Imaging services

SERVICES: Diagnostic and Interventional

Approximately 3,50,000 exams are performed each year with busy, surgical, oncologic, medical, pediatric, obstetrical and trauma services.

Plain Radiographs (X Rays)

This refers to plain radiographs such as Chest X-rays, spine x-rays, KUB, Abdomen, extremities, joints.

Patient Information:

Plain radiography, or X-ray, is the most common diagnostic procedure in imaging. It uses X Rays which after passing through the body part under consideration produces a ‘shadow’ or ‘image’ on a receptor which can be documented on a X Ray film.

Preparation and Procedure

For most X-ray examinations (except X Ray of the abdomen), no special preparation is required. As with most other imaging procedures, jewellery and other metallic articles should be removed because they may interfere with the exam.

The patient is positioned - standing, Sitting on a stool or lying on radiographic table depending on the body part radiographed.. Typically two or more x-rays are taken from different angles to give the radiologist multiple views of the region being studied for a better understanding of the pathology.

Fluoroscopic procedures

Fluoroscopy is a live, real time radiology technique using X Rays that enables the radiologist to visualize the organ or organ system being studied, either with or without the aid of a contrast agent,. The contrast agent is needed to enhance the visibility of soft tissues which normally are not visible on x-ray alone. During fluoroscopy the image is viewed on a television monitor by the radiologist. The contrast agents (or "contrast media" as they are also known) used are administered through intravenous injection, oral ingestion, as an enema or retrogradely through a fissure/sinus or an external opening visible on the surface.

Fluoroscopic procedures that are performed in our department include:

• Gastrointestinal barium studies such as barium swallow, barium meal Upper GI study, barium meal follow through, barium enema, distal cologram,
• Small bowel enema (enteroclysis)
• T-tube cholangiograms
• Sinograms/Fistulograms
• Hysterosalpingog
• Sialograms
• Micturating cystourethrography
• Retrograde urethrography
• For movements of diaphragms / cardiac examination

PATIENT INFORMATION: BARIUM STUDIES

Barium studies are used to examine the Gastro-Intestinal system, including the oesophagus, stomach, small bowel and large bowel. A ready made barium sulphate suspension (powder in water) is used to coat the inside of the area being investigated. Air or other gas is often used along with barium to expand and coat (double contrast) the area under investigation to allow for more complete and better delineation of the normal and pathological regions. A Radiologist (specialist doctor) and a Technologist will perform the examinations, sometimes assisted by a Registered Nurse.

IT IS IMPORTANT THAT PATIENT BRINGS ALL PREVIOUS X-RAYS, SCANS OR ANY OTHER BIOCHEMICAL REPORTS WITH THEM ON THEIR DATE OF APPOINTMENT.

Mammography :

Refers to X Ray mammography (digital mammography with 3D Tomosynthesis) available in our department:

Patient Information:

Mammography is also a type of x-ray examination used to identify early cancers in breast tissue. Women should schedule a mammogram at a time when their breasts are likely not to be tender, such as the week before their menstrual period. The breast is compressed in a cassette for better visualization and both a top-to-bottom and a side view of each breast will be taken. Occasionally, additional views or an ultrasound exam may be requested by the radiologist for more information.

Other procedures also performed under mammographic guidance include ductography (imaging of the ducts of the breasts), Stereotactic facility (which enables needle biopsy procedures using computerized aid) and hook-wire localization.

Ultrasound

Ultrasound imaging, also called ultrasound scanning or sonography, involves using high-frequency sound waves (Ultrasound) in diagnostic range to produce images of the inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays or CT scan). Because ultrasound images are captured in real-time, they can show both the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

Ultrasound imaging is a noninvasive medical test that helps radiologist to diagnose diseases. Also since it does not use ionizing radiation, it is safe to use in children and in pregnant women.

Ultrasound tests that are performed in our department include:

• Upper abdomen
• Whole abdomen
• Pelvic sonography
• Neck sonography : Thyroid, Parathyroid, nodes
• Cranial sonography in neonates
• Orbit (eye) ultrasonography
• Breast ultrasound
• Musculoskeletal ultrasonography : hip, wrist, shoulder, soft tissues, joint effusion
• Doppler : Extremity Arterial, extremity venous, renal, carotid, penile
• Obstetric sonography (level I, Level II and third trimester sonography)
• Scrotal ultrasound
• Trans rectal ultrasonography (TRUS)
• Trans vaginal sonography (TVS)
• Sonography for superficially located pathologies
• Ultrasound Elastography
• Contrast enhanced Ultrasound

Patient Information:

Patient lies on a couch and an operator places an ultrasound probe (transducer) on the skin over the part of the body to be examined. The probe is a bit like a very thick blunt pen. Lubricating jelly is put on patient’s skin so that the probe makes good contact with the body and ultrasound beam can traverse into the body part. The probe is connected by a wire to the ultrasound machine and monitor. Pulses of ultrasound are sent from the probe through the skin into your body. The ultrasound waves then bounce back from the various structures within the body.These echoes are detected by the same probe and are transormed into images by the computer within the ultrasound machine which are then displayed on the monitor of the machine. The picture is constantly updated so the scan (real time) can show both movements as well as structure. For example, the valves of a heart opening and closing during a scan of the heart. The operator moves the probe around over the skin surface to get views from different angles.

The ultrasound scan is a painless procedure and takes about 5-45 minutes, depending on the indication. A record of the results of the test can be made as still pictures or as a video recording.

Some special preparations are needed for specific studies which are communicated to patient in the appointment document e.g full urinary bladder for prostate or pelvis examination in women. Patient should continue to take their usual medication.

CT scan :

Also called a computed axial tomography (CAT) scan, CT is a method of body imaging in which a thin X-ray beam rotates all around the patients body part. Small detectors measure the amount of X-rays that make it through the patient or particular area of interest. A computer analyzes the data to construct a cross-sectional image.

CT scans may be done with or without contrast. "Contrast" refers to a substance taken by mouth (oral contrast) or injected into an intravenous (IV contrast) line that causes the particular organ or tissue under study to be seen more clearly. Contrast examinations require special preparation.

Patient will be asked to lie on a narrow table that slides into the center of the scanner gantry. Depending on the study being performed, one may need to lie on their stomach, on the back, or on the side. If intravenous contrast needs to be administered then an intravenous line will be placed in a small vein of the back of a hand or arm.

A CT scan is done to examine any part of the body : head and neck including brain, chest, abdomen, extremity and spine. CT is used not only as a diagnostic tool but is also used to guide interventional procedures such as biopsies and placement of drainage tubes.

CT scans may be performed to help diagnose tumors, evaluate blood vessels, evaluate infective and inflammatory conditions, determine calcium "scores" of the coronary arteries or check for other internal diseases, injuries (trauma) or damage.

CT scan uses ionizing radiation and therefore needs to be performed very carefully in selected patients after proper advice and recommendation from your treating physician.

Following CT investigations are performed in our department :

• Non contrast and contrast enhanced CT scans of various body regions
• Dual phase / Triple phase CT scans
• CT angiograms
• CT enterography and colonography
• CT urography
• CT sinograms
• Dual energy CT for renal calculus and joint crystal/ gout characterisation
• CT guided FNAC’s/ Biopsies
• CT guided Drainage procedures
• CT guided ablative procedures for lung cancer and osteoid osteomas

Patient Information:

Preparing for CT exam

Some patients are at high risk of allergic reaction or kidney failure when given Iodine-based intravenous contrast.

If you have any of the following occurrences in your medical history please inform the staff while you are scheduling your appointment:

1. Allergic to Iodine in a previous CT study
2. Allergic to any other drugs (including any antibiotics)
3. Pregnant or lactating mother
4. On dialysis
5. High Creatinine level
6. Diabetic and taking Metformin
7. On Chemo or Radiation treatment

All patients undergoing contrast enhanced CT scans must have BUN and Creatinine blood test results within 30 days prior to their CT exam.

Please do not eat within 4 hours of your exam, but drink plenty of water before if you will have IV contrast for your study.

Diabetic patients will need to stop Glucophage or Metformin the night before the examination. This decision is best taken in consultation with your treating doctor.

Do not re-start medication until BUN and Creatinine are back to normal results . This decision is best taken in consultation with your treating doctor.

MRI :

Also called Magnetic Resonance Imaging or nuclear magnetic resonance (NMR) imaging, an MRI is a non-invasive procedure that uses powerful magnets and radiofrequency waves to construct images of the body.

The patient will be asked to lie still on a table that slides into a long tunnel-like tube within the scanner. . In this environment, some patients may feel claustrophobic. If contrast is to be administered then a canula will be placed, usually in a small vein of the hand or forearm. A technologist will operate the machine and observe you during the entire study from an adjacent room while taking several sets of images.

Following MR procedures are performed :

• MR scans of various body regions: Brain, neck, Joints, extremities, spine, chest, abdomen and pelvis
• pecial MR procedures: Dual phase/Triple phase MR , MR arthrograms of shoulder, knee and wrist, MR spectroscopy, Diffusion weighted imaging, DTI, MR neurography, MR enterography and colonography, MR perfusion, liver fat and iron quantification.

Patient Information:

Preparation for MRI

Most MRI exams require no special preparation. However for some types of scans you may be asked not to eat or drink for 4 hours prior to your test.

Most MR examinations do not usually require any special patient preparations. Whenever required, the contrast medium is administered immediately prior to the examination. It is safe and and is usually well tolerated by most patients. Caution needs to be taken in some patients with chronic kidney disease. Patients with cardiac pacemaker and cochlear implants cannot undergo MRI. However patients with metallic clip and hip or knee prosthesis may undergo MRI subject to the nature of prosthesis.

If you have had recent exams to diagnose this same or a similar problem at another facility, it would be helpful for the radiologist to see those exams. If available, please bring prior studies with you.

The duration of study may vary in different patients. Most examinations would finish in an hour.

Interventional Procedures

Interventional Radiology (abbreviated IR or sometimes VIR for vascular and interventional radiology) is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. Some of these procedures are done for purely diagnostic purposes (e.g., angiogram), while others are done for treatment purposes (e.g., angioplasty, embolization) or taking biopsies / FNAC samples. Pictures (images) are used to direct these procedures, which are usually done with needles or other tiny instruments like small tubes called catheters. The images provide road maps that allow the Interventional Radiologist to guide these instruments through the body to the areas of interest

The procedures that we perform fall into three broad categories:

Diagnostic Angiogram / Venogram

• Diagnostic arteriogram except coronary.

• Diagnostic venography

Arterial interventions

• Angioplasty & stenting
• Embolization in trauma patients with bleeding due to vessel rupture (splenic, hepatic, renal
• vessel injuries
• and in pelvic fractures)
• Embolisation of GI bleeding,
• Embolisation of Pseudoaneurysms
• Severe haemoptysis
• Preoperative embolisation of bone tumors, head and neck tumors
• Embolisation of vascular malformations
• Percutaneous sclerotherapy for low flow vascular malformations
• Uterine fibroid embolization
• Transarterial chemoembolization (TACE) for liver tumors and liver metastases

Venous interventions

• Venous angioplasty & stenting
• Inferior Vena Cava (IVC ) filter placement
• Laser ablation of varicose veins
• Foreign body retrieval
• Central line placement
• Portal Vein embolization
• Hepatic interventions: TIPS,TJLB
• Dialysis Access Failure Management

Non Vascular Intervention

• Renal interventions: nephrostomy and ureteral stenting
• Biliary interventions: PTC, internal/external drainage, biliary stenting, hepatico-jejunostomy stricture dilatations
• Pancreatic interventions: abscess drainage, infected pancreatitis collections drainages
• RFA and acetic acid ablation of liver tumors, Osteoid osteoma and lung cancer
• FNAC and Biopsies of various organs under CT and ultrasound guidance
• Vertebroplasty for osteoporotic compression fractures
• Stereotactic breast biopsies and preoperative clip or hook wire placement

Education

1. The teaching is elaborate and consists of both theoretical and applied/ hand on training. It is based on the prescribed curriculum of the Institute.
2. Postgraduate teaching and training of MD Radiodiagnosis )3 years course) residents, - inclusive of Seminars, Journal clubs, Case discussions, Interesting Film Sessions, Thesis presentations, clinical-radiological meets, CCR, CGR, Surgico-pathology meets
3. Three Fellowship programs of 1 year each on : GI Radiology, Thoracic Radiology and Pediatric Radiology, are running in the department. Very active teaching and skill development has been incorporated in these courses curriculum.
4. Teaching of medical radiography (MTR) and nursing students.
5. Trainees on rotation from other departments – MD Trainees in Nuclear Medicine, MS Trainees in General Surgery, DM students from Anesthesia department, M Ch residents of Breast endocrine & General Surgery
6. Training to doctors from other Government hospitals/organizations or from abroad.