Radiology: Past, present and future

Dr Deepak Patkar, Consultant Radiologist and HOD Radiology — Nanavati Super Speciality Hospital, details how radiology has evolved across the decades to emerge as a key diagnostic and therapeutic tool in healthcare delivery

Radiology since its origin as a medical speciality has been a keystone in healthcare. It is probably one of the most rapidly advancing branches in medicine. As we all know, to start treatment for any ailment the first thing needed is correct diagnosis and no one can imagine diagnosing diseases without radiologic investigations. Earlier, physicians had to rely on their clinical knowledge and skills to diagnose diseases, which was mainly based on imagination like they used to suspect that a patient with right lower abdomen pain could have acute appendicitis but now we can actually see and pick up diseases. Medicine with radiology has moved from imagination to imaging and now we are in an era where technology is even beyond imagination.

Technology has progressed by leaps and bounds, pushing the boundaries of imaging for the benefit of mankind.  Radiology has moved from conventional analogue systems to digital image acquisition modalities. Direct radiography systems, to start with,  allow improved image quality and/or dose reduction. With amorphous Selenium coated flat panel thin film transistor (TFT) array technology, there is improvement of the workflow due to shorter preview times and therefore a higher thoroughput of patients.

Ultrasound is a perfect combination of effective, sensitive and non invasive, free of radiation, bedside, portable as well as patient friendly imaging technique. The high end scanning systems enable us to do real time 3D and 4D scans. None of the other modalities compare with USG in terms of antenatal scans. Colour doppler evaluations are a part and parcel of vascular medicine.

Computed tomography (CT) is an essential tool in diagnostic imaging for evaluating many clinical conditions. In recent years, there have been several notable advances in CT technology that already have had or are expected to have significant clinical impact, including extreme multidetector CT, iterative reconstruction algorithms, dual-energy CT, cone-beam CT, portable CT, and phase-contrast CT. The net effect of all these advances is higher spatial and temporal resolution. This allows faster acquisition of high quality images. Examinations like angiography has emerged as a highly efficient diagnostic alternative to conventional catheter angiography, significantly reducing the examination time and precluding the risks associated with catheter angiography.

With newer reconstruction algorithms like iterative reconstruction, there is significant dose reduction to the patients. Technology like DECT has enabled gallstone and renal stone characterisation, differentiating gout from pseudogout, metal artifact reduction, myocardial iron detection, etc.

Magnetic resonance imaging (MRI) has been playing an increasingly important role in biomedical research and in clinical diagnosis. There have been several advances in the MRI hardware and software which has enabled faster acquisition of high resolution images. Other advances include functional MRI (fMRI) of the brain which detects neuronal activation in the brain based on local increase in the oxygen-enriched blood in capillaries associated with the signal change measured in traditional BOLD MRI technique. Diffusion tensor imaging (DTI) is another interesting, advanced MRI technique which can depict neuronal tract projections in the brain and spine and the effect of various pathologies on these neurons. Arterial spin labelling is a non-invasive MRI perfusion technique which allows assessement of alterations in the blood flow in the the brain in various pathological states. For example; in a treated case of brain tumour there will hyperperfusion in case of residual disease or recurrence vis-à-vis post treatment changes, which would be hypoperfused.

MR guidance can also be used for biopsy of soft tissue pathologies affecting organs like breast, prostate etc.

Now, we not only deal with diagnostic radiology but also therapeutic radiology. Vascular and non-vascular interventions, guided procedures and techniques like MR guided high frequency ultrasound for treating fibroids, bone tumours etc. provide effective minimally invasive treatment to patients.

A challenge specific to the field of radiology is its fast pace of advancement which necessitates every radiologist to keep him/her self up to date. A person trained around 20 years back might have not been trained in many of the techniques in use today, many of the things might have become simply obsolete. In this scenario, we specifically need an organisation which can provide a platform to bring these updates to the reach of each and every practising radiologist. Another problem streaming out of the same fact is that the latest technology is available only to a small strata of students who are getting trained in big corporate hospitals or tertiary level medical colleges in major cities. The ongoing CMEs and conferences are really a help. Digital media is a wonderful tool as we can always find reference materials in text and audiovisual format to upgrade our knowledge and keep ourself upto date.

We, as radiologists, have a special benefits of teleradiology wherein an expert from say Mumbai or Delhi can report for hundreds of villages and townships from across the country. We need to support and encourage such teleradiology networks and organisations. At the same time, national level organisations should take efforts to set a benchmark for their basic standards. The final goal would be that each and every town in this country have their own qualified and competent radiologist.

Successful practise of modern day medicine needs true integration of medical skills, technology and management proficiencies.  Our aim should always be to provide our patients with best possible level of care and treatment. One thing to remember is that learning is an ongoing process and with medicine its a never ending process. Future is yet to see much more and one should be ready to keep pace with these advances.