Radiology – the Third Eye of Medical Sciences

BY PROF (DR) MAJID JEHANGIR

With the help of X-ray and CT scan, GMC Srinagar’s Department of Radiodiagnosis has played a key role in fighting COVID-19 disease and thus reduced the morbidity and mortality of our patients.

While as, in earlier pandemics, health care workers (HCWs) would not volunteer to work in high risk zones (X-ray & CT scan being amongst them) but in the current pandemic, Radiologists and Radiographers worked 24×7 and many of them, not only got COVID-19 themselves but some of them even transmitted the disease to their near and dear ones.

I, and many of my colleagues would get numerous X-ray and CT scan images of patients 24×7 on Whatsapp and I would respond with a report within minimal possible time.

Also, I was personally busy doing research on COVID-19 and in fact five of my articles on “Chest CT features of COVID-19 pneumonia” got published in reputed International journals like European journal of Radiology & British journal of Radiology within a month’s period time.

It is in a way unprecedented, as usually it takes years to get an article published in journals of international repute. Radiology is a branch of medicine that uses imaging technology to diagnose and treat diseases. Doctors who analyze these images are called Radiologists.

Radiology has two main branches. Diagnostic radiology helps health care provides to see inside the body and to diagnose various diseases from “head to toe”. It also helps monitor how well the body is responding to a treatment. Screening for various cancers and heart diseases is also possible using various tests.

Interventional radiology helps to treat patient in a non-invasive manner. Interventional radiologist makes no or a very small incision, through which wires and catheters are inserted into patient’s body, to treat various diseases.

The most common tests of radiology exams included X-rays, Mammography, Ultrasonography (USG), Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Bone DEXA and PET-CT Scan. At GMC Srinagar, the department provides 24×7 Radiology services and is committed to improve patient care.

It has, few years back, been upgraded to Post-Graduate Department and getting recognition for 12 M.D. Radio-diagnosis seats by National Medical Council of India, will be a major milestone in the history of our Department. Also, we have started a BSc Radiography course recently.

These training programmes have not only boosted the academic activity and research but have also supplemented the manpower in the Department. All this, ultimately culminates in improving patient care in the long run.

At present, the Post Graduate Department of Radio-diagnosis can boast of having a “State of Art” 256-slice dual source CT Scanner, a 3 Tesla high end MRI scanner, a “State of Art” Biplane Digital Subtraction Angiography, Digital Mammography with Tomosynthesis, high end Colour Dopplers, Bone DEXA, amongst others.

Most of these equipments were procured under Prime Minister’s Scheme after the devastating deluge of 2014, in which SMHS had lost all its equipment.

I would like to place on record and thank the then Principal, GMC, Srinagar, Prof. Rafiq Ahmad Pampori without whose relentless efforts, getting all these equipment would never have been possible.

I would also like to take this opportunity to thank our present Principal GMC, Srinagar Prof. Samia Rashid for her constant support in helping us to kickstart Interventional Radiology.

USG and MRI do not have any radiation hazard and are even safe during pregnancy. The radiation from all other diagnostic modalities falls under “Low Dose” range. Based on current literature, the risks for developing cancers due to radiation from these tests are grossly exaggerated.

Also, it is important to understand that potential carcinogenesis is a ‘stochastic effect. However, unnecessary imaging should always be avoided and radiation should be kept to minimal possible level. Also, medical ethics and PC-PNDT act should be followed in letter and spirit.

One of the greatest misconceptions about radiologists is that they ‘just analyze images”. Such simplified assessments oversimplifies what radiologists do. “Clinical Radiologists” interprets images in context of clinical and laboratory findings, makes early and accurate diagnosis of various diseases and thus helps the patient to get best possible treatment.

Without an accurate diagnosis, any treatment recommended is bound to be a failure. In the present era of evidence based medicine, Radiologists have a more vital role to play as they are “Jack of all medical specialties” and have a working knowledge of all the specialties.

Sometimes, patients present to a wrong super specialist and many a times, a patient with multi-system involvement presents to one or the other super specialist, who has limited knowledge outside his area of expertise. In such a scenario, Radiologist are in a better position to perform primary care triaging. Interventional Radiologists directly saves patients lives.

The common people should be made aware about the importance of Radiologists.

I am the alumnus of Govt. Medical College, Srinagar and was declared the “Best outgoing Graduate” for the year 1991. I appeared for the postgraduate entrance examination of PGIMER, Chandigarh. Having topped the said entrance examination, I opted for the sole MD Radio diagnosis seat at this prestigious institute.

The first reason for choosing Radio-diagnosing was that of all the options, Radiology could utilize the greatest amount of knowledge that I had crammed during my medical college days.

Another, more pragmatic reason, was that as a medical student, I was enchanted by the USG images of fetus and CT images of brain given in a few text books. And I could imagine how Radiology could revolutionize medicine in future. So I aspired to become a Clinical Radiologist.

That was the time when USG and CT were emerging and MRI was very new in India and even the prestigious PGIMER, Chandigarh lacked one. So, after completing my MD Radio-diagnosis, I joined the renowned Bombay Hospital, Mumbai for my training in MRI.

Since then, I have been updating my knowledge by attending various short-term training programmes at AIIMS New Delhi and PGI Chandigarh. Also, I did an observership in Cancer Imaging at Roswell Park Cancer Institute, New York.

Personally, I have lead authored papers like “MRI findings in Infantile Encephalitic Beriberi” which has been published in reputed “Pediatric Radiology” in 2015 and this article has been referred to in the latest edition of “Text book of Pediatrics” by Nelson.

The importance of this research work is that these infants were being wrongly diagnosed as Leigh’s disease, a fatal neurological disorder due to identical imaging findings. Infantile Encephalic beriberi is a benign disorder caused is vitamin B1 (Thiamine) deficiency and almost immediately responds to thiamine replacement.

My research on Imaging findings in “Gujjar Lung” and “Ladakh Lung” have also been accepted for publication in international journals. These Environmental pneumoconiosis were again being wrongly diagnosed as pulmonary tuberculosis due to similar radiological findings. Some of my other research publications are regarding sonologic ovarian morphology in polycystic ovarian syndrome (PCOS) and Imaging evaluation of pediatric sensorineural hearing loss in potential candidates for cochlear implants.

Predicting the future is never easy. But it is my dream to take the Postgraduate Department of Radio-diagnosis, GMC Srinagar to new heights and to bring it at par with the best in the departments country and I will leave no stone unturned to fulfill my long cherished dream.

Radiology is evolving at an ever increasing rate. It has moved from structural to functional and now molecular imaging and radiogenomics. Radiogenomics is about personalized treatment. Artificial intelligence (AI) will also have an important role to play in the future of radiology.

AI’s impact on radiology can be best compared to commercial flights. While as, AI algorithms can help diagnose various conditions but it can never replace a “Clinical Radiologist” as Clinical Radiologist analyzes images in the context of clinical & laboratory findings. In my opinion, it is the AI-enabled “Clinical Radiologist” that will replace the “Current Radiologist”.

Tele-radiology involves transmission of radiological patient’s images from one location to another, for reporting by a qualified Radiologist. It is the most practical solution to dealing with shortage of on-site radiologist. Pertinently, the Government of J&K started a 24×7, free Tele-radiology services in June 2020, at various rural and remote areas.

This, in fact, proved to be doubly effective during the ongoing COVID-19 pandemic as it not only prevented inaccurate interpretation of images but also helped to curb the COVID-19 spread by reducing interaction between patients and healthcare workers.

I personally feel that Teleworking should be extended to various others departments like Dermatology, whenever possible.

The author is a faculty at Post Graduate Deptt. of Radiodiagnosis & Imaging, Government Medical College, Srinagar.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.