Radiology and Interventional Radiology
The Department of Radiology and Interventional Radiology provides comprehensive imaging services under the banner of ILBS and is one of its kinds, in the country to be solely dedicated to the subspecialty of hepatobiliary radiology.
Opportunities : The department boasts of high-quality patient care with world class equipment and highly trained specialists. In addition, the department continues to play a key role in advancing the state of the art: invasive, image-guided vascular and non vascular interventional procedures as well as imaging technologies including CT (computed tomography), MRI (magnetic resonance imaging), X-Ray (radiography) and ultrasound. Hence there is ample opportunity for growth in clinico-radiological work, teaching and research activities.
Challenges: Sub-specialty niche work is a challenge in all sub-divisions of this field namely: clinical, teaching, research and administrative as well as financial and manpower related issues.
Department of Radiology and Interventional Radiology employs more than 15-certified radiologists specializing in abdominal imaging and performs more than 100,000 imaging examinations annually at the hospital. We provide excellent-quality, radiation safe and cost effective care to patients through medical imaging. The department integrates imaging into research for further advancement of technology and improved clinical benefits. We aim to pass on the torch of knowledge and experience gained in the field of imaging through teaching programs. Maintaining highest quality of care in clinical work, procedures and teaching is a priority.
Future plans of the department: We plan to further our department’s growth in the field of teaching and research programs as well as design a teleradiology centre for outreach to remote areas providing them with sub specialized standard of care in the existing specialty.
|Transplant Evaluation (Myrian)||800||1000|
New services & facilities added to the department in 2018
We plan to further our department’s growth in the field of teaching and research programs as well as design a Tele-radiology centre for outreach to remote areas providing them with sub specialized standard of care in the existing specialty.
a. Details of the Educational activities (CME/Conf/workshop) hosted by the department in 2018:
Abdominal and Hepatobiliary Imaging CME, November 25th 2018 hosted by the department of Radiodiagnosis in collaboration with Delhi State Chapter of IRIA:
Brief description :- Apart from galaxy of eminent speakers on HPB and GI topics, the event provided immense opportunities to students and young radiologists for interaction between skilled teachers and practicing radiologists. This event served as an ultimate platform to polish their knowledge and imaging skills in HPB radiology.
b. Courses offered by the Department
|Course||Candidates admitted||Candidates passed|
|PDCC-HPB Interventional Radiology||5||3|
|PDCC Abdominal Imaging||3||3|
Visiting faculty to the department in 2018
|Dr Pankaj Sharma||Professor, AIIMS, Rishikesh|
|Dr Madhusudhan KS||Associate Professor, Radiodiagnosis, AIIMS, Delhi|
|Dr Ruchi Rastogi||Sr. Consultant, MAX Healthcare|
|Dr Raju Sharma||Professor Radiodiagnosis, AIIMS, Delhi|
|Dr Karthik Ganesan||Consultant and Division chief – Body Imaging Sir H.N. Reliance Foundation Hospital and Research Centre|
|Dr Puneet Sethi||Sr. Consultant, Mahajan Imaging and Research Centre, New Delhi|
|Dr Sonal Krishan||Sr. Consultant, Medanta, Gurgaon|
|Dr. Kulbir Ahlawat||Director Radiology and Imaging, Medanta, Gurgoan|
|Dr Rama Anand||HOD, Lady Harding Medical Collage Department of Radiodiagnosis and Imaging|
|Dr Shibani Mehra||Professor Radio-diagnosis, PGIMER, RML|
|Dr Natasha Gupta||Specialist, Depart. Of Radiology and Imaging UCMS, GTB Hospital and Incharge Radiology CNBC|
|Dr B B Thukral||HOD, Professor VMMC and
|Dr L Upreti||HOD, Professor, UCMS, GTB Hosp.|
|Dr M K Mittal||Professor, VMMC and Safdarjung Hosp.|
|Dr O P Bansal||Past president National IRIA, Dir. Millennium Diagnostic|
|Dr U C Garga||Sr. Specialist, HOD, Department of Radiology RML Hosp.|
|Dr Sunil Puri||Dir. Professor and HOD, GB PIMER|
|Dr. Prakash Lalchandani||President, IRIA|
|Dr. Anil Taneja||Prof. and HOD, RML Hosp.|
Interventional radiology (IR) is the minimally invasive, image-guided treatment of complex medical conditions without surgery. IR delivers precise, targeted treatment to complex and sometimes life-threatening diseases and conditions. Interventional radiology (IR) is one of the biggest advances in medical practice, offering treatments with less risk, less pain, shorter recovery times and hospital stay. IR is particularly relevant for patients who are in frail health and unfit for surgery.
IR offers treatment for diseases and conditions affecting liver, biliary tract, pancreas, spleen, bowel, and kidney like hepatocellular carcinoma (Radio Frequency Ablation-RFA, Microwave ablation-MWA, Trans-arterial chemo embolization-TACE), portal hypertension (Trans-Jugular Intra-hepatic Porto-systemic Shunt-TIPS), HVOTO (DIPS, angioplasty, stenting), abscesses, inducing remnant liver hypertrophy and preventing post-operative liver failure (portal vein embolisation), refractory hepatic encephalopathy (Balloon-occluded retrograde transvenous obliteration of varices-BRTO, PARTO), mesenteric ischemia and portal vein thrombosis (thrombolysis, angioplasty, stenting), traumatic bleeding and collections (embolisation, PCD), post liver and kidney transplant complications, post-surgical complications, benign and malignant biliary strictures (PTBD and stenting), cholecystitis (percutaneous cholecystostomy), acute pancreatitis (percutaneous necrosectomy), hypersplenism (splenic artery embolisation), GI bleed (embolisation), renal artery stenosis (angioplasty±stenting), renal tumors (ablation), dialysis fistula related complications (fistuloplasty, central venoplasty), dialysis access creation (permcath, peritoneal dialysis catheter), diagnostic studies (FNAC, biopsy, diagnostic angiography, HVPG, transjugular liver and kidney biopsy). We also have the expertise to manage aneurysms and pseudoaneurysms, arteriovenous malformations, deep vein thrombosis, pulmonary embolism (IVC filter), hemoptysis (bronchial artery embolisation), and uterine fibroids (uterine artery embolisation).
Our department is one of the few in country performing some of the innovative procedures like plug assisted retrograde transvenous obliteration (PARTO) to minimise the post procedural compliactions and monitoring time, per-cutaneous trans hepatic antegrade gastro/lienorenal shunt occlusion for patients with complex venous vascular anatomy, endobiliary RFA for opening biliary stents which get blocked by tumor in-growth and transjugular kidney biopsy (TJKB) in patients with low platelet count and increased prothrombin time (especially in patients with liver cirrhosis).
|OPD & IPD||2017||2018|
|TIPS (Transjugular intrahepatic portosystemic shunt)||71||80|
|TACE (Transarterial chemo-embolization)||207||241|
|BRTO (Ballon occluded retrograde transvenous obliteration)||33||29|
|Hepatic vein / IVC stenting/ Plasty||50||53|
|RFA (Radio-freqency ablation)||129||95|
|Other miscellaneous vascular procedures||334||377|
|Other non-vascular procedures (PCD, FNA, Biopsy)||2876||2928|
|Pre and post intervention USG||4225||6353|
|USG GUIDED ARTERIAL VENOUS LINE||2174||2058|
New Services and Facilities added
World class Myrian French liver volumetry software was incorporated into existing MDCT and MRCP scans, to provide MEVIS like in-house reformats for the liver transplant workup. On site training at Paris was also given to faculty regarding operations of the same.
Liver volumetry software Myrian™ XP-Liver uses unique segmentation algorithms to isolate entire hepatic vascular systems, healthy parenchyma and lesions and calculate their volume with high precision. It generates highly accurate, dependable and reproducible measurements, as well as three-dimensional images which facilitate interdepartmental communication. This software has set new standards in decision-making for living donor liver transplant surgery and interventional radiology procedures.
3D reconstrcuctions for evaluating the liver anatomy and volume rendered image for pre transplant evaluation as shown below:
Balloon-Occluded Retrograde Transvenous Obliteration (BRTO):
This procedure was introduced in the mid-1990s in Japan and is being practiced mostly in Asian subcontinent. It is a minimally invasive, highly effective treatment for gastric varices. It is an effective treatment option for portal-systemic encephalopathy secondary to extrahepatic portalsystemic shunts. Although, its use in India is not widely popular, ILBS is amongst the very few centers where the procedure is being frequently performed with excellent clinical outcomes. The multidisciplinary team at ILBS consisting of the Hepatologist and Interventional Radiologists is proud to have performed one of the highest number of BRTO procedures in the country.
Per-cutaneous trans hepatic antegrade gastro/lienorenal shunt occlusion:Large spontaneous porto-systemic shunts in the setting of liver cirrhosis may sometimes lead to recurrent severe hepatic encephalopathy. Patients who do not respond to medical management require closure of these shunts. Patients with complex venous vascular anatomy may require percutaneous access of portal vein and further cannulation of the shunt and closure of the same. A rare and challenging procedure which our team has succesfully performed in few cases.
TIPS shunt reduction:Hepatic encephalopathy is the most common complication seen in patients with TIPS. Those patients having recurrent severe hepatic encephalopathy require either closue or reduction of TIPS shunt. While closure of the shunt may lead to recurrence of the symptom (UGI bleed / Ascites), reduction of the shunt remains the most reasonable treatment. Although challenging task but our interventional team has done few of these procedures using novel parallel stent technique.
Transjugular renal biopsy: Renal biopsy is one of the most important invstigation for a nephrologist to determine appropriate therapy. However percutaneous biopsy may be risky in patients with low platelet count and increased prothrombin time (specially in patients with liver cirrhosis) and in such cases biopsy may be safely performed via jugular route. Our institute is amongst few to initiate and perform this procedure on regular basis.
Courses Offered :
This abdominal imaging PDCC program is in accordance with the mandate of the Institute “in developing patterns of teaching in postgraduate medical education in as many branches as possible and to provide specialists in several disciplines of medicine”. The main objective of the course would be to develop an interest in abdominal imaging and facilitate learning in terms of establishing research oriented diagnostic algorithms in hepatobiliary imaging.
|Name of the course||Number of candidate admitted||Number of candidate Passed Out|
|PDCC in Diagnostic and Hepato Biliary Interventional
|PDCC in Abdominal Imaging||6||6|
Details of the Educational CME/Conf/workshop hosted by the department in 2017 under following headings:
|Course||Candidates admitted||Candidates passed|
|PDCC in HPB Interventional Radiology||6||6|
Dr Arpit Taunk got best paper award at Interventional Radiology CME organized by IRIA, Delhi Chapter