Radiology and Interventional 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.
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.
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.
- Pass on the torch of knowledge and experience gained in the field of imaging through teaching programs.
- Maintain highest quality of care in clinical work, procedures and teaching.
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 for technologies in 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.
- Diagnostic abdominal imaging
- Vascular imaging and intervention
- Non vascular imaging and intervention
- Transplant imaging
- General diagnostic radiology ( involving neurological, renal, thoracic , pediatric , emergency and cardiothoracic imaging)
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.
The diagnostic division is comprised of four unique sections:, conventional radiography and procedures, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). The interventional set up comprises of one of the finest laboratory in the country catering to both vascular and non-vascular procedures. Cutting-edge, fully digital, multimodal technological resources are used to provide the following services:
- 4 outpatient Ultrasound units with 1 unit dedicated to contrast ultrasonography
- 3 portable Ultrasound units
- High end Ultrasound unit dedicated to the transplant programme
- One (3-tesla) MRI
- One Multispectral 64 slice CT scanner with Gem stone Imaging
- 3 Digital Radiography units with flat-panel detectors
- Fluoroscopy suite with C-arm and flat-panel detector for flouoroscopic guided procedures
- Barium Studies
- DEXA – whole body as well as dedicated hip, spine & wrist bone density scanner equipped with rotating C arm and facility for animal model research
- 3D Imaging - The 3D imaging service of the Radiology department takes data from cross-sectional CT (computerized tomography) and MRI (magnetic resonance imaging) studies and produces life-like spatial views of body systems through the Myrian software, especially utilized in transplant realted imaging.
- Our department supports the full spectrum of imaging-related services in support of clinical trials.
Interventional radiology Suites For
- USG / CT guided FNAC and Biopsies
- PCD (Percutaneous drainage)
- PTBD and stenting; Radio Frequency Ablation (RFA)
- Transjugular liver and kidney biopsy.
- Trans-arterial chemo embolization (TACE)
- Trans-Jugular Intra-hepatic Porto-systemic Shunt (TIPS)
- Diagnostic angiography
- GI bleed embolisation
- Bronchial artery embolisation
- Balloon-occluded retrograde transvenous obliteration of varices (BRTO)
All of the diagnostic and interventional radiology services are supported by the latest hospital informatics and PACS capabilities. These technologies are a part of the Radiology Department's commitment to offer the best care and technology for patients and fellow physicians. .
To list a few, our section of Interventional Radiology specializes in the following procedures:
Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): Since its introduction in the mid-1990s, balloon-occluded retrograde transvenous obliteration (BRTO) has become widely accepted in countries such as Japan as a minimally invasive, highly effective treatment for gastric varices. It is an effective treatment option for portal-systemic encephalopathy secondary extrahepatic portal-systemic shunts, including gastro-renal, spleno-renal, and mesenteric-renal shunts in patients with and without liver cirrhosis. 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.
Trans-Jugular Intra-hepatic Porto-systemic Shunt (TIPS): TIPS is a procedure wherein an interventional radiologist creates an artificial channel within the liver between the inflow portal vein and the outflow hepatic vein so as to treat portal hypertension associated with unrelenting GI-bleed or ascites. This procedure becomes life saving in the setting of uncontrolled variceal bleed.
The procedure requires high expertise and is being performed at meager number of institutes across the country. However, we are fortunate to have performed 31 procedures in the year 2012 with majority of patients showing good post procedural results. Of these, 15 of them were performed on an emergency basis as a life-saving procedure to arrest catastrophic upper GI bleed from gastro-esophageal varices in patient with liver cirrhosis.
Trans-arterial chemo Embolization (TACE): TACE is a treatment that combines the blocking (embolisation) of the blood supply to liver tumor with an embolic material (with lipiodol or drug-eluting microspheres DE-beads) and delivery of chemotherapy directly into the blood vessels which supply the liver tumour. Even in cases where chemoembolization is not curative, this approach may relieve a patient's symptoms and extend survival. We performed TACE in 62 patients in the past 12 months.
Radiofrequency Ablation (RFA): Interventional radiology techniques of applying heat to tumors as a means of killing cancer cells is been in clinical use since past couple of years. However, this type of treatment, called tumor ablation, is a relatively new technique for opening biliary stents which get blocked by tumor in-growth. This novel and innovative technology is now being routinely performed at ILBS and has been shown to offer promising palliative results for treating advanced biliary cancer (cholangiocarcinoma).
All of the diagnostic and interventional radiology services are supported by the latest hospital informatics and PACS capabilities. These technologies are a part of the Radiology Department’s commitment to offer the best care and technology for patients and fellow physicians.
|Transplant evaluations (Myrian)||500||800|
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|
PDCC in Abdominal Imaging (course duration = 1 year)
The educational program will provide:
- A broad understanding of abdominal radiology including transplant imaging
- The diagnostic techniques required in the practice of hepatobiliary and abdominal radiology
- Understanding of the areas detailed in the curriculum
- Knowledge of specialist areas in hepatology and HPB surgery related diagnostic radiology correlation
- The communication skills required for the practice of abdominal radiology and the teaching skills necessary for effective practice in a hospital setting as well as stand alone diagnostic centre
- Experience of research and development
- The acquisition of life-long habits of reading, literature searches, consultation with colleagues, attendance at scientific meetings and the presentation of scientific work that are essential for continuing professional development
Eligibility: MD / DMRD / DNB Radiology or equivalent postgraduate qualification recognized under IMC Act 1956. The candidate would be required to clear the selection interview as per format of the Institute.
Existence of similar course elsewhere: None
Daily work rounds and weekly clinical conferences are held in the department. Biweekly morning conferences are given for the benefit of all clinicians and radiologists in the Institute. Each section contains an extensive teaching file.
Residents participate in the functions of the various specialized sections of the department, newer radiological techniques, and the operation of state-of-the-art imaging modalities.
Specific educational opportunities include:
- Observation of Spectral CT protocols for Liver, Pancreatic protocols
- Transplant imaging of Liver and kidney
- Doppler in the liver transplant ICU
- MR protocols for liver, pancreas and biliary system
- Evaluation of focal and diffuse liver diseases on MRI
- Introduction to MR Elastography and spectroscopy
- Participation in review of daily case material
- Review sessions with the faculty
- Possible involvement in clinical research and publications
- Attending departmental and interdepartmental conferences
- Understand the most recent technologic advances and the diagnostic capabilities of CT, MRI and Ultrasound
- Establish criteria for patient selection and the appropriate protocols for use of each modality.
- Incorporate both established and newer techniques into their radiological practice
- Learn the latest advances in specialized techniques such as MR/CT angiography, MR Cholangiopancreatography, hepatocyte specific contrast usage in MRI etc.
The following teaching/learning methods are used:
- Practical bench work and scanning experience
- Working under consultant supervision
- Task specific on the job training
- Observation of scanning protocols
- Participation in Quality assurance schemes
- Personal study
- Report interpretation and clinical correlation
- Team meetings
- Attending multidisciplinary team meetings
- Awareness of appropriate guidelines
- Learning with peers
- Work-based experiential learning
- Formal postgraduate teaching
- Independent self-directed learning
- Formal study
Details of the Educational CME/Conf/workshop hosted by the department in 2017 under following headings:
Name of the activity: Hepatobiliary and interventions CME (One day CME)
Date of the activity: 18th November 2017
Brief description: - A galaxy of eminent speakers who are doing active work in the sub- specialized field of hepatobiliary imaging and interventions’ as well as gastrointestinal imaging were invited to discuss their experience’s and current practice of evidence based Imaging. This CME was accredited with 6.5 hours by the Delhi Medical Council and provided immense opportunities to students, practicing general and young trainee as well as fellow radiologists for interaction with skilled teachers. There was active participation by 300 delegates in the attendance of the event as well as in the Quiz and film reading sessions. This event served as an ultimate platform to polish specialized knowledge and imaging skills in HPB radiology.
Dr Prayas Vvats: Course thesis completion- Differentiation of pseudo-tumoral inflammatory conditions versus malignant mass lesions of the pancreas on magnetic resonance imaging.
• Dr Jitender Singh:- Course thesis completion- Study of pulmonary Complications in Liver cirrhosis : An imaging perspective.