Rajiv Gandhi Cancer Institute and Research Center (RGCI & RC), New Delhi, started in 1996 primarily as a cancer diagnostics and treatment hospital geared for tertiary care and today stands as a pioneering institute in the field of cancer research and treatment. The hospital which acquired NABL (2011) and NABH (2012) certification was the first globally to qualify for ISO 9002 and 14001 certification in 2001. Express Healthcare was keen to find out what the radiology department of this hospital is upto and hence paid a visit to find out more. Located on the ground floor, in the A block of the hospital and 2nd basement in the C Block, it offers easy access to patients.
Armed with linear accelerators, simulators, high dose rate remote after loading Brachytherapy system, dedicated treatment planning computers and mould room to fabricate lead shields and templates in house, it is intricately networked to CT scan and MRI with DICOM image transfer capability. Talking about the early days, Dr AK Chaturvedi, Director, Radiology says, “We acquired the first state-of-the-art stereotactic mammography machine from Siemens (Mammomat 3000) soon after our inception. It was a sophisticated breast diagnostic system which could do biopsy of lesions.” He added that even AIIMS did not have one that time. Today the digital version takes its place of pride, a newer more advanced system that integrates a small field digital mammography (SFDM) with digital breast tomosynthesis (DBT) and results in computer generated good quality images that are clearer and hence help in better diagnosis.
The department prides itself in having a fully functional PACS with secure private cloud storage in a complete digital environment that ensures reports are generated within a day, optimised imaging protocols conforming to international practice with a focus on clinically oriented reports and carrying out most bed side interventional procedures. Care is also taken to ensure patient management through active participation in multi-speciality clinics (held on a daily basis) and tumour board meetings. “The radiologist plays an important role in staging the disease and detailing its exact extent which is a driving factor for treatment by the physician. This includes evaluation of the treatment being given to understand its responses so that the physician can either change the dose or suggest an alternative course,” adds Dr Chaturvedi.
With more than 200 radiofrequency ablations (RFA) to its credit, the department is a pioneer in the treatment, which is ideal for patients with local tumours or those who have failed conventional therapies. Not only does it save the trauma associated with surgery, but also reduces hospital admission time to a day or so. RFA is performed under CT guidance and combined with chemotherapy for best results. The hospital’s reputation in image guided interventions is evident by the number of referrals coming in from multiple hospitals across the country, most of which are carried out on an outpatient basis. Another technique called Transarterial Chemo Embolisation (TACE) therapy involves administration of chemotherapy directly to the liver tumour via a catheter that reduces many side effects of traditional chemotherapy that is given to the whole body.
Apart from the ultrasonography (USG) guided fine needle aspiration cytology (FNACs) and biopsies (with yield rates as high as 96 per cent), stereotactic biopsy procedures and guided wire localisations are also performed. A state-of-the-art MR guided biopsy system takes care of any abnormalities detected on MR mammography. Last year saw the addition of TrueBeam technology for the first time in Northern India at RGRC. The advanced radiotherapy device dynamically synchronises imaging, patient positioning, motion management, and treatment delivery with precision. With applications in all modalities including Image Guided Radiotherapy, Radiosurgery (SRS, SRT), Intensity-Modulated Radiotherapy (IMRT), Volumetric Intensity Modulated Arc Therapy (VMAT) and Stereotactic Body Radiotherapy (SBRT) along with conventional and 3-D conformal radiotherapy. “We have breached the stratosphere of operative technology with the addition of cutting-edge technology of Da Vinci robot assisted surgery and addition of four more modular operation theatres,” informs Dr Chaturvedi.
Touching upon the merits of functional imaging, he further elaborates how PET CT scans have changed the course of management of cancer. “So far in radiology, the focus was on studying the internal composition of the body, whether through CT scan, X-Ray. However, certain molecular changes also need to be mapped. A PET CT scan gives structural image with a superimposed functional image detailing the metabolic processes in the body which leads to better insights into the disease.” An 18 channel, high gradient 1.5T MRI performs dynamic studies and multiphase angiographic studies alongwith venography, MR spectroscopy, perfusion, diffusion imaging and mean curve analysis functions for evaluation of complex cases. Breast imaging is routinely performed with a high resolution breast coil with advanced software available for analysis of post contrast kinetics of mass lesions. The machine is equipped with a unique ‘total imaging matrix’ (TIM) technology making it possible to combine the elements for more than one coil for optimal imaging.
Currently, the department has 10 radiologists and five more in training. Almost 12 students have passed out so far as a part of its postgraduate DNB programme in radiology (three-year residency) accredited by the National Board of Examinations, New Delhi which started in January each year. Apart from this, it runs a one-year fellowship programme in oncological radiology for radiologists certified by IMA academy of medical specialities, a short-term training programme in radiology (two to four weeks) recognised by the Indian Radiological & Imaging Association (IRIA) and Indian College of Radiology, as well as diploma courses in X-ray and medical Imaging Technology for technicians (two-year programme recognised by Delhi Medical Association).
Dr Chaturvedi is currently working on a project for early detection of breast cancer under International Atomic Energy Agency (Vienna) and recently conducted a workshop in interventional procedures for radiologists in Malaysia. All in all, the department, with its cutting-edge technology supplemented with training and research, looks poised for growth.
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