'Radiology will eventually move towards Functional Imaging'

Dr Deepak Patkar Organising Secretary, IRIA-2007 and Consultant Radiologist at Nanavati Hospital, Mumbai

What was the purpose behind organising IRIA-2007? Can you give a brief background to this conference?

The IRIA is an annual conference held every year in different cities of the country. In fact, this conference was conceptualised even before independence. The IRIA annual conference 2007 is the 60th one and last year it was held at Chennai. Before Chennai, it was at Agra and Chandigarh. Next year, the conference will be held at Bangalore and after that in 2009 we are pitching in either for Patna or Delhi.

What according to you were the main highlights of this event this year?

This year our topics concentrated on the future of radiology and imaging for the four-day conference. The conference was scientific in nature, and it was the cutting edge technology in imaging that our speakers had discussed upon along with high-end technology like CT Scan, MRI and PET-CT. Along with topical issues pertaining to the future of radiology, we also focused on the basics of radiology. So, looking back, it was a mixed conference attended by around 3,000 experts, of which around 15-20 per cent were Indian resident doctors and doctors in training. Other highlights were presentation papers, quiz shows, exams, crosswords and exercises of similar patterns. We also had a film reading sessions, which means that cases were presented and we accordingly diagnosed cases as if we were diagnosing it in a hospital.

During the day, parallel sessions were conducted in nine parallel halls, covering a wide spectrum of topics like CT Scan, MRI, conventional X-Rays, international radiology and cutting edge technology. We had 40 international speakers and 220 Indian speakers attending the conference.

How did you zero in on the topics to be discussed ?

For any of our conferences, we scrutinise events happening across the world. There are major conferences like RSNA or European Society for Radiology that are being conducted from time to time, we check the topics discussed there and try to check the relevance in our situation.

Planning for such a conference happens over a period of two years. You have to bid for the conference like how bidding for venues and locales takes place for the Olympics.

For instance, planning for the Bangalore conference (to be held next year) has already being done. Once the venue of the conference is decided, the organising committee starts doing the base work. The actual work happens in the last six to eight months -getting the foreign speakers, speakers and experts from the country and localising the centres.

Apart from these conferences, what does IRIA do to create awareness?

We conduct sessions on a continuos basis in different zones of a region. We have various activities at the regional level. The Indian College of Radiology has five-mid term sessions which are spread across all zones of India. All eminent speakers go there to teach students for two-three days. At the state level, for example the Maharashtrian chapter of IRIA organises monthly meetings, at the regional functions or two-day seminar on CT Scan or two-day sessions on MRI.

What should be the focus for IRIA in the future?

Today, there is no formal training in imaging for experts. Members of the IRIA including the president, the general secretary and the Indian College of Radiology from where the chairperson and secretary handles the management so they need to plan how to train radiologists. The other aspect is to have uniform training across the country. The prime institutions in India have better technology than smaller institutions which cannot afford such technology. So, keeping the training universal and uniform is a great challenge. Training, keeping yourself updated with future technology and how to optimally use these technologies should be the focus of IRIA.

Please brief me on the recent evolution and advances in radiology and imaging.

Radiology has gone a long way right from the first time in 1896 when an X-Ray of a hand was taken till this day of PET and advanced CT. Henceforth for 70-80 years, imaging and radiology was restricted only to X-Rays. But X-Rays could be restricted only to bones and soft tissues. All you could do was look at fractures, look at tumours of the bones, but nothing beyond that.

In around 1970's, three or four new things came up like ultrasonography, CT Scan and MRI. They came in more or less at the same time. That completely changed at the way the inner organs of the body were looked at. The brain, kidney, heart, liver spleen could be looked at by experts and this was completely unheard of before that. These were all invasive tests.

Now, the focus in the last 10 years is on non-invasive diagnosis. So, now nothing is left to the surgeons's imagination. A surgeon does not have to open the abdomen to see what is wrong. You diagnose it before, plan your treatment and then go ahead. That is one focus for imaging today. You diagnose symptoms as if you seeing things directly inside without actually having to open the patient.

The other focus is that eventually radiology will move towards functional imaging. For the last 70-80 years, the focus was more on structural imaging. In this, for an ultrasonography and CT scan, you had to cut the patient's body into three slices and then looking at a structure. In this way, for the last 10 years, even if a patient was brain dead, imaging systems would show a normal brain. That is not happening now, even if there is a slight abnormality in any organ, including psychological abnormality, it will be easily detected. If there is something in the heart- say the heart might be pumping normally but functionally, it has some abnormalities, imaging can detect these abnormalities. With functional imaging, the anatomical as well as the physiological aspects would be covered.

What so you feel are the biggest challenges in radiology and imaging in our country?

The biggest challenge in our country is cost-effectiveness. Most of the machines cost a million dollars. And simultaneously, keeping the cost low is very difficult because most of the technology has a life cycle of four to five years. Everything gets outdated in a few years. A radiologist say 30 years back, would buy an X Ray machine and make a livelihood out of that and would not replace it. Now, even if you like it or not, or no matter how experienced you are you need to go for updated technologies. For that, you need to be cost-effective in terms of recovering the machine cost , plus taking care of your staff, your own income. So, that is becoming a major challenge. We need to keep the cost down. If the costs are exorbitant our sect of patients cannot afford it.

The second biggest challenge is education. Now, what we as experts were taught during our college days become totally outdated in a few years. Technology is changing and everything gets outdated with time. An expert needs to get himself updated by either attending conferences like this or by getting himself trained abroad or getting trained in the prime institutions in the country

Nayantara Som