Illuminations: The shadowy world of radiology

Dr Rajat Bhargava, HOD-Radiology, Fortis Hospital, Mulund, shares how radiology departments, in a hospital, is an important asset. He shares how radiologist plays an important role in detection of the disease and its cure

Radiologist

It was a routine day for me in my radiology department with several scans piled up. However, the flow got interrupted regularly with a stream of clinical colleagues, who came to see the scans of their patients. It was in the midst of this; one of my colleagues barged in and wondered if one of his patients, in the Emergency Room, with a history of minor injury in a bicycle accident, would require a CT scan.

He said that based on relatively innocuous preliminary findings, they were considering to discharge the patient, but for the fact that there was a niggling abdomen pain; he is going to order a CT scan. He added that the chances of finding something are low.

At 6 p.m., it was my phone call which interrupted the surgeon’s ride home. With urgency in the tone, I informed him that the CT scan of his young patient shows a complete pancreatic tear with bleeding, and would warrant an urgent surgery. “Are you sure” was his immediate incredulous reaction. It is after years of practice and handling successful emergencies that the surgeons believe in radiologist advice. We were steadfast in our reports, and hence the patient was taken to the OT. Soon reports were confirmed, and the doctors operated the Pancreas. The danger was averted; the patient went home healthy in a few days leaving everybody with a satisfied smile.

It is the story that a radiologist remembers and craves for, because not only did he diagnose an emergency condition when nobody was suspecting it, he also helped in the treatment plan which finally led to saving the life. It also shows why modern diagnostics have so become vital in today’s clinical care. Imaging Technology often comes to the aid of doctors in confirming their suspicion, and also occasionally throwing up completely unsuspected diagnoses. It is not an overstatement to say that innovations in imaging medicine is one of the most crucial advancements that revolutionised the modern medicine, and has enabled more effective and efficient care that save countless lives.

The various tools of imaging available to radiologists which include the X-rays, sonography, CT scans, MRI scans, catheter angiographies, and PET scans. While X-rays continue to be the cost-effective and widely available imaging tool to look at lungs, bones, and others, sonography occupies a stellar position in imaging the foetuses.

With sonograms, one can assess the development of the foetus and also diagnose developmental anomalies. Sonography also is the first imaging tool to look inside the abdomen and other soft body parts.

The advantage being, it’s non-ionising nature and also wide availability. The cross-sectional modalities like CT, MRI, and PET have revolutionised the diagnostic care enabling high resolution and precise imaging to diagnose the smallest of tumours. The multi-slice CT scanners work so fast that, in just ten seconds the entire body can be scanned. The most modern CT scanners even allow imaging of beating heart with the exquisite anatomy of the Coronary Arteries and pick up small plaques that may cause a heart attack in the future.

In MRI, the patient is placed in a magnetic field, and then small radio frequency pulses are sent to the body which results in changes in hydrogen protons of the body, which are then read and the images are generated. MRI is also non-ionising and safe for all ages.

The modern scanners have evolved into a stronger 3-Tesla strength and have bigger bore sizes and reduced noise for the comfort of the patient. PET scanners are molecular imaging tools which take help of tumour metabolism to diagnose cancers.

A radiologist not only reports the scans but discusses the findings with the clinicians, often guides the surgeon on the pathological anatomy, enabling them to take decisions on the approach for surgery. Through this discussion, the surgeon prepares himself for what difficulties he may encounter even before operating the patient. In the modern medicine oblivious to the patients, the treatment plan for the patient is often made in the radiologist’s room. The radiologist, therefore, plays a role of consultant to the other consultants of the hospital.

Radiologists these days are not just content with diagnosing diseases; a modern intervention radiologist is using catheters and tubes for treating emergencies like bleeding aneurysm or blocking blood supply of tumours. They often open up arteries by placing stents and obtain tissue pieces from deep inside for biopsies. Radiology has been around for over a century since Wilhelm Rontgen first discovered the strange new phenomenon he called – X-rays. It has been evolving ever since and changing the way medicine is practiced.