Med Tech

Understanding Radiology in India: The Journey Thus Far

While conventional radiology only consisted of X-rays, the advent of newer technologies and imaging modalities has broadened the horizons of the field. Current day radiology also includes teleradiology options which enables the radiologist to report and analyse the scans from the comfort of their homes. 

Dr. Gomathy Subramanian, the President of the Indian Radiological and Imaging Association (IRIA) Kerala, spoke about the myriad aspects and challenges in radiology with reference to its status in India. Dr. Subramanian completed her PG in Radiology from Government Medical College, Calicut and has more than 20 national and international publications to her credit. She is also a Professor and heads the Department of Radiodiagnosis at Malabar Medical College, Calicut. Her areas of interest include cross sectional imaging especially of the thoracic, abdominal and cardiac regions. 

A radiologist is as involved in treating the patient as the consulting doctor since they detect and report the diagnosis to the oncologists, physicians and surgeons. “By identifying the roots of the disorder, the radiologist is indirectly involved in curing the patient,” says Dr. Subramanian. 

What are some of the common challenges in the field of radiology? 

The radiologist should have a keen eye to find out even the most minute of details on cross-section scan through a 14 inch monitor screen. The high chance of missing any key details is a huge challenge for radiologists. 

These challenges are more pronounced in dynamic studies like ultrasound scanning in Obstetrics, specifically with NT (Nuchal translucency) or Anomaly scanning. NT scans are normally performed during the first trimesters and the chances of errors are reduced by correlating with standardised markers. However, if the radiologist misses out on a twin, triplet or a quadruplet in an NT scan, it becomes a problem. In early pregnancy, the twin may appear as a membrane or maybe hidden or attached to the other foetus making it difficult to accurately find them. 

Many times, an organ can be incorrectly detected even if it is surgically removed in the patient. Spleen is oftentimes hard to catch on a scan as it is hidden by other organs. In patients who have had a nephrectomy, a radiologist may mistake the enlarged loaded bowel for a kidney. A fluid loop can be incorrectly detected as a gall bladder in patients who have undergone cholecystectomy. 

How can a radiologist tackle these challenges and avoid mistakes?

The patients may question the radiologist on the mistake and even have emotional outbursts causing them or the bystander to verbally, even physically, attack the radiologist. To avoid such issues, Dr. Subramanian suggests that the radiologist should not directly convey the diagnosis to the patient and allow the concerned referring doctor to do so. She also suggests that the radiologist should have a complete record of the patient history with them even before performing the imaging procedure.

If these misdiagnosis cases do move forward, the institutions get involved and raise an inquiry with a team of doctors along with an advocate and concerned officials. Following this, the board will decide on how to proceed with the case. Dr. Subramanian also implores all radiologists who have completed their PG in Radiology to take an IMA (Indian Medical Association) or an IRIA membership as these boards can offer legal support in such medico-legal cases. 

Do women opt for radiology?

“Radiologists occupy higher positions and thus form the creme de la creme of the medical society” states Dr. Subramanian. Many people, especially women opt for radiology due to less physical stress, despite there being considerable mental stress. Out of the few seats (around 10-11) reserved for PG in Radiology, 95% of the seats are occupied by women.

Which are the subspecialities that women gravitate towards? 

There are various kinds of radiology subspecialties such as spine, hand, breast, musculoskeletal, and foetal radiology. With the current advances in technology and PACS (picture archiving and communications systems), many female radiologists with familial responsibilities opt for teleradiology solutions as they can easily detect and interpret the scans from the comfort of their homes. Many women also choose breast imaging and foetal imaging as most of the female patients prefer a female radiologist to do an ultrasound or mammogram. 

What is the scope of radiation oncology in India and how has it improved over the years?

In order to work in radiation oncology, a medical student must specialise in radiation or surgical therapy. Previously, to detect any kind of changes in cancer patients, nuclear studies were done. However, with the emergence of PET Scan and radiopharmaceuticals, the radiologists can easily arrive at the cancer diagnosis by finding out even the smallest of metastases anywhere and throughout the body. PET scans also help in finding deposits on the bones, lungs etc. 

Fusion imaging fuses radiology with radiation and is a novel technique that is yet to come to India, but Dr. Subramanian believes it will be an extremely valuable tool for treating brain tumours. In fusion imaging, the radiologist will find out the lesions through the scan and supply the therapeutic radiation to the lesion at the same time. This will help reduce the size of the tumours making it easy to surgically remove them. 

Associations like IRIA conduct various Cancer Awareness Programmes by giving talks on YouTube aiming to educate people on the various types of cancer thus encouraging early detection and cure. These awareness programmes also encourage students to study and explore radiation oncology.

Has COVID-19 pandemic boosted the importance of radiology in India?

Multislice CT was the primary tool used to find out any lesions in the lung caused due to the SARS-CoV-2 virus during the pandemic. It also helped in identifying any vascular and lung parenchymal changes in COVID-19 patients. 

High resolution CT and Contrast Enhanced CT techniques also helped to identify post-COVID sequelae, especially in the myocardium of the heart. “Radiology techniques were extensively used in detecting COVID-19 and understanding the post-COVID complications. So yes, the pandemic definitely boosted the necessity of radiology!” emphasises Dr Subramanian.

Author: Parvathi Nair

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