laboratories in the world use the Judkins
technique for selective coronary arteriography is evidence that his desire
Dr. Melvin Paul Judkins
Judkins was a member of numerous professional organizations, including the
American College of Radiology, Inland Radiological Society of North
America, American Roentgen Ray Society, the North American Society for
Cardiac Radiology, American College of Cardiology, Council on
Cardiovascular Radiology, the Society for Cardiac Angiography and the
Society of Thoracic Radiology. Besides his many memberships, he was an
officer in several national organizations and served on many national
committees, he was a member of honor societies and a recipient of numerous
awards. Dr. Judkins was a prolific writer and published over 160 articles,
monographs, book chapters and major scientific exhibits.
Dr. Judkins died January 28, 1985. Until his death in 1985, he was
recognized internationally as an authority on radiologic equipment and on
the diagnosis of coronary artery disease.
Sincere gratitude to Eileen Judkins for permission to use text from
"Master Angiographer: Melvin P. Judkins", by Eileen Judkins published in
the Alumni Journal of the Loma Linda University, School of Medicine,
Original art work by Charles T. Dotter
Lumen following a safety J-guide insertion
Dr. Nelson (Sam) Niles and coronary vessels
Sam Niles, former professor of Pathology at the University of Oregon
Medical School preserved, by plastination, these coronary vessels for Dr.
Oregon cardiac surgeon, professor of surgery, and chief of the
Cardio-pulmonary Surgery Division at the University of Oregon Medical
School developed the Starr-Edwards heart valve in 1960. Starr requested
that all valve replacement patients over 50 years of age receive routine
preoperative coronary arteriography.