Management

Latest Advancements in Radiology

Radiology has come a long way; there are no longer water-tight compartments as far as this speciality is concerned

"The radiologist even wants to do intervention and why not, as he is the one visualising many things better than other specialists and there are many areas where he can do the best job" - Dr Priti Kapoor Consultant Radiologist Fortis Hiranandani Hospital Vashi

The need for imaging was born out of a desire for studying the human body and the diseases therein without actually any intervention. From the first time that Roentgen actually saw his wife's hand's image, till today, there have been tremendous amounts of progress in this field. Somewhere along the line, we have developed little buds which have shaped up into study branches. There is no longer just X-radiation but many other modalities which are all a part of this mammoth speciality, where the aim is to see, to image and to deliver information. The means for the same are ever-evolving. The goals remain the same; better visualisation, more safety as also, lesser time, lesser cost, better patient comfort etc.

Radiology has come a long way. There are no longer water-tight compartments as far as this speciality is concerned. The initial break-through was visualisation of anatomy, followed by pathology and ultimately the quest for studying physiology and physiological or functional aberrations, and then stepping into allied grounds not to compete but to enhance treatment modalities available to the ailing and offer help to the treating clinician; Radio-surgery, virtual surgery. The radiologist even wants to do intervention and why not, he is the one visualising many things better than other specialists and there are many areas where he can do the best job. In interventions done through radiological methods, what is remarkably striking is a relatively more minimally invasive approach, a more conservative approach, where the aim is that the natural milieu is least disturbed, a more precise approach as none else can see so well the target like the proverbial eye of the fish for Arjuna- bang on the target!

Similarly, there are branches of imaging which are no longer the sole prerogatives of the radiologist, e.g., imaging in nuclear medicine. Radiology remains a dynamic field, open to expanding its horizons, as and when more scientific ideas are born that serve our purpose. Here, we shall glance upon the panoramic view of the recent technical advances in radiology. Every new modality strives to be better than the previous ones, be it new pulse sequences in MRI for better visualisation, new contrast agents for better patient tolerance even e.g., where the patients have compromised renal function tests.

Computers in Radiology

Throughout the world, the trend is towards using a Picture Archiving And Communication System [PACS], and the aim now is to engineer the whole clinical workflow process to become digital, so that hospitals may become paperless as well as film-less, not just with respect for radiological examinations, but for the whole of clinical workflow. PACS now replaces, image acquisition, storage, transportation and display.

Tele Radiology

The most commonly used types of teleradiology are, review of images from home when on call, teleradiology linkage between two or more hospitals, outsourcing of imaging examinations by understaffed hospitals for reporting elsewhere by a private company, last but not the least, tele-education, whereby a digital image teaching library is accessed remotely by the users.

Speech Recognition Dictation System

Powerful and accurate speech recognition systems are getting integrated into the departments although acceptability for widespread use in radiological reporting demands consistent maintenance of very strict standards.

CT

Over the last decade, computed tomography has developed rapidly due to a number of advances in hardware and software, from conventional, single slice machines through helical CT to the current multi-detector scanners, conferring significantly the advantage of greater speed of acquisition, allowing large volumes to be scanned within a single breath hold, guaranteeing contiguity of the reconstructed slices and minimising the risk of movement artifacts.

USG

Ultrasound has benefited significantly from the massive improvements in computing power and data storage that has taken place recently, allowing major advances in signal generation and processing techniques, as also the advent of echo-enhancing agents. The role of USG continues to remain unrivalled because of the ability to show events in real time. The continuing improvements in contrast sensitivity and resolution, technological advances in equipment, together with the emergence of new techniques such as elastography, higher frequency probes, endoscopic USG; a progressive trend to produce better and better images, sometimes even at par with MRI.

Virtual Intraluminal Endoscopy

New paradigms are opening up with the manipulation of 3D datasets, particularly in conjunction with contrast enhancement, producing virtual imaging endoscopy [Virtual colonoscopy and virtual gastroscopy]. These techniques emulate standard endoscopic procedures without being invasive producing iatrogenic injury or patient discomfort. They can also be used in areas inaccessible to standard endoscopy [virtual angioscopy] Computer-simulated endoscopy allows for a fly-through facility and interactive viewing. This is a powerful tool requiring more work and development to determine its true clinical efficacy.

SPECT - Single Photon Emission Computerised Tomography

What CT scanning brought to X-rays this modality serves the same purpose in Nuclear Medicine, creating three dimension images with the help of a gamma camera, utilising computers.

PET - Positron Emission Tomography

Only in the last few years has this technology become more widely available for clinical application. Much of the early work with PET focused on brain metabolism, but 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.

MRI

The utility of MRI techniques to medicine appears to advance relentlessly and consistently. It provides new, non-invasive alternatives to existing imaging techniques, mostly with improved diagnostic information. There is also a move towards more quantitative imaging techniques, providing data quicker than other modalities and without need for multi-imaging investigations. Whole body MR is one such recent useful trend. Interventional MRI, though technically challenging, is another one of the latest trends in this field. MRI is increasingly being proposed as a desirable means of guiding and monitoring interventions in many organs as well as in vascular intervention.

Radiosurgery

Each year cancer research programmes continue to grow to introduce treatment options where the aim is that patient gets to endure lesser and lesser of painful and invasive treatments. Radiosurgery is a non-invasive, non-surgical treatment of tumours that allow doctors to direct beams of radiation with a gamma knife to precise locations in order to focus it directly over the tumour. This method can help treat and remove especially intracranial tumours that would otherwise not be accessible for open surgery such as skull base tumours.

High Intensity Focused Ultrasound

High intensity focused ultrasound or HIFU is a new type of therapy where a strong high intensity ultrasound beam is focused directly onto a specific part of a tumour, thus causing death of these cells. When Forsemann injected contrast into a hand and did the first angiography, he was not planting a stake as a cardiologist. He was merely making a contribution to mankind. Similarly, as the field of imaging expands, there will be wide-spread ramifications into allied territory but the aim remains to alleviate the suffering of mankind in the best possible way. Radiology marches ahead, with a firm commitment not only to better diagnosis but also with focused therapeutic intent. The most forward-thinking of all modalities, it embraces modern methods of self-management. Being associated with risks like radiation, it is ever alert in adopting safer trends. This youngest branch of medicine remains the most progressive and is aware there are more horizons to be explored and also that it has to remain ever-vigilant; always on its toes.

pritikaps@gmail.com