Modern imaging methods in Radio-diagnosis can open a window in the human body, as it were, and supplement the clinical expertise in diagnosing the presence and extent of cancer and other diseases. The department of Radio-diagnosis has a vital role to play in a tertiary referral centre for cancer such as the Tata Memorial Hospital, as it caters to the needs of several departments including the surgical, medical and radiation oncology departments.

The initial diagnosis of disease is the first and most important step in the diagnosis and management planning for a cancer patient. The department of Radiodiagnosis at Tata memorial Hospital is geared to take up this task with a dedicated team of health care professionals including Trained Radiologist, Technicians and other paramedical & supporting staff.

Accurate staging of the disease is made possible by various imaging studies which enable the radiologist to determine the precise size and extend of a tumour, possible invasion of adjacent organs or blood vessels, whether it has spread to regional lymph nodes and whether metastases to distant sites has occurred. This information enables planning the therapy for the patient, keeping in mind the stage of the disease

The department is well equipped to provide the full range of diagnostic imaging services including Computerized Radiography, Ultrasonography (USG) & Colour Doppler, Multi slice Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Mammography and Interventional radiology. Images from the above mentioned modalities are stored on PACS (Picture Archival and Communication System).

Its activities also include post-graduate education and clinical research.

Clinical Activities                                                                                              Top

Computerized  Radiography  ( X-Rays )

In addition to routine radiography of the chest, abdomen and bones, a large number of  specialized procedures such as Orthopantomograms (OPG), as well as procedures employing contrast media such as Barium studies, IVU, Cysto-urethrograms,  Angiograms, Sialograms, etc are carried out in the Radiodiagnosis department.

All routine radiography is performed using the Computerized Radiography (CR) system, and the radiographs of chest, bones, etc, as well as contrast procedures are acquired in the digital format and stored in the PACS (Picture Archival and Communication System). The reporting of these investigations is done directly on the Workstation Monitors (soft copy reporting).

Digital  Mammography

Mammography is performed on the new GE Senograph DS Full Field Digital Mammography unit, which provides unsurpassed image quality at minimized radiation dose.

Soft copy reporting of the digital images is done on the attached Reporting Workstation. The workstation is also equipped with Computer Aided Detection (CAD) software which assists the radiologists in detecting small masses and microcalcifications in the breasts.

A few mammographic examinations are also performed on the older conventional GE Mammography machine using film – screen combination.

Special Procedure performed:

1. Needle Localization
2. Stereotactic Biopsy

Mammography and ultrasound guided needle biopsies and hook-wire localization procedures are also performed in order to achieve a definitive diagnosis in suspected cases of breast cancer.

ULTRASOUND & COLOUR DOPPLER

The Ultrasonography department is equipped with six state of the art Ultrasound achines which contribute to the high level of confidence of the Radiologist for evaluation of the lesions and serve as excellent guiding tools for the various Diagnostic and Therapeutic procedures.

Four machines are used for the diagnostic purpose to carry out various ultrasound examinations of the abdomen, pelvis and small parts, as well as intracavitary (transrectal and transvaginal) examinations.

The tissue Harmonics helps for high resolution at depth and the Cross Beam Imaging facility makes the lesion to stand out with better border delineation.

The 3D Application further helps to understand better the relations of the lesion with organs in the vicinity and the Biopsy Attachment helps in precisely targeting the lesion.

The Color Doppler scanners are extensively used to assess the vascularity of the tumors. The arterial and venous Doppler examinations are carried out for the evaluation of patients with associated peripheral Vascular Diseases and screening as well as diagnosis of the Deep Venous Thrombosis.

A registry is maintained in the Ultrasound section for the patients with Venous Thromboembolic Disease as a part of the Thrombosis Management Group Activity.

The Ultrasound Equipment in the Interventional Radiology Unit is an integral part of the set up as it serves as an important guide for the Vascular as well as Non-vascular procedures for access and precise placement of the needles.

The portable Ultrasound unit delivers the conveniences and versatility with its application in:

1. The ICU for Emergency Scanning of ICU patients
   
   
2. Bedside Drainage procedures like – Pleural & Peritoneal Tapping
                                                         - Abscess Aspiration 
                                                         - Indwelling Pigtail Drainage

Intraoperative Ultrasound Scanning facility is provided to facilitate

1. Resection of the tumors by localization of small lesions
2. To assess vascular involvement intraoperatively
3. To assess complete removal of the lesion
4. To perform Intraoperative Tumor Ablation (Radiofrequency Ablation)

Ultrasound evaluation of Breast lesions in conjunction with mammography contributes in the diagnosis of

1. Isodense lesions
2. Imaging of dense breast
3. Young glandular breast
4. Differentiating between solid and cystic lesions
5. Differentiating between post op seroma and recurrent masses.

Computerized Tomography  ( CT Scan )

Multi-slice CT is one of the most potent tools for the early detection, diagnosis and treatment planning of cancer

CT scanning of the whole body is carried out on the GE Lightspeed 16 Multislice CT scanner, which is capable of obtaining 16 slices per rotation of the x-ray tube.  Dual / Triple phase contrast enhanced scans, Dynamic scans, CT Angiography, and 3D reformations are  carried out wherever applicable. Multiplanar reformatted images are routinely obtained on the diagnostic workstations to aid in the diagnostic interpretation of the CT scans.

Special Services Offered

1. CT Angiography
2. CT Perfusion
3. CT Cholangiography
4. Virtual Colonoscopy
5. Virtual Bronchoscopy
6. CT Enteroclysis
7. CT Arterioportogram
8. CT Guided Procedures:
        * CT guided Biopsies
        * CT Guided Drainage Procedures
        * CT Guided Tumor Ablation (RFA)
        * CT Guided Nerve Blocks
        * CT Guided Sclerotherapies
9. Dentascan
10. 3D Reconstruction image
11. Multiplanar Reconstruction

Magnetic Resonance Imaging  ( MRI )

Magnetic Resonance Imaging of the whole body is performed in our department on the  Wipro GE Signa 1.5 Tesla MRI System , using a variety of pulse sequences including ultra-fast sequences. The majority of MR imaging studies are of the brain, head, neck, spine and musculo-skeletal system; followed by MR imaging of the abdomen and pelvis,   and other specialised investigations like MR Cholangio-pancreatography.  MR studies of the pelvic organs, especially the uterus and cervix, and Endorectal coil imaging of the prostate are also carried out.  MR Angiography of abdominal, neck and intracranial blood vessels is also performed whenever indicated.

MR Proton Spectroscopy is employed in selected cases for evaluation of brain tumours or other lesions, using both the single voxel and multi-voxel spectroscopy available on our system . MR Perfusion studies for the brain also have been introduced in our department for evaluation of suspected primary or recurrent brain tumours.
 
With it’s exquisite soft tissue contrast, MR is the imaging modality of choice to investigate cancers of the brain, spine, liver, and breast.

Picture Archival And Communication System  ( PACS )

Images from the digital imaging modalities i.e. CT, MRI, Ultrasound, Computerized Radiography, DSA and Digital Mammography, are stored in the PACS (GE Centricity) and can also be transmitted across the hospital network so that as soon as the images are acquired by each of these modalities, they can be viewed by the referring clinicians without any delay on the PC in their office, OPD, or any other site in the hospital. The Radiology report of each examination stored in the Radiology Information System (RIS ) can also be viewed  along with the corresponding images.

Reporting of all Computerized Radiography, CT, MRI, Ultrasound and Mammography examinations is carried out on the Diagnostic workstations (soft copy reporting) , and routine filming of these examinations has been discontinued. The department has become almost filmless, and films are only printed on request by the patient or referring clinician, at an extra charge.

Interventional  Radiology

The Interventional Radiology (IR) Unit of the department is a team of health care professionals committed to the cause of enhancing patient care by using advanced technology.

Here the patients are treated with minimally invasive and targeted therapies that help for early recovery of the patients. The various needles or catheter required to be placed deep in the body of the patients for diagnosis or treatment of the patient’s disease are introduced precisely under the guidance of imaging modalities like Ultrasound , Digital Fluoroscopy  , Digital subtraction Angiography or CT Scan .

Most of these procedures are done under Local Anesthesia and IV Sedation through a tiny incision in the skin.

The unit is well equipped with two Digital Subtraction Angiography (DSA) Machines and an Ultrasound Machine. The recently installed DSA machine the ‘INNOVA 4100’ is state of the art equipment that gives very high resolution angiography Images with the 3D Rotational angiography. With the unique 3D CT acquisition facility on this machine patient need not be shifted to CT scan in emergency as the Angiography and CT like imaging can be done on the same machine.

Diagnostic Procedures

1. Ultrasound Guided Fine Needle Aspiration cytology (FNAC) and Biopsy
2. CT Guided  FNAC and Biopsy
3. Diagnostic aspiration of ascitic or pleural fluid for cytology
4. Diagnostic Angiographies
5. Transjugular Liver Biopsy

Therapeutic Procedures

→Non-Vascular:

• Biliary Drainage – external
• Biliary Drainage – internal/external
• Biliary Drainage – internal metal stent placement
• Nephrostomy Drainage – external
• Nephrostomy Drainage – internal/external
• Nephrostomy Drainage – Internal “double J” stent
• Ethanol / Acetic Acid Injection
• Fluid Collection / Abscess  Drainage
• Foreign Body (catheter fragment) removal
• Chest Tube Placement

→Vascular:

• Angioplasty / Stent
• Arterial Infusion Catheter Placement
• Arterial Thrombolysis
• Arteriograms
• Foreign Body (catheter fragment removal)
• Inferior Vena Cava Filter
• Uterine Artery Embolization (UAE)
• Venograms
• Venous Thrombolysis
• Transjugular Intrahepatic Portosystemic Shunt (TIPS)
• Transarterial Brachytherapy
• Portal Vein Embolizations
• Pre-operative Embolization
• Pulmonary (lung) Angiogram

Pain Management in Oncology

To improve the quality of life of the cancer patients, various image guided procedures are carried out
      - Image Guided nerve Blocks like Coeliac Plexus Block, Stellate Ganglion Block
      - Vertebroplasty, Kyphoplasty
      -Transarterial Embolisation
      - Radiofrequency Ablation

Tumor Ablation Therapy

The tumors which are not suitable for surgery can now be treated by ablation (practically burning them out) using very fine needles,

- Chemical (Ethanol/ Acetic Acid) Ablation
- Radiofrequency Ablation of Liver, Lung, Soft Tissue & Bone and Spine Tumors     

Thrombosis Management in Oncology     

Thrombosis Management in Oncology:
      Thrombosis of various veins and arteries is a big problem for oncology  patients .
      IR unit plays an active role in management of these conditions with procedures like;
      - Deep Vein Thrombolysis / Embolectomy
      - Pulmonary Thrombolysis / Embolectomy
      - Intracranial Venous Sinus Thrombolysis
      - SVC / IVC Filter Placement  and Retreival     

Emergency Services

The IR unit is committed to provide round the clock services for inpatients  like
        - Angiography & Embolisation for Gastrointestinal Bleeding,  
           Hemoptysis , Hematuria , Tumor Bleed , Intra/ Post Operative Bleeding
        - Drainage Procedures for Abscesses , Cholangitis , Obstructive Uropathy                

Training and Education

The following faculty members of the Radiodiagnosis Dept. have been recognized as Post Graduate Teachers by the Maharashtra University of Health Sciences (MUHS) for the post graduate degree and diploma courses (MD and DMRD) in Radiodiagnosis with effect from 8.1.2007, except Dr. S. Arya and Dr. S. Juvekar are also recognized Post Graduate Teachers of the University of Mumbai.Prior to this the department was affiliated to Mumbai university for MD and DMRD courses.

1. Dr. N.H. Merchant
2. Dr. M.H. Thakur
3. Dr. P.G. Kulkarni
4. Dr. S.M. Desai
5. Dr. S. Arya
6. Dr. S. Juvekar

The department is also recognized as a teaching department for the D.N.B. degree by the National Board of Examinations.  5 candidates are registered for DMRD and 5 candidates for MD (Radiodiagnosis) courses annually, in addition to the candidates for the DNB course.

Observers

Qualified Radiologists  are also accepted as Observers in the department for short term training of 2 weeks to 3 months duration in specific areas of onco-imaging (viz mammography,CT,MRI) and interventional radiology.

Residency programme

Post graduate students who are registered for the DMRD and MD courses at TMH enter the residency programme of 2 years duration for DMRD and 3 years duration for MD students, and are designated as Junior Registrars I, II or III.

For Senior Registrars posts, a MD or DNB qualification in Radiodiagnosis is required, and candidates are selected at an interview on the basis of their qualifications and experience. The SR posts are of 1year duration, and can be extended upto 3 years.

The SR posts commence on 1st March and 1st September each year, and are advertised 2-3 months in advance

Research

The staff members of the Dept. of Radiodiagnosis are participating in more than 30 multidisciplinary clinical research projects.  The thrust areas of clinical research are :

• Evaluation of the accuracy of MDCT scanning in staging of rectal and gastric cancer, and assessment of the diagnostic potential of virtual bronchoscopy.
  
  
• Evaluation of new radiotherapeutic and chemotherapeutic protocols in the treatment and follow up of brain and bone tumours, and cancer of cervix using Magnetic Resonance Imaging.
  
  
• Ultrasound evaluation of neck node metastases in carcinoma of lung, oesophagus, and head & neck tumours.
  
  
• Assessment of the impact of mammography on early detection of breast cancer and survival of patients diagnosed to have breast cancer.
  Evaluation of color Doppler ultrasound (CDUS)and contrast enhanced MRI (CEMRI) for detection of local recurrence after breast conservation therapy.
  Evaluating the efficacy of Radiofrequency ablation of hepatic neoplasms.
  
  
• Participation in new drug trials for the treatment of recurrent or metastatic breast cancer and head & neck cancer, employing ultrasound, CT and MRI scanning in the evaluation of response to chemotherapy.