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At the Forefront of

Diagnostics

The improved techniques in radiology have dramatically increased the range and the scope of diagnostic information By Dhirendra Pratap Singh and Shally Makin

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february / 2012 www.ehealthonline.org


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adiology is the key diagnostic tool for many diseases. It plays an important role in monitoring treatment and predicting outcome. It has a number of imaging modalities in its armamentarium that have physical principles of varying complexity. This medical specialty employs imaging to diagnose and treat the diseases. Shortly after the discovery of xrays at the end of the 19th century, radiology has been a medical specialty that is dedicated to excellence in the provision of imaging services to support the care of patients. There have been dramatic advances in the field of radiology in the past few decades. Today the imaging armamentarium includes multi-detector row CT, MRI with a host of advanced sequences, PET-CT, digital mammography etc. While all segments of healthcare have benefited from such technologies, those that have seen the greatest benefits are the subspecialties of neurology/neurosurgery, oncology, orthopaedics and cardiology/cardiac surgery. Radiologists, these days, are involved in these technological developments and have been responsible for much of the evaluation of the strengths and weaknesses of different investigations. Radiologists have developed the knowledge of the appropriate integrated imaging algorithms, which maximises clinical effectiveness. They are responsible for the implementation of these developments into the clinical setting and for ensuring the best use of assets and healthcare resources. The improved image clarity and tissue differentiation in a number of situations has dramatically increased the range of diagnostic information and in many cases the demonstration of pathology without the requirement of invasive tissue sampling. The use of imaging for functional evaluation and cellular activity has created a new challenge for radiologists whose training has predominantly been based on the anatomical and pathological model with limited experience in physiology and cell function.

Market The radiology market in India is growing very fast with investment being poured in as a result of India’s economic growth. There is a profusion of high-end imaging technologies, not just in the major metros but also in tier II and III towns. The technology gap between west and east has disappeared and the latest technologies are today unveiled in India simultaneously with the West. This is a heartening trend. Consumers are becoming more enlightened about their healthcare and diagnostic needs and more discerning of their choices, thanks to the availability of information on the internet today. People have started expecting quality imaging, and they are less likely to be manipulated by corrupt practices in our system, such as referral fees and the like. Indian health imaging market is expected to double from the existing `1,575 crore, in the next five years. X-ray, ultrasound, CT and MRI will drive this domain and collectively account for 68.6 percent of the health imaging market. Tele-radiology

holds 90 percent of the market share in the country, growing at 50 percent year on year. Since the days of X-ray, various technologies have exploded in the radiology market. Major evolution has been noticed in the domain of CT, MRI and ultrasound, while digital radiography and teleradiology have given a whole new meaning to diagnosis.

Interventional Radiology Advances in interventional radiology have simplified most of the procedures while retaining safety. There are fewer instances of trauma to patients. Besides angioplasty, drainage procedures, tumour ablations, and embolisations are now increasingly becoming image-guided, minimally invasive interventions, due to the refinements in technologies. Successful evolution of IR procedures could be attributed to advances, such as improved multidimensional imaging techniques, microcatheter technology, improved guide wires, small sized

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balloon catheters, vertebroplasty, drug eluting and flexible stents and removable vena cava filters. Interventional radiology (IR) utilises various imaging techniques such as CT, MRI to guide percutaneous minimally invasive procedures for both diagnosis and therapy. This has paved the way for applying IR to a vast number of medical conditions that are otherwise performed using invasive methods. february / 2012 www.ehealthonline.org

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Interventional Radiology is Definitely What the Industry is Looking up to Dr. Rajesh Kapur, Vice President, IRIA spoke about the scope of technology in the field of radiology which has now paved the path for the shining waves to travel and diagnose, identify and treat the diseased part

How do you see the advancements in the field of radiology over last few decades? Which areas of healthcare have mostly been benefited through such technologies? The advancement in radiology has evolved from conventional x-rays to ultrasound, MRI CT scanners to many other devices. We have benefitted a lot with such medical equipments, which help surgical specialities, specifically prosthetics and gynaecology, to diagnose and treat effectively. Many a times the surgery used to be exploratory rather than identifying the diseased in the pre-operative phase. The surgeon opens up the abdomen and look for the diseased part. Unlike today when ultrasound gives a clearer view of the body parts, and leads to a better monitoring and developing of treatments or of conventional surgeries.

Radioembolisation is a latest technique of intra arterial radiotherapy. It involves delivery of Yttrium 90 labelled microspheres into the blood vessels supplying the tumour The new position of the radiologist became even more envious with introduction of multi-slice volume CT scanners, superconducting MRIs, SPECT and fusion imaging, and teleradiology. With emergence of interventional Radiology and its advantages of minimal invasiveness in treating diseases, the radiologist has come close to becoming a surgeon. The innovation of digital radiography (DR) system has significantly improved the clinical workflow and efficiency of the department. It has also helped shorten the diagnostic and therapeutic decision-making processes. Additional benefits

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are improved patient comfort, reduction in radiation doses, higher examination throughput (i.e. multiple examinations during one visit) and a more pleasant atmosphere in the waiting room (through shortened examination and waiting times for xray). The x-ray images are available throughout the hospital, in a PACS environment. All this represents major benefits for the patients. Radioembolisation is a latest technique of intra arterial radiotherapy. It involves delivery of Yttrium 90 labelled microspheres into the blood vessels supplying the tumour. These microspheres get embedded in small blood vessels inside the tumour and emit beta particles which treat the tumour. Since the average penetration of a beta particle is only two millimetres, the radiation therapy delivered is highly targeted and is limited to the area of interest.

Nuclear Medicine In the course of a Single Photon Emission Computed Tomography (SPECT) scan, a three-dimensional image is obtained by rotating the detectors of the gamma camera around the


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Tell us about the latest technology which has revolutionised the imaging and diagnosis worldwide. Latest technology is now revolutionising the imaging and diagnosis worldwide. It is true that x-rays have advanced a lot over the years. 6-7 years back, the investigation was done in dark rooms and today the X-rays are very well exposed in a full bright light creating better impressions and imaging thus developing a digitised data. The maximum benefit is from ultrasound because the current scanners are now much better in terms of high frequency and clarity. New additions in radiology are the contrast feature in ultrasound, which was earlier seen only in MRI. It can pick up infection with greater degree of accuracy. Ultrasound equipments need to be registered with the authorities before use. There are 35,000 systems registered so far that are catering to more than a million people. Elastography can now tell us about the malignant tumours, which appear to be a little harder. Ultrasound has also gone into the therapeutic part, as they are combining it with MRI generally used to diagnose fibroids for prostate and breast cancers. The applications are

diversified with a cutting edge technology in biopsy with a greater use of 128 slice scanners. MRI is also getting better with 1-1.5 and 3 Tesla being the latest in the industry. India is catching up really fast with technology in the radiology market. Molecular Imaging cardiac shows promising future. With the industry witnessing a constant change in terms of advancements, share your views on the changing market trends? The market shows great opportunities for private players to invest in the industry. The equipments are really expensive and thus needs to be upgraded with government chipping in and making it economical for diagnostic centres to create high end facilities. The investment is really high. The diagnostic equipment needs to be much more economical. It is better to buy the technology at the right point of time otherwise it becomes obsolete. So by the time you have installed a version of the equipment a new system with better features appears in the market. The finances need to be worked out in such a way that small centres should get solutions which are worth providing facilities to the patients.

patient. For evaluation, slices in any orientation can be reconstructed from the original three-dimensional scan. PET scanning is a nuclear medicine procedure that deals with positrons. The positrons annihilate to produce two opposite travelling gamma rays to be detected coincidentally, thus improving resolution. With the introduction of improved instruments, allowing acquisition of whole body images in under an hour, applications in oncology have opened avenues for expanded clinical use of PET. With a focus on adding functional information to the anatomic knowledge, the ability to diagnose and treat will get better. PET/CT scanners will continue to revolutionise oncology. Interventional techniques will get more and more refined and the combined impact will place radiology in the forefront of patient management. In future will see enhanced efforts towards greater use of molecular imaging, which will enable us to detect lesions before they attain even pin-head size and are only at cellular levels. By understanding the molecular basis of disease and developing methods to detect and treat changes in the body at the molecular level, physicians will be able to

What are the challenges faced by the standalone Indian radiology providers vis-a-vis multispecialty corporate hospitals? Funding is the major challenge in the industry as it takes up to 5 years for an imaging centre to survive in the market. The people should take one step at a time to set up a small facility centre in their neighbourhood. There is a scope for standalone centres, which are generally advised by private practitioners. They do not send their patients to the organisations such as MAX and Apollo, as they can lose their patients. What are your views on interventional radiology? Interventional radiology is definitely what the industry is looking up to. They are trained to be part of every speciality. From cardiology to paediatrics all use ultrasound for surgeries and the credit goes to the radiologist for being in a position to help different departments of the healthcare industry. Ultrasound equipments need to be registered with authorities before use. There are 35, 000 systems registered so far that are catering to more than a million population along with unregistered systems further gratifying the whole country.

identify diseases in the earliest possible stages. This will by far remain the major focus of research and development in clinical medicine in the 21st century. The increasing proportion of imaging modalities that generate images in digital form has lead to the development of digital image management systems. Such systems referred to as Picture Archiving and Communication Systems (PACS) are emerging in clinical and radiological environments. It is an integrated set of information technology systems designed to provide a complete solution for image management in a film-less radiology department. While introducing PACS to the hospital environment, it is critical to establish a Hospital Information System (HIS) or Radiology Information System (RIS) beforehand. Integration of Radiology Information Systems (RIS) with PACS is a defining trend in the imaging market. In radiology, the safety of patients and healthcare personnel permeates most features of the imaging process. It is necessary to use the lowest dose possible of the ionizing radiation to either achieve the necessary images and arrive at a correct diagnosis. february / 2012 www.ehealthonline.org

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eHEALTH-Feb-2012-[34-37]-At the Forefront of Diagnostics