Diagnostic radiology plays a crucial role in bringing quality healthcare to the masses. This field of medicine, which uses imaging exams and procedures in the diagnosis of deadly diseases or injuries, is witnessing an unprecedented growth. It has become indispensable for health professionals to provide quality care to patients, writes Rajbala of Elets News Network (ENN).
Diagnostic Radiology and Digital Shift
The innovations in diagnostic radiology – X-rays (radiographs, CT, fluoroscopy), nuclear medicine, ultrasound and MRI – are witnessing a paradigm shift with patient safety emerging as the prime concern for equipment manufacturers by reducing radiation output without impacting the quality of results.
Consistent advancements have significantly improved equipments in terms of their variety, strength and postprocessing methods. Among the most visible advancements in the diagnostic radiology is the widespread use of digital X-ray, which has become a norm due to its cost effectiveness.
Bedside X-rays are moving from analogue to digital, helping the point of care to act immediately and swiftly. If there is a requirement for X-rays in the emergency department – ICU or OT – these digital radiology equipments hold capability to instantaneously create images, reducing dependency on the time taken for image creation.
Giving an overview of the advancements made in the ultrasound technology, Dr S Pradeep, Consultant Radiology, Fortis Hospital, Bengaluru, says, “Great advancements have been made in ultrasound, where the machine has moved out of the armamentarium of the radiology department to other departments like anesthesiology or neonatology.
“Today, small equipments can be used by neonatology department for diagnosing premature babies with intracranial haemorrhage at any time without the need of a radiologist. Later, the pictures can be sent for the radiologist’s opinion. Similarly, anesthesiology departments have also started using ultrasound for point-of-care, where they are learning ultrasound themselves for local block anesthesia. Point-of-care ultrasound is a great advancement.”
In CT and MRI, the technology has developed by leaps and bounds in past few years. CT scanning has become much faster, while the dose of radiation imparted has reduced. The types of analysis post processing are also becoming very strong. PET-CT is the gold standard in cancer diagnosis today. MRI scanning today is evolving as the one-stop-shop for examining most organs, except the lungs. The advancement in MRI with 3 Tesla, MRI-guided biopsy, MRI spectroscopy, etc, are also advancing at a very fast pace.
Diagnostic radiology is witnessing huge advancements in terms of equipment and in terms of post processing probabilities, connectivity and digitisation.
Diagnostic Radiology in India
The Indian government’s focused approach in the healthcare sector is set to boost the diagnostic radiology market in the country, allowing more facilities to purchase or upgrade their diagnostic imaging equipment.
Associations like the Indian Radiological and Imaging Association (IRIA) are promoting R&D on various imaging technologies. Moreover, multinationals have started modifying their products to suit the Indian healthcare needs. The evidence-based technology-oriented treatment is set to become the cornerstone of the Indian healthcare system. The push will come from the government’s committed effort to bring quality healthcare to the remotest areas of the country, thus boosting growth of the diagnostic imaging equipment market in India.
In terms of market share, “diagnostic radiology would probably have 30 per cent share in the healthcare sector”, says Dr Pradeep, adding that the field may emerge as the second highest income generator after operation theatres.
Solution Providers in Indian Market
In the last few years, India has witnessed a technological shift from analogue to digital and is fast adopting cost-effective imaging solutions. When it comes to digital solutions like x-ray, mammography, CT or MRI, there are three market leaders in India. These are GE Healthcare, Siemens Healthcare and Philips Healthcare. These companies are providing high-end systems in the country and have the largest market share. Toshiba, Samsung and Hitachi are among other companies which are selling a good number of equipments in India.
Majority of radiological investigations today are in digital format and every machine is required to be DICOM compliant. Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. Therefore, it is important to ensure that the imaging devices are DICOM licensed.
The images and data from the devices should also be able to connect to PACS (Picture Archival and Communication Systems) for economical storage and convenient access to images. All equipment should be able to send data and images to PACS and in turn PACS should be able to store this data in servers and the cloud for indefinite time for the benefit of the patient. Thanks to this digitised system, remote viewing through smart phones, computers and emergency reporting using smart phones has become a reality now.
Practicing Radiology and Quality Assurance Parametres
With technological advancements in radiology, every few months the models of ultrasound and CT or MRI are changing. New equipments with faster imaging and processors are entering the market. Companies are giving a lot of emphasis on reducing the radiation dose to the patients during the examinations that are conducted by using X-rays.
Dr Jatin Sarin,
Oncologist, Chandigarh Cancer and Diagnostic Centre“Diagnostic radiology has a very important role to play in the oncology along with intervention radiology. It plays a very important role in ascertaining the overall spread of tumour and for doing biopsy. So, effective treatment of cancer is not possible without radiology. Sometimes it is difficult to differentiate between a cancer and other disease. But PET CT scan is very good modality for early detection of the deadly disease. However, accessibility and affordability are the biggest challenges for most patients.”
“Availability of trained persons in India is another challenge. There is a shortage of good radiologists who have exposure to oncology imaging. The other problem is the lack of awareness among patients. Biopsy and radiology interventions are important for starting cancer treatment. But there is a misunderstanding about it and people are often advised against biopsy. Therefore, there is a need to educate the patients about these interventions. It is also important that doctors practicing alternative medicine develop their own radiology infrastructure.”
Dr Jagdish Modhe
“Diagnostic tests are playing an increasingly important role in the healthcare sector. People these days are developing more awareness about their health and diagnostic radiology is playing a vital role in interpreting health concerns of the patients. So, demand and advancements in diagnostic radiology are set to grow in India. India has a huge population and it is going to be big market for the radiology providers.”
“Also, to help adopt this technology in India, certain duties on machineries can be reduced to make them affordable. Also, the government can give subsidy to assemble or manufacture these equipments in India.”
In radiology, MRI and ultrasound do not use radiation. But general X-rays, mammography, BMD and CT scan and all procedures done under fluoroscopy, both in radiology and operation theatre, emit radiation. Besides, ERCP done by gastroenterologist and various procedures conducted by orthopedic surgeons in OT also use X-rays.
Although radiology departments are aware of the dangers posed by radiation exposure, the increased usage of radiology devices by other departments in the hospital has emerged as a serious challenge.
The workers in radiology departments follow all safety procedures. But those handling radiology equipment in other departments like OT, endoscopy room, urology suite and orthopedic suite may not have adequate personal protective equipment like lead aprons, dosimeters etc. Other hospital staff including ward boys, nurses, anesthesiologists, anesthesia assistants, etc, are also vulnerable as they are neither concerned nor aware of the radiation risk from the equipments placed within their surroundings. Hospitals need to provide their workers dosimetres and ensure that the staff members are exposed to radiations within the safe limit.
By far, the equipments used today are safe. Most companies are adopting technologies to keep radiations low. Every year, quality checks are done by external agencies so that leakages or malfunctioning of equipments in radiology systems are prevented.
Challenges and Opportunities in Diagnostic Radiology in India
India has only 12,000 radiologists for a population exceeding 1.3 billion, which points to a wide gap between the demand and supply. Even if a hospital or a diagnostic centre can afford radiology equipment, they are not able to find an adequate number of radiologists. But this can be changed, as good software are available today to make it possible for radiologists to examine the reports from anywhere in the world.