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Evidence for a cure

education Updated: Sep 22, 2011 11:50 IST
Pranab Ghosh
Pranab Ghosh
Hindustan Times
Highlight Story

Apatient comes to a hospital with clot in a vessel that supplies blood to the brain. The doctor needs to dissolve the clot, or thrombus, in order to save the patient. It could be done through medicine or surgery. In cases where medication takes time to be effective or surgery is considered too complicated, a doctor is likely to insert a catheter under imaging guidance and follow minimally invasive procedures to clear the blood clot. This process is quicker than surgery and requires the patient to be hospitalised for very little time.

A patient comes to a hospital with pain in the abdomen. Investigation – an ultrasound is done – reveals pus collection in the liver. Instead of using a surgical procedure to remove the pus, a needle, under imaging guidance, is inserted to drain it out.

Welcome to the world of radiology. Both of the above are examples of interventional radiology, which is diagnostic as well as curative in nature. “Radiology is a branch of medicine dealing with the use of radioactive substances for the diagnosis and treatment of disease,” says Dr Bharati Singhal, senior resident at a leading city hospital. “It includes diagnosis using modalities such as X-rays, ultrasound, Doppler, mammography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and PET wedded to CT/MRI. Radiology also encompasses intervention radiology, which is curative/therapeutic.”

This branch of medicine, however, is largely diagnostic and it is, according to Dr Yatish Agarwal, consultant and professor, Department of Radiology and Diagnostic imaging, Safdarjung Hospital and VM Medical College, “today the mainstay of evidence-based medicine”.

The scope of work of a radiologist is tremendous, says Dr Sunil Bakshi, consultant radiologist with special interest in ultrasonography. “It is a highly coveted branch among medical professionals,” he adds. “Radiology has grown exponentially,” says Dr Agarwal. “You can today develop expertise in any one of the modalities – X-rays, ultrasound, CT, MRI and PET.” Alternatively, as is the practice among a number of institutions globally, divisions have also been drawn along the lines of various organ systems. “You could develop special skills in neuroradiology, cardiovascular radiology, gastro-intestinal radiology, gynecological radiology, forensic radiology, and so on,” adds Dr Agarwal.

With India’s economy looking up, medical facilities are also on the verge of major expansion.

“Keeping in step with this expansion, the need for radiology facilities is in for a quantum jump,” he says.

However, there is a dearth of good radiologists in the country. “That is because fewer number of students get to do the MD course each year due to the limited number of seats,” says Dr Singhal.

“Most of the government institutes earlier were also not equipped with state-of-the-art technology,” says Dr Devlina Chakravarty, head radiology, Artemis Health Institute, Gurgaon.

This trend, however, is changing thanks to better-equipped hospitals and private institutes providing Diplomate of National Board (DNB, equivalent to MD) in radiology, she says.

There are many challenges facing the profession, says Dr Chakravarty. Increased dependence on radiology services for diagnosis and treating patients with less clinical input are major challenges. Added to this is the fact that “radiologists are faced with the problem of handling massive data per patient as newer imaging modalities provide higher resolution and a large number of images”, he adds. Moreover, the fact that clinicians are becoming more dependent on radiologists to provide diagnosis is adding to professional pressures.

Whatever the challenges, radiology has a great future. “The profession continues to grow in size and scope as the number of imaging procedures tend to grow steadily and technology becomes more and more exciting,” says Dr Chakravarty.

What's it about?
Radiology is the hi-tech branch of medicine, which pries open the lid on the human body, revealing both the structure and function of the various organs and the changes that may occur within. It helps diagnose various diseases, disorders and abnormalities. Thanks to the discovery of X-rays by Wilhelm Roentgen in November 1895, radiology has grown immensely, both in its dimensions and capabilities. It is now endowed with such diverse technologies as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and PET wedded to CT/MRI. Doctors specialising in radiology are called radiologists. A radiograph (X-ray picture) of the leg can reveal a fractured bone. A CT scan of the brain can detect a tumour or blood clot. In examinations of certain organs including the intestines and the urinary tract, the radiologist may administer a substance called contrast agent to the patient. The substance may be a barium mixture given orally to coat the lining of the bowel so that it becomes more visible. The substance may also be made of an iodine mixture that is injected into the blood vessel to study arteries or veins

Clock Work
A radiologist’s routine can vary, depending on where he or she works. A senior resident in a leading hospital would have a timetable very similar to that of a doctor working in a private imaging clinic and this is what it would be like:
6.30 am: Wake up and exercise
8.30 am: Reach hospital
9 am to 11 am: Conduct ultrasonography of subjects
11 am to 1 pm: Do CT scan/other examination of patients
1pm to 2 pm: Lunch break
2 pm to 4.30 pm: Work continues
A resident in a government hospital also have to do night duties – two to five in a month - and 24- to 36-hour shift, depending upon hospital rules. One also does academic work to upgrade one’s knowledge

The Payoff
Earnings are variable, depending upon where you work and what you do. At entry level you may be getting around Rs50,000 per month and at the senior level it may go up about Rs2lakh per month. But if you have your own set-up, you could earn much more

Skills
. Excellent knowledge of anatomy, pathology and all clinical branches of medicine
. A keen eye, an analytical mind and scientific temper
. Patience and diligence
. Ability to absorb knowledge by following up on patients and learning from the clinical events, which unfold during the follow-up
. Unqualified humility to recognise that even if you are the best, the variables are so many that you can not be rigid, nor arrogant at any time and have the modesty to accept the truth

How do i get there?
. Take up physics, chemistry, biology at the plus-two level, pass the pre-medical entrance examination and study MBBS and become a physician. Following this, you have to write the MD entrance exams, and qualify absolutely at the top to get in. Once you are into the MD programme, you have to work hard to acquire the required knowledge and skills to become a good radiologist. During the MD, you also have to carry out research. However, you are almost there once you qualify the MD exams. You can then do a three-year senior residency and/or sub-specialty training, subsequent to which you can practice as a radiologist

Institutes & urls
. All India Institute of Medical Sciences, New Delhi -
www.aiims.edu
. Assam Medical College and Hospital, Dibrugarh -
www.assammedicalcollege.net
. Dr B R Ambedkar Medical College, Bangalore -
www.bramc.org
. R G Kar Medical College and Hospital, Kolkata -
www.rgkarmedicalcollege.org
. University of Calicut -
www.universityofcalicut.info
. Deccan College of Medical Sciences -
www.deccancollegeofmedicalsciences.com

Pros & cons


.

Very interesting and an ever-evolving field


.

Advances in technology occur every other year. Keeping pace with it is both challenging and exciting


.

Making a diagnosis key for effective treatment


.

Reasonably well-paid


.

Even if you do a good job, if the treating doctor fails to cure the patient, all your good work will come to naught


.

Lack of awareness about the importance of this field. Many patients do not recognise the significance of radiology, and in this situation, you feel more like a playback singer or the cine director, who


hardly gets the benefit of people’s recognition

The need is truly acute

A senior doctor talks about the challenges and opportunities

Are there adequate numbers of good radiologists in the country? If not, why?
The tribe of trained radiologists in the country is rather small. The reasons are many. One, the number of medical graduates allowed entry into radiology has, until recently, been very small. The universities are, however, now waking up to the situation. Two, the growth in radiology has been sudden and exponential; hence the requirement has grown more acutely only in the last three decades.

Three, we, as a nation, have never been futuristic in our thinking, planning, and strategy-building processes, and hence, we did not recognise this simple fact that the need for radiologists would get so acute. Four, many of our radiologists move to greener pastures in the West, where there is a positive environment for free-thinking, research, and evolution.

Is the quality of care/facilities in radiology in the country up to world standards?
The standards of facilities and care are comparable to the best in the world. However, we lag behind by a mile in research. But then, that’s true in all fields, be it medicine, other sciences, or even social
sciences.

Where can a radiologist find employment?
Jobs are aplenty both in the public sector and the private clinics, hospitals, and institutions. Medical colleges, public hospitals, large health centres – none can do without a team of radiologists. However, if you have the entrepreneurial streak, you could well open a diagnostic centre of your own.

How important is the role of a radiologist in the medical setup in India?
The edifice of modern medicine is built upon the quest for hardcore evidence, and since most people now prefer to be treated by modern medicine, radiology is in a dominant position, be it in India or anywhere else in the world. Interestingly, even though the paths and philosophies of other medical systems like homeopathy, ayurveda, unani and siddha are quite different, these practitioners have also started to turn to radiology to impart direction to their treatments and use it as a tool in the follow-up.

What are the challenges facing radiologists today?
Over time, radiology has been on a fast track mode, evolving at a breakneck pace. The demands on the older radiologists is to come to terms with change, keep learning and, at the same time, yield their places with dignity and grace to youngsters without feeling awkward about it. They must work at moulding young radiologists, smoothening out their weaknesses and brashness, teaching them humility and compassion, and in imparting the basic philosophy in practice of medicine: “Life is short, the art long, opportunity fleeting, experiment treacherous, judgement difficult.”

Dr Yatish Agarwal Interviewed by Pranab Ghosh

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