Radiology And Interventional Radiology

Radiology and Interventional Radiology

Radio-Diagnosis

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.

Services Rendered

  2017 2018
X-rays 28867 29172
Ultrasound 26643 26927
CT Scan 10916 11508
MRI 3808 3923
Dexa Scans 1967 2043
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

Department’s Achievements

Visiting faculty to the department in 2018

Name Institution/strong>
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
Safdarjung Hospital
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

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).

radiology
 

Services Rendered

Services 2017 2018
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
PTBD 281 295
Other non-vascular procedures (PCD, FNA, Biopsy) 2876 2928
TJKB 08 01
Permacath 145 99
Angio embolisation 56 30
TJLB 62 47
HVPG 07 16
DSA miscellaneous 50 69
Thrombolysis 04 06
PCN 02 05
Fistula plasty 25 26
Pre and post intervention USG 4225 6353
PICC LINE 26 31
USG GUIDED ARTERIAL VENOUS LINE 2174 2058
GRAND TOTAL 11234 12839

radiology

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: radiology

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
Radiology
6 6
PDCC in Abdominal Imaging 6 6

Educational Activities

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

Department’s Achievements

Dr Arpit Taunk got best paper award at Interventional Radiology CME organized by IRIA, Delhi Chapter

 

Faculty

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