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Dr Mukund Joshi
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He finds his happiness in helping as many people as possible, through his work. He is a deft radiologist and a mentor to many in the field of radiology. He has extensively taught and promoted ultrasound in India and the rest of the world. Moreover, he is the second Indian in 100 years to get a honorary membership of RSNA in 2012 and the first Indian to receive a fellowship of American College of Radiology in May 2013. He is Dr Mukund Joshi, Consultant Radiologist, Jaslok Hospital, Mumbai, a name synonymous with ultrasound in India. His contributions to the field range from grey scale ultrasound to interventional procedures and 4D ultrasound imaging. With his constant effort in promoting the field of radiology, he has been honoured with the prestigious awards such as Sir JC Bose Memorial Oration Award by IRIA in 1985 and the Lifetime Achievement Award by ISR in 1998. He was one of the members of the expert working group of the Planning Commission during 1997-2002. He has held editorial positions in national and international journals including Ultrasound Clinic of North America, Clinical Imaging Science and British Journal of Ultrasound. He is currently on the Board of Directors of Medical Imaging Partnership and a member of International Advisory Committee of the RSNA. He is the recipient of ‘Life Time Achievement Award’ by Association of American Radiology of Indian Origin in 2008 and has several other honours to his name.
How the story began…
Dr Joshi was born in a very illustrious family, dedicated to the field of medicine. Seeing his father, one of India’s eminent ENT surgeons achieve excellence in his field, gave him the impetus to take up medicine as his career. He completed his medical education from Seth GS Medical College and KEM Hospital respectively. Further, he pursued his diploma in medical radio-diagnosis at the College of Physicians and Surgeons, Bombay. He completed training in ultrasound at Herlev Hospital, Copenhagen, Denmark, and the Royal Marsden Hospital, UK, and training in breast imaging at Sydney Square Breast Center in Australia. Dr Joshi trained in Doppler ultrasound at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and the University of California, San Francisco.
Dr Joshi’s association with ultrasound imaging began during the times when medical practitioners and radiology worldwide were sceptical about its clinical applications. During the initial days of his career, he practised general radiology for a long time but then he got bored. Remembering those days when he shifted focus from general radiology to ultrasound imaging, he recalls, “I was bored doing the usual radiology practice of asking my patients to breathe in breathe out and take general images using X-ray and giving out radiation to patients. I wanted to do something more, something in-depth. I got into diagnostic imaging which would benefit all kinds of diagnosis in medical practice. I decided to further upgrade myself in the field of sonology and ultrasound imaging. At that time, I read an advertisement that spoke about Danish government giving scholarship to students interested in specialising in ultrasound imaging. I applied for the same and landed up at the Herlev Hospital, Copenhagen, Denmark, one of the most reputed institutes for radiology in the world.”
Thus, began the journey of an ultrasound expert. However, learning at the Herlev hospital was not a cake walk. He confesses, “Doctors at Herlev were just great, even the nurses there were apt in understanding the applications of ultrasound. Initially, I found it very difficult to understand. I even thought that I may not be able to pull it off.” Nevertheless, Dr Joshi put his entire heart and soul in learning the clinical applications of ultrasound. Thereafter, he went to London to study further and work with Dr David, who was the Head of Department at Royal Marsden Hospital, United Kingdom. Working at the Royal Marsden made him a competent radiologist and from there on, sky was the limit.
So, how did Dr Joshi utilise his skill in India?
Establishing ultrasound in India
“In the late 70s, X-rays were the only thing in India and for some reason CT scans were more established as compared to ultrasound. Where ultrasound is concerned there was one group of doctors at the Bombay Port Trust Hospital under the guidance of Dr Pai who was the chief of medicine there had installed an ultrasound machine out of curiosity and started doing ultrasound on his patients. Gradually, he became the first man to start ultrasound in India. Then, Dr Amrish Dalal, returned to India after gaining his education in ultrasound imaging from America around the 80s and started his own private practice in ultrasound. So, these were the only two established people practising ultrasound in Mumbai. However, a top of the line complete state-of-the-art ultrasound department was established first by Jaslok Hospital in 1983. I was very fortunate that the management of hospital gave me the opportunity to establish this department. They extended their full support to me and allowed me to buy the equipment I needed to establish the ultrasound department here at Jaslok. I would also give credit to Dr GN Mansukhani, who was the head of Gynaecology and Dr Keshav who have been my strongest support in establishing the ultrasound department here at Jaslok. Now at the same time, AIIMS in Delhi had also started an ultrasound unit at the hospital; these were the two major well-established ultrasound units in India during those days. The institutes were trying to propagate the uses of ultrasound in India.” In order to spread awareness about the uses of ultrasound Dr Joshi travel far and wide across the country. Apart from bringing the latest technology and applications to India he is responsible to introduce techniques like the Acoustic Radiation Force Impulse (ARFI) Imaging – a type of ultrasound imaging used in medicine, particularly for the diagnosis and monitoring of cancers and the Automated Breast Volume Scanner (ABVS) used for complicated breast imaging.
The world scenario
| Ultrasound is used in many interventional procedures making it a boon to medical sciences |
When asked about the growth of ultrasound imaging in the rest of the world, he disclosed, “World over, the scenario was different. People around the world were hesitant to use ultrasound. They had queries about how much can sound waves penetrate a human body and how much can they give information etc. Europe has adopted it in clinical practice but the Americans were not ready to accept ultrasound as a useful imaging modality. It took some time for the Americans to bring ultrasound into clinical practice. On the other hand in India, ultrasound was slowly getting noticed.”
So, how did the ultrasound technology develop further? How did the Indian market respond to this development?
The transformation
“The first use of ultrasound came during the Second World War to detect German submarines. They sent sound waves into the sea to observe the returning echoes to characterise submerged objects. The reading of which were then used to prepare a graph that indicated that the object was a submarine. The technology was developed by the navy people. It was also brought into clinical practice by navy doctors,” inform Dr Joshi, when asked about the origins of ultrasound technology.
He furthers talks about the development and technological advances, “Ultrasound began with the A-mode (amplitude mode) which was the simplest type of ultrasound. In this type of ultrasound, a single transducer scans a line through the body with the echoes plotted on screen as a function of depth. These were used for quiet some time to detect haematoma in the brains. The next development came in the B mode (brightness mode) ultrasound, in which a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen. After the B mode came the real time imaging. Then came the Doppler which was further developed to colour Doppler. And finally, around the 90s came the 3D ultrasound imaging. But, people wanted more. They wanted more real time imaging, so 4D technology was introduced in ultrasound. Also, on the research side, people started working on developments in the transducer technology.”
All the above mentioned advancements, especially the ones in the transducers have completely transformed ultrasound technology. Dr Joshi further mentions, “Today, we have the hand-held ultrasounds with wireless transducers which are extremely useful in emergency medicine.”
Moreover, he informs that with these rapid advancements in ultrasound technology, ultrasound is used in many interventional procedures making it a boon to medical sciences. Although he stresses that it cannot replace CT and MR.
Vision for India
Dr Joshi believes that healthcare in India needs a new direction, especially where medical education is concerned. Talking about the lack of specialised radiologists in India he says that there is a huge shortage of manpower in the field of radiology. “Government needs to allow institutes to generate more seats at the PD level of medical education and introduce new PG courses in radiology.”
Lastly…
Dr Joshi has immense knowledge on ultrasound imaging, which is why people refer to him as the ‘Father of Ultrasound Imaging.’ He says that there is more work to do. In the coming years, we will see a new era of diagnostic imaging, specially in the field of molecular diagnostics.