February, 2014
Rs. 100
IRIA 2014:
Wordsworth: Sunil Khurana
Call for Better Imaging!
BPL Med Tech CEO shares company’s immediate targets as it enters radiology
Vol 3, Issue 2, Pages 44
COLOR DOPPLER | FEBRUARY, 2014
India's First Complete Medical Imaging Magazine
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COLOR DOPPLER | FEBRUARY, 2014
February, 2014
Rs. 100
IRIA 2014:
Wordsworth: Sunil Khurana
Call for Better Imaging!
BPL Med Tech CEO shares company’s immediate targets as it enters radiology
Vol 3, Issue 2, Pages 44
India's First Complete Medical Imaging Magazine
Advancements in medical imaging reveal many mysteries behind cancer, paving the way for more effective and affordable treatment for the deadly disease
Killing
the Killer! Under the Scanner P|17
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Inside Scan Under the Scanner –
Killing the Killer! COLOR DOPPLER | FEBRUARY, 2014 Volume 3 | Issue 2 KERENG/2012/41766 editor-in-chief Joby Joseph joby@colordopplermedia.com publisher Niranjan Kumar K R M niranjan@indiaultrasound.com
Advancements in medical imaging reveal many mysteries behind cancer, paving the way for more effective and affordable treatment for the deadly disease. Color Doppler brings to you an in-depth analysis on the impacts of medical imaging and a few products that make future perfect for clinical oncology
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design editor Gireesh gireesh@colordopplermedia.com
Wordsworth –
Dawn of a New Era
chief coordinator Saraswathy M saraswathy@colordopplermedia.com
On the verge of BPL’s entry into the medical imaging devices market, the company’s President and CEO, Sunil Khurana shares company’s immediate targets to Color Doppler. He affirms that huge customer centricity, efficient use of technology and delivering affordable services has been the success mantra of BPL
chief correspondent Jumana Engineer jumana@colordopplermedia.com co-ordinating editor Rini Baby Thottil rini@colordoppleronline.com copy writers Ria Lakshman V ria@colordoppleronline.com Purnima Sah purnima@colordoppleronline.com senior designer Sohan V K sohanvishnu@colordopplermedia.com designer, new media Amit Sudhans amit@colordoppleronline.com manager-product & HR Kishore Kumar P S kishore@colordopplermedia.com assistant manager, IT Swetha G swetha@colordopplermedia.com
page 14 Talking Point –
Striving for Positive Changes “Our commitment to quality diagnostics would be a persistent pursuit, where we intend to leverage our market leadership position to work with government and advocacy groups to bring in positive change for the industry,” says Ameera Shah, MD and CEO, Metropolis Healthcare Ltd.
page 24 Eventful
manager, accounts Hariharan V V
Call for Better Imaging
assistant, accounts Shahana P shahana@colordoppleronline.com
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COLOR DOPPLER #2/1775-B, Florican Road, P O Civil Station, Calicut, Kerala - 673020, India Phone : +91 495 2378808/ 09 Email : info@colordoppleronline.com www.colordoppleronline.com Vision and opinions expressed in this magazine are not necessarily those of Color Doppler, its publisher and/or editors. Color Doppler does its best to verify the information provided but will not take any responsibility for the business moves taken by any reader on the basis of any article published in this magazine. No part of Color Doppler can be reproduced without the prior written permission of the publisher, Niranjan Kumar K.R.M. The rights to reproduce any information published in this magazine are vested with Color Doppler. The magazine is sold on the condition that the jurisdiction for all disputes will be courts/ forums/tribunals at Kozhikode, Kerala. Printed, published and owned by Niranjan Kumar K R M, 3/1614 C, Sridevi Niranjan, Near 6th Rly Gate, Nadakkave Post, Calicut-673011 and Printed at Anaswara offset Private limited, 48/2123-c Perandoor Junction, Elamakkara, Cochin 682026 and Published at 34/1347-A, Florican Road, Malaparamba, Calicut-673009. Editor: Joby Joseph.
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Fulfilling the theme ‘Better Imaging for Healthier Life’, IRIA 2014 underscored the need for the radiologists to stay alert and updated on recent advances in the field
Eventful
Listening to the Good Hearts
The 3rd National Conference on Echo Doppler Evaluation Techniques — CEDET 2014 addressed various concerns in clinical Echocardiography and discussed the commonly encountered problems in areas such as valvular heart diseases in-depth
page 36 Event Preview –
Emergency Care to Emergency Care International Summit on Emergency Medicine and Trauma 2014, to be held from February 14 to 16 at JIPMER, Pondicherry, aims at building a strong base in new specialty of Emergency Medicine
page 40
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[ news scan ]
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Samsung Launches 5D Ultrasound
amsung Electronics recently launched the UGEO WS80A, its first premium ultrasound with 5D technology in India. With stylish Samsung design and innovative features including the 5D technologies, MPI and ElastoScan that provides superior image performance, the UGEO WS80A redefines premium ultrasound for women’s health. The device features a 21.5” wide LED imaging screen and a 10.1″ touchscreen for the controls, as well as a variety of software optimizations that help resolve relevant anatomy and outputs data to 3D TV’s for an even more realistic view. “As the first premium device, the UGEO WS80A represents the latest ultrasound innovation and leading IT technologies of Samsung,” said Dinesh Lodha, Vice President, Health and Medical Equipment
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Business, Samsung India. The other key features of UGEO WS80A include the 21.5” Wide LED screen, a 10.1” Touch Control Pad, Feto Realistic
GE Acquires Strategic Assets from Thermo Fisher Scientific
E Healthcare and Thermo Fisher Scientific announced that they have entered into an agreement for GE Healthcare to acquire Thermo Fisher’s HyClone cell culture media and sera, and gene modulation and magnetic beads businesses for approximately $1.06 billion. The acquisition will allow GE to expand its offering of technologies for the discovery and manufacturing of innovative new medicines, vaccines and diagnostics in its growing Life Sciences business. Cell culture plays a key role in manufacturing medicines to treat diseases such as cancer and rheumatoid arthritis, as well as a new generation of vaccines. John Dineen, President and CEO, GE Healthcare said, “This deal makes a good business even better and will help us realize our vision of bringing better healthcare to more people at lower cost.” The acquisition is consistent with GE’s strategy to invest in high-technology, innovative businesses that deliver strong
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Ms Priya Joshi (GM-Ultrasound, HME, Samsung India Electronics), Dr Sneh Bhargava (Ex. Director-AIIMS), Mr Sameer Garde (Sr.Vice President and Head-Enterprise Business, Samsung India Electronics) and Mr Dinesh Lodha (Vice President, HME, Samsung India Electronics)
top-line growth and expanded margins. Kieran Murphy, President and CEO of GE Healthcare’s Life Sciences division said, “We look forward to the HyClone cell culture and other businesses joining the GE family. They are a great fit with our key areas of focus, and bring exciting new technologies, enhanced manufacturing capabilities as well as a great group of talented people to help grow our business.” “In addition to providing us with new approaches to drug discovery and biomedical research,” Murphy said, “this acquisition is a significant step forward for our customers in biopharmaceutical manufacturing. They will benefit immediately from an expanded range of “start-to-finish” technologies that will help them improve product yields and reduce time-to-market. By expanding our production facilities to three continents, we will be able to offer the biopharmaceutical industry greater confidence in the security of supply of cell culture media and sera, a key part of their production process.”
View, 5D Nuchal Translucency, 5D Cine, ElastoScan, Additional EV Probe Holder, Probe Cable Hangers, Default Gel Warmer and Up and Down Lift.
market scan Ultrasound Market to Experience Steady Growth India’s diagnostic ultrasound market value will experience significant growth over the coming years, achieving Compound Annual Growth Rates (CAGRs) of 9.6 percent between 2012 and 2019, reports GlobalData, a research and consulting firm. The company’s latest study reports that India’s ultrasound revenue will increase from an estimated $101m (around Rs 500 Cr) in 2012 to $192m (approximately 1200cr) by the end of 2019. “We expect the global ultrasound market to continue expanding alongside ongoing technological developments and the rising acceptance of products within emerging countries,” says Niharika Midha, Analyst, Diagnostic Imaging, Global Data.
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OLYMPUS110HG synthetic Thermal Papers for printing Ultrasonic Video Images. OLYMPUS110HG Video Papers have become very popular worldwide, replacing Sony and Mitsubishi papers with Lower Cost and Consistent Quality. OLYMPUS110HG is successfully exporting high image contrast thermal papers to world markets for medical recording and industrial applications.
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e-mail: tarun@atsequipments.com, website: www.xrayglobal.com
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[ news scan ]
GE Healthcare Partners with HTIC to Develop Affordable Healthcare Solutions
GE
Healthcare and Healthcare Technology Innovation Centre (HTIC), a multidisciplinary R&D center of IIT Madras, has announced a three-year collaborative research and development agreement to innovate a range of disruptive and affordable healthcare solutions. Talking about the partnership, Terri Bresenham, President and CEO, GE Healthcare, South Asia, said, “ This collaboration between HTIC and GE Healthcare will bring together start-up dynamism and corporate scalability to healthcare innovations.” Prof Bhaskar Ramamurthi, the Director of IIT Madras said, “We need to take a completely new approach to screening, diagnosis and treatment in order to make healthcare affordable and universally accessible.” Dr Mohanasankar Sivaprakasam, Head, Healthcare Technology Innovation Centre, IIT-Madras said, “Together with
Terri Bresenham and Dr Mohanasankar Sivaprakasam
GE, we look forward to develop a pool of affordable and accessible technologies and solutions that create large impact in healthcare in India, and the world.” This initiative will address the unmet and unvoiced needs in the areas of mother and child health, cardiology and cancer. GE will provide a grant of Rs 75 Lakhs to HTIC towards research and development of these disruptive solutions.
book scan Specialty Imaging : Functional MRI Specialty Imaging: Functional MRI is an introduction for teaching functional anatomy and imaging essentials to practicing neuroradiologists, neurolo-
Authors: Jeffrey S. Anderson, MD, PhD; Lubdha M. Shah, MD Pages: 304 Price: $299.00
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gists, neurosurgeons, psychiatrists, and imaging scientists interested in designing, acquiring, and interpreting functional MRI studies for scientific and clinical purposes. The book contains background in related MRI physics, sequence configuration, and image processing strategies. An important highlight of the book is an authoritative treatment of functional brain anatomy, including regional cortical anatomy, brain network anatomy, and functional anatomy of core cognitive functions such as language, motor, vision, memory, attention, and social brain function. The book also contains detailed portraits of more than 20 common fMRI paradigms, with instructions for implementation and sample activation maps expected from each paradigm. The book will serve as a resource for physicians interested in establishing a clinical functional brain imaging service.
event scan ISEMT 2014
Date: February 14-16, 2014 Venue: Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry For Details: www.isemt2014.com
2nd National Biomedical Engineering Training Program Date: February 12-23, 2014 Venue: NH Healthcity, Bangalore For Details: www.trimedx.com/indianbe-training
APICON 2014 Date: February 20-23, 2014 Venue: Palace Conference Complex, Ludhiana, Punjab For Details: www.apicon2014.com
30th Annual Conference of IRIA Karnataka State Chapter Date: March 29-30, 2014 Venue: The Taj Gateway Hotel, Hubli For Details: iriahubli2014@gmail. com
ULTRAFEST 2014 Date: April 18-20, 2014 Venue: The Renaissance, Powai, Mumbai For Details: www.msbiria.org
INSUOG 2014
Date: May2-4, 2104 Venue: Hotel Taj Mahal Palace, Mumbai For Details: www.insuog.com
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[ news scan ]
Carestream DRX Systems Numero Uno in Performance and Reliability: MD Buyline Market Report
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eading healthcare professionals again applauded Carestream’s DRX Systems for offering excellent performance that exceeded expectations—along with strong reliability—in MD Buyline’s Market Intelligence Briefing for the Fourth Quarter of 2013. Carestream’s wireless DRX detectors are “the core products that live in portable, fixed and standalone X-ray units in a retrofit capacity or integrated with new systems,” according to the report, and many facilities upgrade existing equipment with DRX detectors “one by one as their budgets allow.” Users value “the continuity of the previous generation CR systems’ user interface incorporated into the current digital X-ray system platform.” They also stated “the DRX-1C detector offers excellent image quality and low dose.” Carestream was the highest ranked company for both service response time and service
Quote Scan Dow R Wilson President and CEO, Varian Medical Systems
“Globally more people die of cancer than AIDS, malaria and tuberculosis combined. Each year 14.1 million people learn that they have cancer and 8.2 million people die from the disease worldwide. Until cancer awareness is improved globally and actions are taken to prevent and treat the disease, millions of people around the world will die unnecessarily every year.”
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repair quality. Healthcare providers also gave Carestream high marks for installation and applications training. “Our expanding family of DRX-based diagnostic imaging systems continues to exceed the patient care requirements of medical imaging services providers and the independent evaluations from MD Buyline are further proof of that,” said Doug Spotts, General Manager, the US and Canada Medical Sales, Carestream
Health. “Equally important is the fact that this customer feedback also validates our expertise in critical areas such as installation, service and total customer support.” Carestream’s wireless DRX family of DR imaging systems allows a single wireless detector to work across all DRX equipment to convert, expand or replace existing imaging solutions. The full line of digital X-ray systems meet healthcare providers’ current needs.
Varian Medical Systems Joins Global Community in Promoting World Cancer Day
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arking this year’s World Cancer Day observation February 4th, Varian Medical Systems has joined with an international network of cancer care providers and advocates to raise awareness of the disease and to encourage individuals and governments around the world to take action against it. “Until cancer awareness is improved globally and actions are taken to prevent and treat the disease, millions of people around the world will die unnecessarily every year,” said Varian CEO Dow Wilson, noting that according to the UN International Agency for Research on Cancer (IARC), 8.2 million cancer related deaths were reported in 2012. “The World Health Organization (WHO) projects that the global number of deaths
from cancer will increase by nearly 80 percent by 2030. That is unacceptable. Empowering people with all of the tools, knowledge and resources available is crucial in waging a successful fight against cancer.” Varian is a proud supporter of the Union for International Cancer Control (UICC), which coordinates events for World Cancer day. This year Varian has asked its 6,400 employees to sign the UICC’s Declaration Against Cancer, which calls upon government leaders and health policymakers to significantly reduce the global cancer burden, promote greater equity, and integrate cancer control into the world health and development agenda. As a company dedicated to helping save millions of lives around the world every year, Varian has launched a promotional campaign to acknowledge World Cancer Day.
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[ new product scan ]
CURiUS HiQ
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URA Healthcare’s CURiUS HiQ is designed to allow greater precision and best-in-class image quality. It has an ergonomic design packed with advanced imaging technologies, ensuring intelligent workflow. CURiUS HiQ provides a comprehensive range of transducers such as multiplane,
intra-operative, TV/TR thus enabling use in radiology, OBG/Gyn and cardiology. It delivers uncompromised contrast resolution and penetration with flexible features. The elegant design of CURiUS HiQ helps operators to achieve device positioning very easily.
Comfortable and Efficient CURiUS HiQ is a user-friendly system. It has 17 inch screen with an articulated arm, four universal transducers sockets compatible with full range probes, abundant connection interfaces: DICOM 3.0, USB port, VGA, S-Video and ECG etc.
User-friendly Keyboard The system features a colored backlit keyboard, making it convenient for the operator.
OTHER FEATURES
High Quality Noise Filter
CURiUS HiQ provides improved color flow and spectral Doppler images.
Multi-treatment Technology
Multi-beam parallel processing technology helps the diagnosis of cardiovascular disease/real-time 3D imaging.
Real Time 3D
The real-time 3D (4D) provides real-time three dimensional images of the fetus.
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M-Tuning
M-tuning gives one button image optimization technology, providing quick B-mode and Spectral Doppler image optimization.
U-Scan
CURiUS HiQ uses real-time advanced image processing algorithm to eliminate speckle and noise artifact and improves visualization of real tissue information.
Temperature Detection Technology The temperature detection technology will display on the screen automatically, to make sure the diagnosis is safe for patient.
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[ new product scan ]
Discovery IGS 740 Free from Rails The Discovery IGS 740’s swiveling wheeled gantry moves freely on the floor, not on the ceiling, eliminating overhead rails. So you can place your monitors exactly where you need them for comfortable viewing without straining.
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iscovery IGS 740 is a mobile angiography system from GE Healthcare aimed at interventional radiology market. The system comes with a 41x41 centimetre detector. It frees constraints for Interventional Radiologists. The unique rail-free design aims to allow healthcare professionals sufficient access to the patient while freeing clinical teams from the constraints of fixed ceilingmounted system rails.
The wide bore C-Arm and dedicated armimaging positions are designed to enable ease in imaging the anatomy of interest and full patient access from left to right. By removing the ceiling rails, installation is intended to be simplified for elasticity in designing the room and positioning ceilingmounted ancillaries (monitors, rad-shields and lights).
Dedicated Arm Imaging Positions Clinicians can execute procedures such as left arm fistulograms at ease with the Discovery IGS 740’s dedicated arm imaging positions.
OTHER FEATURES
Center of Procedures
Discovery IGS 740 can image the anatomy of interest easily; position monitors freely and access patients completely from the left or right side.
Large Anatomies in One View
It covers large anatomies such as the liver or both legs simultaneously, with fewer runs than smaller detectors, for efficient use of contrast and dose.
Large Detector
Discovery IGS 740 system with its broad 41x41 cm (16.1 in) digital detector, boasts one of the largest fields of view for interventional imaging.
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2D Coverage
With InnovaBreeze take full advantage of the Discovery IGS 740’s very large field-of-view and follow the contrast bolus in both legs in real time using variable panning speed control.
Large 3D Coverage
With wide-bore C-arm and 41x41 cm (16.1 in) digital detector large organs like liver can be seen in 3D.
No Complex Infrastructure Required
The mobile Discovery IGS 740 system needs no long and complex infrastructure improvements.
Ample Wide-bore C-arm With a full 129 cm (50 in.) of space between the tube and the detector, large patients can be easily imaged, achieve steep angulations conveniently and perform off-center 3D acquisitions to image the borders of the liver or the skin line with the help of Discovery IGS 740.
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[ new product scan ]
Philips Multiva 1.5T MR
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hilips Multiva 1.5T is designed to offer flexible MR application capabilities with high quality and reliability. Multiva 1.5T meets all the needs for fast, high-quality routine MR imaging. It is designed with FlexStream workflow with new Head/Spine/Torso (HST) and 8-channel SENSE MSK coils. The product is built to provide fast and easy patient set
up in brain, spine, MSK and body exams. Philips Multiva delivers high quality routine imaging in as little as 10 minutes time. It offers clinical applications, including whole body, oncology and breast imaging. It also gives up to 40 percent reduction in patient/coil set up time with new FlexStream workflow.
Superior Technology, High Performance Philips Multiva 1.5T MR’s technology is acclaimed for its speed; clinical competence and reliability, to provide high performance levels for patient care.
Faster Set-up, Higher Throughput FlexStream workflow enables 100 percent of total spine studies and 100 percent of head, body, musculoskeletal and neurovascular studies with a single ultra-lightweight anterior coil or the 8-channel SENSE MSK coil.
OTHER FEATURES
Ease and Efficient
The next generation of Philips powerful combination of SmartExam and ExamCards can divide the number of repetitive tasks for greater efficiency.
High Speed Imaging
SENSE, Philips revolutionary parallel imaging technique, continues to lead the industry with high acceleration factors. The system enables imaging up to 16 times faster than conventional imaging.
Efficient Use of System Time
Dockable patient trolley simplifies patient preparation, outside the exam room with
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more competent use of the scanner.
Clinical Breadth
Multiva 1.5T covers a wide range of applications and methods—spectroscopy, diffusion tensor imaging, fiber tractography including advanced cardiac, breast and whole-body imaging.
High Patient comfort
Multiva comes with superb patient comfort with sufficient space for patient headset.
Coils and Accessories at Hand Multiva’s FlexCaddy provides useful storage for coils and accessories.
Cost Control Philips Multiva 1.5T controls the economical installation. Compact Siting enables installation in an average of less than 10 days. PowerSave technology reduces power consumption and costs. Lightweight design and small fringe field footprint gives low siting costs.
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[ wordsworth ]
Dawn of a New Era On the verge of BPL’s entry into the medical imaging device market, president and CEO Sunil Khurana shares the company’s immediate plans to Color Doppler
Sunil Khurana
BPL has never left behind when it comes to technology and always provided people with the right solution. The company has always been in the forefront when it comes to providing the customers with best televisions or any other electronic products
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ith a glorious record of over four decades of service to different segments in medical fraternity, BPL Medical Technologies Pvt. Ltd is all set to revolutionize the medical imaging market. The company has always been at the forefront of the medical service providers with their commitment to service support and this made them one of the largest and most accessible medical equipment company in the country. At the dawn of their entry into the medical imaging industry, Sunil Khurana, President and CEO of BPL Medical Technologies Pvt. Ltd shares the company’s aspirations and dreams as a committed medical imaging service provider in the country. Prior to his current position at BPL, Mr Khurana served as the COO and a member of the Core Executive Council at Bharti Infratel. He holds a splendid record of serving the GE Group for nearly three decades as the Director of Computed Tomography and Vice President, P&L, South Asia. Excerpts from an interview. BPL is celebrating its 50 years in the market and has always been a favorite brand of the Indian population. On this occasion, please share us the success mantra of the company? BPL has always been a company that touched the lives of many people by providing them with products that added value to their life. BPL has never left behind when it comes to technology and always provided people with the right solution. The company has always been in the forefront when it comes to providing the customers with best televisions or any other electronic products. The service that we render is so efficient
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[ wordsworth ] that only a four hours time will suffice to make a television. BPL has hundreds of van running across the country and in case of any service help, it would be delivered in a four hours time. No company has extended their services at this mark. Huge customer centricity, a wide array of products, efficient use of technology and delivering affordable services has been the success mantra of BPL. As a person who has been in the medical imaging industry for the past three decades, how do you evaluate the medical imaging industry in India? When I began my career in the medical imaging industry 30 years ago, there existed a huge gap between the Indian market and the US market. And today, the gap does not exist at all. If you look at the products that are launched during RSNA or CSR, we can see these products coming into the Indian market very quickly. This has been a major change. There has been a dramatic change in the acceptance of technology and willingness of people to invest money in healthcare in India. I remember the days when X-ray used to charge Rs 30 or Rs 40 and people used to pay the money with a lot of reluctance. But if we look at the current trend, a lot of people continuously go for medical check-ups. From this, it is evident that the medical imaging industry has witnessed a dramatic change. BPL is gradually entering the medical imaging market. The competition is very intense in the medical imaging market with many global companies as the major players. How is BPL planning to tackle this competition and planning to stay afloat in the market? The first thing is that the market is pretty big. The second thing is we all have our own USPs. I have a unique selling point and a unique position for me. Everyone does in the share of market assigned to him. What I want to focus is in building a very customer centric organization, where the service we render remains the DNA of our organization. You can secure your piece of market share once you are close to your customers, once you attend breakdowns very quickly and once when you are affordable. The market has been growing at an annual rate of 10 to 12 percent. If I am able to catch up with the growth rate and if my competitors stay COLOR DOPPLER | FEBRUARY, 2014
I want to focus on building a very customer centric organization, where the service we render remains the DNA of our company. You can secure your piece of market share once you are close to your customers and once you attend breakdowns very quickly
where they are, I will enter the market in a good way. And I really don’t see any challenge ahead because of this factor called ‘trust’. BPL has earned the trust of the customers through our unparalleled service and this would definitely help us in staying afloat in the market. Another factor is the relationship we maintain with our customers. Both trust and relationship will always remain the key elements of our fundamental etiquette. There are a certain group of people who prefer foreign products to indigenous products. There is a notion among them that foreign products are superior to indigenous products. What is your take on this? Finally it’s only a five percent of the population who would want to do that. The rest of the 95 percent is an open one. Even if you look at today, for example let us take China as a market where products are being made. Many products of Philips, GE, Siemens and even if you look the Apple phones, everything is being made in China. There are vendors who are making products for them and products for others as well. So, it is just a myth that exists in the market today. Ultimately what I look at is the performance of the product once its installed at a place; the image quality it delivers and what kind of wave form the system delivers is what matters. So, it just an initial part and it does not stay beyond installations. Above all, according to me mouth publicity will definitely make a big impact. As we move forward, we would like to have happy customers who would say that they are happy with the products from BPL and that day is not so far when it comes to medical imaging.
We are not in a direct competition with GE, Philips, Siemens or other MNCs. We want to be a humble Indian company and we will definitely make our own space. Look at the pharmaceutical industry in India, about 85 percent of them are local and only 15 percent of them are foreign. Look at the market in Bangladesh, about 98 percent is local and only two percent is foreign. If the pharmaceutical companies can, then why not the medical device placers? We can definitely rise to a level where we start getting a better share. Today the share of Indian players in the medical imaging market will be ten percent. But I am sure that it will increase to a 30 to 50 percent and this trend will go on. So, it is all about how we look at it. Indian brains are doing best. With the funding that we are getting from Goldman Sachs and the connectivity that we are getting from them, we will definitely come up with excellent products and technologies. Cost has always been a major concern and people are always hesitant to go for low-cost products with a fear of quality being put at stakes. How do you look at this? Like I said earlier, any MNC will have a lot of overheads. This is where BPL has advantage over these companies. The products we deliver at lower prices do not mean that we compromise in the quality. It is a lower overhead which will definitely help us to stay live in the market and this is going to make a major difference. Regulations differ from country to country and India is a country where the regulations are more in number when it comes into the imaging industry. How do you look at the regulations in India? According to me, the radiation side of the regulations is very valid and that is something which I welcome. They help us in understanding what kind of products can be sold in the Indian market. There are certain X-ray products such as two pulse units which are still being sold in the market even though they are banned. Regulations will put such practices in tighter control. When we look at PNDT, a regulation for ultrasound, it was a right move by the regulatory authority in India when looking at the way things have happened in the country. There were places where either people have overdone it or misused it and
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[ wordsworth ] this always happens. The quality side of it should be tightened as well. I am actually in for a right regulations and India needs more regulations. So, I feel that we need more regulations and proper control for a better radiology practice. The whole world is after ‘Green’ technologies these days. What are the initiatives taken by BPL so as to deliver Green healthcare technologies? Almost all the products that we offer in the market are green. They produce very little heat, consume low power and as we move
We are very confident the day would definitely come when hospitals would recall BPL along with the multinationals when they think of a medical product and that is where we would like to see ourselves standing too. I am confident that it will be not too far and we may be doing it in a couple of years. Undoubtedly we will be the number one Indian player in the market very soon. If the consumers want higher end products, they can go for any other company as we are not looking at that market right now, but if they going for products where we are in, they would
In the initial stage, we are planning to do R&D as a parallel activity by collaborating with the best-in-class unique players from overseas
on, right now, I cannot comment what all green technologies we will be delivering in future. I have worked with MNCs for a long time and was the CEO of Bharti Infratel. During my tenure with these companies, I have seen many of these companies bringing in a lot of green technologies for tower maintenance, instead of burning the generators that produce a lot of fumes. Everybody are moving towards green technologies and what we do today will definitely benefit the next generation. At present, I cannot comment on anything as it is too early for us. We are still working on the products, but we clearly understand the importance of eco-friendly technologies and this would definitely reflect in all the products that we are going to deliver in future. How do you look at the future of BPL in the medical imaging sector?
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I have worked with MNCs for a long time and was the CEO of Bharti Infratel. During my tenure with these companies, I have seen many of these companies bringing in a lot of green technologies for tower maintenance, instead of burning the generators. Everybody is moving towards green technologies and what we do today will definitely benefit the next generation
definitely think about us. We do realize that we have just started the journey and it takes time for us to prove ourselves in this market. But there are other companies who have been in the Indian market for decades who are well established in the market now. It’s a long way ahead and we know it’s not possible to reach that status in a day or two. But we are sure that we will make it. We promise not to be arrogant in the market like many other multinational companies and this will be our USP. People who are dealing with us will definitely understand how straight and honest we are. BPL is now entering into a new market. Please elaborate on the R&D activities. We do have a R&D right now. But in the initial stage, we are planning to do it as a parallel activity by collaborating with the best-in-class unique players from overseas. It takes a lot of time to develop and come up with a product. We don’t want to wait for a long time. But we will be doing it parallelly. We will keep doing it and over a period of time, we are aiming at developing 50 percent of the products in a five years time through our R&D activities. We want at least 50 percent of our products made in India, in our own factory and this will entirely be contributed by our R&D. All I have to do is wait for it to happened we may initiate it on our third year itself. What is your message to the radiology community? The Radiology community in India is growing very well. Decades back, I have seen very a few radiologists in India. But radiology has emerged as the number one choice in the medical fraternity. If you go to any medical institute, radiology is opted as the number one postgraduate qualification. We have been working together and will find a way to make the rest of the world look proudly at India for its contributions in the field of healthcare, especially on the research side. Like in developed countries, the radiology practice in India has become very efficient and people are looking forward to more white papers so as to learn about different researches that are going on in various Indian universities. We would definitely support those in radiology with products and services that would help them in experiencing better radiology practices. COLOR DOPPLER | FEBRUARY, 2014
Oncology Products
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Killing the Killer! Advancements in medical imaging reveal many mysteries behind cancer, paving the way for more effective and affordable treatment for the deadly disease. Here are a few products that make future perfect for Clinical Oncology
Trilogy
Discovery PET/CT 710
The new Trilogy system from Varian Medical Systems is the first of its kind in the new generation of cancer care systems. It is optimized for different forms of treatment ranging from radiation therapy to radiosurgery and adds more powerful advanced motion management capabilities. The versatile Trilogy system brings 3D conformal radiotherapy, IMRT, stereotactic radiosurgery, fractionated stereotactic radiation therapy, and intensity-modulated radiosurgery for cancer and neurosurgical treatment. The Gated RapidArc and the open management interface provide the options for treating moving tumours. The system delivers a better patient experience by providing shorter treatment times.
Discovery PET/CT 710, the all new PET/CT scanner from GE Healthcare and the breakthrough Q.Suite tools employed in the system for quantitative PET support in making suitable treatment decision for individual patients. The system provides advanced applications that help clinicians make fast and confident diagnosis. It helps in simplifying workflow for fast and streamlined operation. The Q.Suite tools provide a quantitative consistency to the treatment procedures. The tools help physicians examine therapy response early and effectively. This helps the oncologists in customizing and modifying their treatment strategies before they get the physical results. This will result in improving patient’s quality of life and overall outcome as well. The system is equipped with a 40 mm detector that rotates at a speed of 0.35-sec. When operated in the energy-saving mode, the CO2 emission is lowered up to 60 percent.
Brilliance CT - Big Bore Oncology
Biograph mMR
Designed and developed with radiation oncology in mind, the Brilliance CT Big Bore Oncology from Philips Healthcare improves the process of detection, diagnosis and treatment of cancer. It helps clinicians to provide better patient care at an affordable cost. Integrated with cutting-edge solutions for radiation oncology such as superior imaging, localization, simulation and planning, the system is backed with superior technologies suitable for conditions where speed and throughput are very crucial. O-MAR technology helps in reducing artifacts caused by large orthopedic implants. iDose4 helps in acquiring images with higher quality by preventing artifacts and by providing increased spatial resolution.
A state-of-the-art 3T MRI with cutting-edge molecular imaging, Biograph mMR from Siemens has set a mark in the field of diagnostic imaging. The system delivers outstanding image quality and the lower examination time provides more patient comfort. The system enables the simultaneous acquisition of wholebody MR and PET. This provides breathtaking images that bring in new insights into the progress of disease. This also widens the scope of research by unlocking new paths to treatment. Biograph mMR combines anatomical, functional and metabolic information with exceptional image quality ensuring a complete picture in one simultaneous scan. The simultaneous motion compensation optimizes accuracy of the diagnosis. The system offers new motion-compensation strategies for PET, based on real-time MR information. The system is a great contribution to the field of oncology imaging.
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Oncology Products
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Aquilion Large Bore CT
Sonialvision safire 17
Toshiba’s Aquilion LargeBore CT accomplishes the need to image patients faster, safer and more comfortably while optimizing workflow at the same time. The system has the capability to accommodate the widest range of patients with its biggest and widest bore, and advanced dose reduction technology. Being the only system that combines the largest bore and true field-of-view (FOV), Aquilion LargeBore covers more anatomy with greater accuracy. The system also features advanced dose reduction and image-processing software.
The latest edition in Shimadzu’s Sonialvision series, Sonialvision safire17 is capable of handling 2880X2880 matrix ultra-high-definition images. This new digital radiography device is designed around the Windows operating system. It enables the rapid processing of high-definition images possible using simple operations. The graphical user interface provides an intuitive operation environment, which is user-friendly. The 17 x 17-inch maximum view field of the system applies the extremely high definition and density resolution of the direct-conversion FPD across an area equivalent to 14 x 17-inch film. The large distortion-free view field means only minimal positioning movements are required.
Amulet Innovality
Versa HD
Amulet Innovality is the new leader in the AMULET series from FujiFilm. The system is equipped with a direct-conversion flat panel detector made of Amorphous Selenium, which exhibits excellent conversion efficiency in the mammographic X-ray spectrum. The new HCP (Hexagonal Close Pattern) detector capably collects electrical signal converted from X-rays to take in both high resolution and low noise. Intelligent AEC employed in the system has advantages in defining the optimal dose for an examination compared to conventional AEC systems where the sensor position is fixed.
Elekta’s Versa HD is an advanced linear accelerator system designed to improve patient care and treat a broader spectrum of cancers and offers the versatility to address the growing cancer management challenges. Featuring high precision beam shaping and tumor targeting, Versa HD has different capabilities designed to maximize healthcare system resources and deliver highly sophisticated therapies without compromising treatment times. The system provides clinicians the flexibility to deliver conventional therapies to treat a wide range of tumors throughout the body.
TomoTherapy H Series
Selenia
TomoTherapy H Series from Accuray is designed and developed to provide personalized treatments for all patients. It offers planning and delivery of highly customized and consistent dose distributions in order to meet the needs of the patients. It provides clinical solutions with accuracy, flexibility and efficiency. This helps the clinicians treat tumors with confidence and without compromise. TomoTherapy H Series is equipped with a wide array of technologies. The TomoTherapy H Series is available in three configurations - TomoHDA System, TomoHD System and TomoH System.
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Selenia digital mammography system from Hologic offers the best possible digital mammography image, the lowest possible dose and the most flexible tools for the technologist. The system delivers exceptional sharp, digital images with excellent contrast and consistency. The system is robust and flexible for any clinical setting and is designed to support the workflow preferences of users. It uses a direct conversion detector, which eliminates the need to convert X-rays to light. The result is an exceptionally sharp digital image and enhanced contrast with greater consistency. COLOR DOPPLER | FEBRUARY, 2014
Expert Opinion
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Deep, Deeper, Deepest! “India has done exceptionally well in the field of imaging in the last few years. Newer and more advanced imaging techniques have emerged to improve our understandings of tissue biology,” says Dr Rakesh Kumar Gupta, Director and HOD, Department of Radiology, Fortis Memorial Research Institute, Gurgaon
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he medical imaging specialty has evolved a very vital component of the world’s war on cancer. It has been widely used in screening, diagnosing, staging and treating cancer. It often detects cancer at its most curable stage and this has made medical imaging the epicenter of the whole world’s effort to cancer prevention and early detection. On the occasion of the World Cancer Day, Dr Rakesh Kumar Gupta, Director and HOD, Department of Radiology, Fortis Memorial Research Institute, Gurgaon, talks to Color Doppler on how medical imaging has progressed as an efficient tool that enabled the clinicians to study the disease at the cellular level thereby providing better, more comfortable and convenient care. Dr Gupta, a veteran in the field of radiolCOLOR DOPPLER | FEBRUARY, 2014
ogy, is a recipient of many prestigious awards including Lt. Gen. Amir Chand Award from Ministry of Defense, Government of India in 1998. He has authored more than 400 research papers, which were published in many national and international journals. Excerpts from an interview: You started your career in MR Spectroscopy way back in 1988. From then to the present scenario, how do you rate the evolution of different imaging techniques during the course of time? I started my career as a Radiologist in 1983 and then, started working on MRI in 1987. Magnetic Resonance Spectroscopy was an emerging technique then. It was a non-invasive analytical technique that could give metabolite information about the tissue in question in vivo, in case of brain tumors, strokes, seizures, Alzheimer’s and other neurological diseases. In 1988, I was sent to various institutes overseas especially to learn this technique. On my return to India, I introduced MR
spectroscopy in clinical practice here and continued with my research on the technique for as many as 10 years. Apart from MRS, there have been continuous improvements in various imaging techniques, both in Radiology and Nuclear Medicine. Newer and more advanced techniques have emerged to improve our understandings of tissue biology. When another World Cancer Day is nearing, how far the country has advanced in the imaging techniques in oncology? India has almost all imaging modalities which are available elsewhere in the world in the field of diagnostic imaging. The Fortis Memorial Research Institute, Gurgaon, employs a range of sophisticated technologies in diagnostic imaging for cancer. It has the 3Tesla Digital MRI that produces exceptional anatomic detail while ensuring optimum patient comfort, the 256 Slice CT Scanner that provides faster and wider coverage area with reduced radiation exposure, the Time-of-
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Expert Opinion
[ under the scanner ] pioneers in high precision external beam radiotherapy to install the Elekta linear accelerator (linac), equipped with ExacTrac Patient Positioning system by Brainlab. ExacTrac is a field-proven system for supporting sub-millimetric positioning for patients with tumors anywhere in the brain and body. It allows clinicians to reduce the amount of tissue irradiated, targeting only the tumor and sparing the surrounding normal tissue. This reduces the toxicity of radiotherapy. At the same time, a number of non-radiation therapies are being developed to reduce toxic effect.
Flight PET/CT that provides significantly better image quality, Digital Mammography, etc. Together with new techniques being performed by interventional radiologists, the precision of this cutting-edge diagnostic equipment is helping doctors understand and treat cancers more effectively. Having served in the best hospitals and institutions in India, how do you evaluate the system of clinical diagnosis and outcomes in India? Having studied and experienced first-hand the evolution of clinical diagnosis over the last three decades, I think India has done exceptionally well in the field of imaging in the last few years. Both public and private healthcare players are continuously adopting state-of-the-art diagnostic technology to enhance clinical outcomes. It may be noted that high-end CT and MRI have also reached the small towns of India along with other diagnostic modalities, taking quality care to the people. In the advanced International symposium on MR Imaging organized by Fortis Memorial Hospital during February 2013, you showcased a unique combination of two cutting-edge whole body MR imaging technologies for the first time in the world that can detect tumors early. Please brief how this transforms the imaging industry? Whole body MR imaging is a path-breaking technique that combines m-Dixon and DWIBS to provide precision high resolution images of one millimeter thickness, making possible the detection of tiny tumors. We had been working on these techniques and had presented a paper to an acclaimed international journal. The journal accepted our paper and it was peer reviewed. This technique will transform cancer treatment by helping the diagnosis of the disease in its infancy, much before the physical symptoms have manifested themselves and the disease has reached an advanced uncontrolled state. With its application on the whole body, tumors or infections that were not revealed in MR imaging earlier, can now be detected easily in as little as 20 minutes and without exposing the patient to radiation. Due to this, there is a lot of excitement among clinicians and radiologists and they all are keen to use it for their patients. These
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Dr Rakesh Kumar Gupta
investigations are routinely performed at the Fortis Memorial Research Institute, Gurgaon. This method was showcased by Philips in a recently concluded RSNA. Medical imaging strongly depends on technology, its progress and further developments. Which imaging technology, according to you, has been a major breakthrough in imaging cancer? The imaging technology that I consider breakthrough is GlucoCEST, which uses radio waves to magnetically label glucose in the body. This can then be detected in tumors using conventional MRI techniques. The method uses an injection of normal sugar and could offer a cheap, safe alternative to existing methods for detecting tumors. Excessive waiting time between the diagnosis and treatment of cancer patients has been a long-standing issue. What measures can be taken to ensure them an access to radiotherapy in a timely manner? Early diagnosis is the key to early therapy. We need to add to the developments in diagnostics to ensure therapy for cancer patients. Ionizing radiation poses cancer risks. So how safe is radiotherapy in treating cancer? While it is an accepted fact that radiation poses a risk for cancer, it is also a necessary evil. It is a major treatment modality for cancer patients. Once the patient develops cancer, the benefit of radiation outweighs its hazards. But technology is also being used to make radiation therapy safer. FMRI has joined hands with
Research studies report that there is an increasing risk of heart diseases in women who undergo radiation therapy for breast cancer. Is it right? Radiation is often an important part of treatment for breast cancer, helping to lower the chances that the cancer will return. Still, women considering breast cancer treatment and their doctors need to take the risks of treatment—including the slightly increased risk of heart disease— into account when making treatment decisions. This is especially important in women who have known risk factors for heart disease. With imaging being one of the major ways to fight against cancer, it is very important that the public be well informed about its benefits and possibilities. What are the initiatives taken by Fortis in spreading the word? FMRI engages with the local community every Sunday to spread awareness about different health conditions. Only recently, super-specialists from the Department of Medical and Surgical Oncology and Thoracic Surgery conducted comprehensive awareness sessions on breast and lung cancer with people from the community in Delhi-NCR. In addition to educating people about the signs and symptoms to watch out for, the experts also spoke about the importance of early detection and different treatment modalities. What are the areas in imaging that you feel need to be focused more on? We have prepared a clear roadmap for pursuing research in the field of oncology. Our team is exploring new techniques that can be added to our capability sometime in the near future and we are close to getting encouraging results. COLOR DOPPLER | FEBRUARY, 2014
Molecular Imaging
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Unlocking the Potentials of Personalized Cancer Therapy Over the past few decades, medical imaging technologies have become a key influence in Clinical Oncology. However, advances in molecular imaging promises that the true transformative power of imaging in the clinical management of cancer patients still lies ahead
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he field of clinical oncology has witnessed immense growth in interest as well as applications of medical imaging technologies over the past few decades. However, when looking at the field of molecular imaging, it is evident that the true transformative power of imaging in the clinical management of cancer patients still lies ahead. At present, the medical imaging segment is at a turning point with molecularly targeted imaging agents broadly expanding the limited capabilities of conventional anatomical imaging methods. The versatility of ‘Molecular Imaging’ not only allows clinicians to identify the location of a tumor in the body, but also to visualize the expression and activity of specific molecules (eg. proteases and protein kinases), and biological processes (e.g. apoptosis, angiogenesis and metastasis) that influence the nature of the tumor and its response to the therapy. Such diverse information has had a major impact on cancer detection, personalized treatment and drug development. It did have an impact on our understanding of how cancer arises and behaves different from person to person. The vital advancements in understanding the molecular biology of cancer and the ability to transform these advances into therapeutic approaches, have paved the way to the discovery of new targets and new drugs for anti-cancer therapy. ‘Personalized Cancer Care Regimens’, being the new mantra, cancer treatments have become more individualized. With this arouse the need to characterize tumors and identify therapeutic targets, which COLOR DOPPLER | FEBRUARY, 2014
Dr Ajit Shinto DRM; DNB; PGDHA; MNAMS Chief of Nuclear Medicine and PET Services, Comprehensive Cancer Care Centre, Asst Prof of Nuclear Medicine, Kovai Medical Centre and Hospital Coimbatore, Tamil Nadu
in turn will help in selecting the therapy that is most likely to successfully treat an individual’s cancer. Be it targeted locoregional therapy, such as surgery and radiotherapy or targeted systemic therapies, such as endocrine treatments for breast cancer or even receptor based therapies for lung and renal cancers, the personalized treatment protocols is the way forward. Thus, tumor characterization has been in the domain of in vitro assays and pathological evaluation of tumor biopsy material. With the development of molecular/receptor/antibody and biochemical probes along with technical advances in functional and molecular imaging, the foundation for testing imaging as a cancer biomarker (namely, to help direct cancer treatment in a way that is complementary to plans based on tissue- and blood-based biomarkers) has been laid. Molecular imaging has already been serving as a cancer biomarker and guiding cancer therapy in clinical practice. Some of the significant implications of molecular imaging as cancer biomarker are: Prognosis: The imaging biomarker will
help in determining the aggressiveness of the tumor and thereby infer the likelihood of the disease progression and the chances of death. This information can help in determining how aggressive the treatment should be. Prediction: The imaging biomarker will help in identifying the presence or absence of therapeutic targets and therefore direct the patient to the most effective therapy. Imaging will also help in identifying those factors that are likely to mediate resistance to particular forms of treatment. Response: Functional and molecular imaging can measure therapeutic response at a much earlier time point than standard anatomic imaging. In addition, imaging the tumour’s in vivo response to treatment may better predict the outcome in relation to important endpoints, such as diseasefree and overall survival. Biology: Molecular imaging provides a unique tool for characterizing the in vivo biology of cancer and its response to the treatment. It may offer insights into factors that determine why some patients respond to specific anti-cancer treatments while some do not. Targeted Therapy: Molecular imaging probes identify the presence of certain molecular pathways or receptors in the tumor, which can then be utilized for therapy by linking with radioactive isotopes. This idea has recently gained significant momentum in recent times and is known as ‘THERANOSTICS’. The important factor that has to be kept in mind is that this type of molecular approach differs from the standard paradigm for cancer imaging, which has largely focused on detection and staging. These imaging probes used for detection must have reliably higher uptake in tumors compared to normal tissue and hence the probes vary from tumor to tumor. As a result, even the absence of a particular feature – for
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Molecular Imaging example, tumour receptor expression – is equally important as its presence to predict the aggressiveness or the failure of standard treatment regimens. Thus, if molecular imaging is to be used as a cancer biomarker, it must be able to go beyond detecting a tumor to quantify tumor in vivo biology across a range of values. The probe should have the ability to locate and characterize tumors at the same time as well. Multimodality imaging techniques such as PET/CT, or other pairs of imaging procedures may prove especially important for biomarker imaging. However, it is important to note that the implementation of molecular imaging as a biomarker in cancer clinical trials and clinical therapy will require a lot of effort to develop rigorous and clinically feasible approaches for multimodality imaging, standardized image acquisition and analysis protocols. Some of the niche areas where molecular imaging has already shown promise are: (As this article is not meant for an exclusive oncology community, the details and patient profiles have not been included.)
Prognosticating Cancer
A number of studies on different tumor types have shown that rates of tumor glucose metabolism, reflected by PET imaging of 18F-fluorodeoxyglucose (FDG) uptake, are highly predictive of patient outcomes such as progression-free and overall survival. The mechanisms underlying these findings are partially understood and are complex as well. They include the association of increased glycolysis with other factors that are predictive of patient outcome, such as indices of cellular proliferation. They may also reflect a cellular stress reaction, also seen in normal non-tumour tissues, that enhances cellular survival and may mitigate the effectiveness of cytotoxic treatments. One of the simplest scenarios, in which FDG-PET is used to determine prognosis in clinical practice is the case of iodine-refractory thyroid cancer. Here, the absence of FDG uptake indicates a quite favorable prognosis that often directs the patient away from further treatment in favor of close observation. On the other hand, the presence of FDG uptake in refractory thyroid cancer identifies a relatively lethal form of the disease, indi-
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[ under the scanner ] cating that further therapeutic intervention is necessary.
Identifying therapeutic targets with imaging
Though complementary to biopsy and in vitro assay at present, imaging has significant advantages in identifying therapeutic targets. Primarily it has the ability to characterize the entire body’s disease burden, measure the heterogeneity of the target within or across the disease sites, and also measure the effect of treatment on the target during follow up. One example is the use of 18F-fluoroestradiol (FES) PET to image regional oestrogen receptor (ER) expression. Studies have shown that the level of FES uptake in breast cancer predicts the likelihood of response to endocrine therapy. This is akin to current clinical practice, which measures ER expression on biopsy material to make treatment selections. Imaging may be particularly helpful in recurrent or metastatic disease, where biopsy can be challenging. Another example is PET hypoxia imaging, using compounds such as 18F-fluoromisonidazole (FMISO). PET hypoxia imaging may be particularly important in radiotherapy treatment planning where the hypoxic regions will need different dosing schemes, given the welldocumented association between hypoxia and radioresistance.
Therapeutic Response Assessment
A decline in cellular proliferation in a tumor mass at an early stage indicates successful cancer treatment. A work demonstrating the efficacy of 11C-thmyidine PET (which images cellular proliferation) for early response evaluation led a number of investigators to develop thymidine analogues that can be labeled with 18F for PET imaging, making them practical for more routine clinical use. The most promising to date is 18F-fluorthymidine (FLT), which has undergone preliminary evaluation in patients. Early studies support serial FLT as a robust indicator of early response, including response to agents that work primarily as cytostatic (versus cytotoxic) therapy. This is a highly promising area of investigation. The multicentre trials of FLT-PET to measure early therapeutic response are underway.
Cancer biology has the ability to measure in vivo cancer biology during treatment and provides a unique opportunity to gain insights into factors underlying response and resistance. One interesting finding has been the association between mismatches in tumor metabolism and perfusion, and resistance to therapy. For several tumor types, investigators have shown that tumors that have high rates of glucose metabolism relative to blood flow are less likely to respond to the treatment and that the patients with tumors displaying such characteristics are more likely to have disease relapse. Identification of flow-metabolism mismatch as a marker of therapeutic resistance suggests the need for further studies to understand underlying mechanisms and may identify alternative targets in tumors that are resistant to standard treatments.
Translating Diagnostic Probes into Vectors for Targeted Therapy In addition to the above mentioned uses, at present, we are trying to create probes that can also be coupled to therapeutic radioactive isotopes, thereby selectively targeting the expression of a particular receptor or biochemical pathway inside the patient’s body. The biggest advantage is that this type of therapy can selectively kill cancer cells and spare normal or non-target cells. This would enable us to deliver a very high dose of radiation with minimal side effects, which is actually one of the major drawbacks when compared to the conventional chemotherapy or external beam radio therapy. Still in its infancy, these promising studies and applications will have to be validated in larger, multicentre trials. A very significant potential contribution, which has not gained momentum, is to evaluate potential new drugs, both for in vivo targeting and assessing response. Molecular imaging technologies that monitor biological processes and measure levels of targeted macromolecules can contribute significantly to preclinical and clinical drug evaluation. There should be a concerted and networked effort to integrate molecular imaging into the drug development process and clinical oncological decision making. The early promising results encourage the efforts to optimize the potentials of molecular imaging.
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Striving for Positive Changes
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“Our commitment to quality diagnostics would be a persistent pursuit, where we intend to leverage our market leadership position to work with government and advocacy groups to bring in positive changes to the industry,” says Ameera Shah, MD and CEO, Metropolis Healthcare Ltd.
multinational chain of diagnostic centers, Metropolis Healthcare Ltd. is the preferred bringer of diagnostic services to more than 10,000 laboratories, hospitals, research centers and 50,000 doctors across India. A CAP (College of American Pathologists), USFDA, NABL (National Accreditation Board for Laboratories) and ISO 15189 accredited diagnostic major, Metropolis is headed by Ameera Shah. Under her leadership as MD and CEO, Metropolis has evolved from a single pathology laboratory to a fully integrated multinational chain of 85 plus diagnostic centers and 600 plus collection centers across South Asia, Middle East and Africa in a decade’s time. With a vision to change the dynamics of the industry through consolidation and consistent innovation, Metropolis is all set to provide accessible, affordable and reliable diagnostic services to the Indian population. “Our business model has
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gradually put a strong foot towards market consolidation. This is an effort through which we have ensured that our quality and technology strengths reach more places,” says Ms Shah. Excerpts from an interview. What are the initiatives taken by Metropolis Healthcare in order to provide affordable diagnostic services to the public in India? Providing affordable diagnostics in India is unlike any other healthcare service in the country. The first challenge comes from the lack of an industry level recognition for pathology services. The second big challenge is the lack of financing mechanism to support coverage for quality diagnostics. In the wake of these two major challenges, diagnostics primarily and almost completely relies on market competition for price control. However, diagnostic majors like Metropolis has a huge potential in ensuring better access to affordable diagnostics. This capability emanates from the very business model we follow, which supports volume based testing further made efficient through the use of technology. Metropolis healthcare has based its philosophy on technological and market innovations. From the techno-
logical perspective, lab automation helps us keep the operational costs in check. Technology ensures minimal wastage of reagents and quality assured means for optimal testing. From the market innovation perspective, Metropolis has brought in some remarkable innovations to the Indian market. Development of in-house logistics capability allows us to penetrate markets adjacent to any Metropolis facility across India, bringing in the strength of a “centralised-decentralised” processing units and reduction in capital expenditures. Another dimension of such a centralised-decentralised methodology of processing units comes from our growth and expansion strategy. This strategy is based on a mix of organic and inorganic based expansion projects. These expansion projects are based upon and influenced by the local pricing structures wherein our flexible model adapts to give a local pricing with centrally driven quality norms. Typically an expansion project of this nature goes through the initial phase of hand-shaking between the local lab management and the central team. It is consensus – driven process where Metropolis provides the quality edge to the local labs along with the technology capa-
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bilities. The local labs bring with them the experiences and market potential of the local markets. As the expansion project matures over a period of two to three years what we experience is the initial rising curve of increasing marginal returns. In a nutshell our every expansion project becomes an initiative towards cost optimisation ensuring financial accessibility to quality diagnostics. According to you, what are the major challenges faced by the Indian diagnostic industry? The major challenge of the Indian diagnostic industry comes from the fragmented nature of the market. A market that brings with it lack of standardization, poor awareness and sensitivity amongst the populace about quality. Market of this nature brings in an unhealthy price competition with quality compromised services and services which can be compared on the parameter of price alone. The challenge is complicated by the lack of compulsory legislations or guidelines which would ensure mandatory quality practices and set minimal standards for laboratory ownership and operations. In India, one would find many labs where there is no pathologist to authorise a report. The largest part of the Indian diagnostic market is populated with non-accredited labs following minimal to no quality practices. Since price is the only parameter which the Indian consumer is sensitive about, compromise in quality and lower prices becomes a strong reinforcement for these labs. This sets in a continuous vicious circle which quality diagnostic majors like Metropolis have to battle regularly. Since Metropolis’ DNA is based on quality, compromise in this factor is not the way for price control. Bringing home a laboratory is not an easy task. Please elaborate on your Lab@Home initiative. Bringing the lab to the doorstep of people was a daunting task. The biggest issue was that even if we make the efforts, whether we would be successful in the Indian COLOR DOPPLER | FEBRUARY, 2014
In India, one would find many labs where there is no pathologist to authorise a report. The largest part of the Indian diagnostic market is populated with non-accredited labs. market where awareness about pathology is low and myths about testing relatively high. Nonetheless we decided to go ahead, keeping in mind the comfort for the Indian consumers. The concept was mainly to provide services for the physically challenged and geriatric populace, who would find it difficult to come to our facilities. We were driven by the aspiration to make quality diagnostics available to them. Lab@home was a concept which gave us an opportunity to channelise our strengths in the direction of providing this ambitious service. Particularly for lab@home services we channelized our strengths in logistics to extend our quality services to the household level. We put together our existing strengths of quality practices like use of vaccutainers for blood collection, logistic services tailor made to provide quality controlled conduit of sample transfer to the facility, internet and mobile based reporting, central IT systems for data handling and management and a host of trained medical technicians. Then came the step of model innovations to diversify our logistics and technical team into going outside the lab for collecting samples. Our in-house customer service department came in handy to track leads, guide patients for sample collection, answer their queries and ensure report delivery through modern communication channels. In order to maintain ourselves locally competitive we extended this service to our patients at minimal or no extra costs. This became a big motivator for loyal customers to switch to a more comfortable service.
As time progressed, our service became popular amongst the existing customers and also gave us the potential to bring in newer customers. As a person heading a multi-national diagnostic chain operating in South Asia, Middle East and Africa, how do you differentiate each of these markets? A company who has been able to not only survive but also grow at a substantial rate in a fragmented market like India, the other markets have fewer surprises to offer. But no market is an easy market, and each of them does come with some unique set of challenges. If you consider the African and the Indian market, there are some striking similarities owing to the larger healthcare and political system. What came as a happy surprise in the African market was that unlike India, African countries do have some minimal standards to ensure quality lab practices. On the contrary, the biggest challenge in the African market was that of cultural differences and service acceptance by the local people by an Indian diagnostic major. If you see the market in the Middle East, similar to Africa they come with an inherent challenge of paucity of trained human resource. While African countries are resource constrained, this problem is relatively smaller in the middle-eastern markets. So if you see these markets from a common frame of accessibility to healthcare, they all pose their own problems. The African and the Indian markets pose a greater challenge of financial accessibility, while the Middle – Eastern markets pose this challenge from the service availability point of view in terms of availability of trained human resource. How do you review the regulatory framework for the diagnostic industry in India? The overall healthcare regulatory framework is far from perfect in India. In fact, the intense need for a regulatory framework has been recognised only in the recent years. The private sector of India, comprising 70 percent of the Indian
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But no market is an easy market and each of them does come with some unique set of challenges.
Healthcare system has contributed significantly in getting new knowledge and practices in India. This new knowledge and learning from the global community has significantly enriched the foundational understanding of an evolved regulatory framework. Although our constitution endears right to life and right to health, implementation of these principles needs well-defined regulatory framework safeguarding the rights of the Indian consumer. I have shed some light on the regulatory framework already. What I would further like to add is the need to bring in some basic minimal standards for lab operations, something on the lines of the Indian Public Health Standards. Please elaborate on your plans to establish Greenfield labs in tier II and tier III cities of India. This financial year we have target for deeper penetration into these markets. In this and previous financial years we have strengthened the infrastructure to set a footing for expansion. As this infrastructure has matured to take on deeper penetrations and service expansion we would extend their spokes and the logistic network to extend their services to the nearby geographies of tier 2 and 3. The awareness about preventive healthcare is increasing in the country. What are the initiatives taken by Metropolis in spreading awareness of preventive
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healthcare measures? Metropolis has designed consumer friendly preventive health packages and we have developed marketing plans which would make our consumers more informed about their health packages. The preventive health packages offer multiple choices and tests range which a consumer can pick and choose based on his/her healthcare needs and personal financial capabilities. In order to raise awareness, Metropolis has undertaken numerous camps in collaboration with corporates and cooperative housing societies based on basic health check – ups covering common non-communicable diseases. The disease segment target is primarily on chronic diseases, whose mainstay of good health outcomes lie on prevention at all levels, for all age groups and both genders. What are the new test facilities Metropolis is bringing in? Cytogenetic and its clinical utility have a huge growth potential for future. Cytogenetic also has an increasing application in therapies and treatments, especially in cancers. The science is also witnessing some revolutionary changes that could make this segment of diagnostic tests more cost effective and affordable for people. Similarly automation in histopathology is a promising avenue for growth, offering faster turnaround times for this speciality which was earlier dominated
by manual testing methods. The automation would not only ensure fasters TATs, but also more standardization in the lab processes for this pathology speciality. Metropolis has made significant strides in both these segments and being an early bird, we expect to reap benefits from the growth to be seen in this segment. The Indian healthcare market is one of the most dynamic and rapidly growing in the world. What are the potential areas to where Metropolis can expand its growth over the due course of time? Yes, the Indian healthcare market has gathered significant pace in recent years. Owing to the rising awareness and our commitment for better health for Indians, we have now expanded our business line in preventive and wellness market though our retail venture. The venture is set to provide easy to use and effective home based health solutions. What all major contributions can the Indian healthcare sector expect from Metropolis Healthcare in the coming years? Our commitment to quality diagnostics would be a persistent pursuit, where we intend to leverage our market leadership position to work with government and advocacy groups to bring in positive change for the industry. The Metropolis global expansion experience would also bring home numerous experiences which would help us further consolidate our leadership stance in attaining this objective. We have already made attempts in ensuring quality in TB diagnostics, and we would continue participating in issues of greater public health importance. Our business model innovation has gradually put a strong foot towards market consolidation. This is an effort through which we have ensured that our quality and technology strengths reach more places. The Metropolis expansion project has had multiple positive macroeconomic externalities and with our positive experience we would continue being on the path. COLOR DOPPLER | FEBRUARY, 2014
[ view point ]
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Intelligent. Innovative. Intuitive.
hey say, “If you want something better than what you have, you will need to do something different than what you have been doing”. As Einstein said, “Insanity is doing the same thing over and over again and expecting different results.” So what are you doing in the field of Radiology? Are you doing something different or doing what you did decades ago? With the ubiquitous internet and fast changing information technologies, there are so many new options today, which seemed like a distant dream many years ago. Today, a doctor can sit in front of his or her computer and diagnose a patient thousands of miles away and have an interactive conversation. A radiologist with specialization in the brain area can look at the studies from a CT and dictate a report sitting in the comfort of his home or hotel again thousands of miles away from the hospital. After the first round of telemedicine ‘boxing’ in the ring, where technology is announced as the winner comes the second round! How cost effective is this technology and what is the Return on Investment (ROI) for a hospital or imaging center or a small clinic? Since the workflows in the segments mentioned above vary and also expenses are different depending on the scale of operations, there is no one simple answer to the ROI question. However it has been proved, that intelligent workflow solutions in the field of teleradiology does contribute to a signifi-
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Intelligent workflow solutions in the field of teleradiology do contribute to a significant improvement in the bottom line of the Healthcare enterprise, writes Ricky Bedi, CEO, Telerad Tech Pvt. Ltd. A key advantage in the work flow feature is the patient portal which facilitate a highly secured, confidential access for the patient to download the complete report cant improvement in the bottom line of the healthcare enterprise. The efficiencies and productivities are seen at various stages in the radiology workflow. RADSpa from Telerad Tech with its ability to adopt multi-workflow character depending on the culture, tradition , local laws, etc. is just not only a technology it is also about business models that can be created effectively. Cloud based RADSpa is a win-win for both the service provider and the user who could be a radiologist, physician, PACS administrator or even a patient. RADSpa is one of the few workflow product, which brings all the stakeholders in one portal. The stakeholders can access the platform from anywhere, anytime. Right at the very beginning where the studies are routed through a DICOM routers, one can start seeing improvements. There are intelligent DICOM routers, which can transmit large images like multislice CT or Mammography at a much faster speed due to the use of intelligent algorithms. In addition, the channels of transmission can increase or decrease depending on the bandwidth. If
the internet stops working the router can remember where it stopped transmission and continue from where it left off. With the exponential increase of image sizes and volume, it is becoming more and more important to push studies to the server as quickly and as efficiently as possible. Once the studies hit the DICOM server intelligent radiology workflow rules determine which study gets assigned to which radiologist. The faster you do, the faster the radiologist can report and reduce the overall turn-around- time (TAT). There are systems out there with a host of intelligent workflow conditions like for example – arrival time of study, or institution name, or referring physician, or modality type, etc. The more the conditions and filtering options, the better is the flexibility to the administrator. Also once a study has been assigned to the radiologist it is important to govern the study around boundaries and parameters within which the radiologist has to report. All this has to be done by the system automatically and the manual intervention by the administrator has to be as little as possible. Many times, there are discrepancies between the number of images sent and received or images coming in without patient demographics or vice versa, and a fair amount of time is spent by the administrator and the radiologist to correct these. If the system is intelligent enough to make these corrections before the study is assigned to the radiologist, then the time saved is a precious saving indeed! A fair amount of time is spent by the radiologist in viewing images and dictating the report. There are many intelligent tools to help the radiologist finalize as many reports as possible in a given duration of time. Even simple tools like change of background colors on the screen, makes
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the visualization easier and completion of reports faster. Accessing priors on the report page, viewing patient demographics with an integrated RIS/PACS solution, are all beneficial features available today in some of the leading solutions. Sharing of images between the stakeholders of the workflow such as a referring physician or a transcriptionist helps in the collaboration and transforms the tedious workflow to the one of ease and comfort. Gone are the days when a radiologist had to receive films or CDs with images or courier reports or CDs back to the physician. Everything happens pretty much instantaneously and the patient is the one who benefits the most with a fast treatment plan. Another significant advance in the work flow feature is the patient portal which facilitate a highly secured, confidential access for the patient to download the complete report from anywhere, anytime. This benefits the patient to collaborate with the remote physicians or to refer the report for a second opinion to a radiologist. RADSpa is an excellent second opinion platform. The viewing stations can now be flexible
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Thanks to the rapidly growing information technology and intelligent workflow solutions, the practice of radiology is seeing a new lease of life with a potential to improve the bottom line and focus more on the business aspects of the workflow Ricky Bedi CEO, Telerad Tech Pvt. Ltd. www.telradsol.com and could be a Windows solution or a MAC platform with multiple monitors, different viewers and all these contribute
to improving the efficiency of the reading. Auto support features like voice recognition, electronic signature, sms alert mechanism, short forms, report templates, scheduling, medical dictionary, etc. builds additional intelligence into the system for an organized, streamlined and efficient work flow process for the centre to deliver quality reports with a minimum turnaround time (TAT). Last but not the least, cloud-based technology and intelligent data centers, which are replicated entirely in a different location thousands of miles away, have helped secure the data under all catastrophic conditions and helped the radiologist concentrate on the business of viewing and reading. Intelligent data collated from DICOM attributes of images and patient demographics have also fuelled the growth of business intelligence solutions which are now becoming a part and parcel of many advanced RIS/PACS systems. Thanks to the rapidly growing information technology and intelligent workflow solutions, the practice of radiology is seeing a new lease of life with a potential to improve the bottom line and focus more on the business aspects of the workflow.
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[ edu scan ]
Counselling in Multifetal Pregnancy Reduction Multiple Gestation
Multiple gestation, refers to a pregnancy in which two or more fetuses are present in the uterus. In general population, this occurs in approximately one to two percent of pregnancies.
Multiple Gestation
The use of fertility drugs for ovulation induction in infertility treatment and assisted reproductive technologies such as IUI and IVF causes significant increase in high order multiple pregnancies. Perinatal morbidity and mortality are directly proportional to the number of fetuses because of higher incidence of premature deliveries. Although earlier diagnosis increased antenatal surveillance and improved neonatal care have improved pregnancy outcome. However, the overall prognosis of multiple pregnancy is bad because of low birth weight and prematurity. Maternal morbidity and mortality are also increasing because of higher incidence of premature labor and premature delivery, pregnancy induced highpertension or pre-eclampsia, diabetes mellitus, vaginal/ uterine hemorrhage.
Dr Mukesh Garg Consultant Radiologist Indira Infertility & Test Tube Baby Centre, UDAIPUR
to increase the chance of healthy successful pregnancy by reducing of perinatal and maternal morbidity and mortality. Technique Transvaginal approach is used in early first trimester. Transabdominal approach is used in late first trimester (11 to 12 weeks). Advantages Early growth lags of any one fetus Spontaneous fetal loss in early pregnancy Exclude abnormal nuchal translucency Exclude major congenital malformation
Multifetal Pregnancy Reduction
IUI and IVF
Within the last few years, there has been a rise in multifetal pregnancies as a result of widespread use of infertility therapies such as ovulation-inducing drugs, in vitro fertilization, gamete intrafallopian transfer and zygote intrafallopian transfer. Multi-
IUI
Alpha survivor
Preoperative Ultrasound Number of fetuses Fetal viability Size Chorionicity Location or mapping of the embryos
Ultrasound transducer
Dead foetus Amniotic sac
Preoperative Ultrasound
Dead foetus
Triplet Pregnancy After MFPR
IVF
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fetal pregnancy reduction has become a realistic technique that reduces the fetuses in utero. Our goal of MFPR is
Placenta
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[ edu scan ] Transabdominal Approach
Among the various techniques proposed for multifetal reduction, transabdominal approach has been the most widely used. It is used in ultrasound guidance by using 20-22 G spinal needle for injecting 1-2 ml KCl in the heart of the most accessible fetus in all aseptic precaution. The remains of the fetus gradually degenerate and often undetectable at delivery. The technique is usually performed at ten to twelve weeks of pregnancy, when there occurs a chance of loss of the rest of the embryos.
Intracranial KCl injection
New technique - First reported case series (2009) Turkey Difficulty in reaching the thorax due to fetal position Fetal intracranial injection of KCl (23mls) Technically easier procedure than the intrathoracic approach Technique should be reserved for selected cases of MFPR by experienced operators In the study, Intracranial KCL Injection - An Alternative Method for Multifetal Pregnancy Reduction in the Early Second Trimester by Li R., Yang R., Chen X., Yang S., Ma C., Liu P. and Qiao J., they propose Intracranial KCl injection procedure as an effective and an easier procedure than intrathoracic KCL injection for multifetal pregnancy reduction (MFPR) between 12 and 18 weeks of gestation.
Pregnancy Outcome Statistics
Triple to twin reduction has shown better pregnancy outcome with premature birth before 32 weeks reduced to 10.1% from 20.3% and miscarriage before 24 weeks reduced to 5.6% from 11.5%.
Premature birth before 32 weeks Miscarriage before 24 weeks
Loss of twins after MFPR 10.1%
Loss of triplets (no MFPR) 20.3%
5.6%
11.5%
(Wimalasundera R, et al. (2003). Reducing the incidence of twins and triplets. Best Practice and Research Clinical Obstetrics and Gynaecology, 17(2): 309-329.)
Following MFPR
To a number of three embryos: 89% of patient will deliver before 37 weeks and 33% before 32 weeks. With a number of two embryos: 52% will deliver before 37 weeks and 13% before 32 weeks. With one embryo: 30% will deliver before 37 weeks and 10% before 32 weeks. (The Art and Science of Assisted Reproductive Technique: Chapter 72; Dr Ashok Khurana et al) This clearly shows that MFPR significantly decrease the risk of premature deliveries.
Disadvantages of MFPR
Entire pregnancy loss Following MFPR may result in spontaneous abortion of the entire pregnancy in 9-15% of the cases. This is usually seen from 4-8 weeks after the procedure. Most common causes of the loss of pregnancy includes PROM, contractions, chorioamnionitis and bleeding. Miscarriage rates can be decreased with the increasing experience of the operator.
Adequate Counselling
MFPR is an area of extreme stress and distress for the infertile patient who conceived after a long years of infertility with extensive treatment. It may be straight forward option for the fertile patient who already has one living child and for a primigravida with a spontaneous conception. Professional counselling is helpful for the couples considering MFPR . Both partners need to be comfortable with their decision and may need emotional support prior to and immediately following the procedure. Resources for providing such counseling include perinatologists, neonatologists, mental health professionals, child development specialists, support groups, and clinicians with expertise in multifetal pregnancy reduction.
Conclusion Multifetal reduction helps in reducing the number of fetuses, but does not eliminate the risk of prematurity in high order multi-fetal pregnancies. In many cases, a consultation to discuss the care of a multifetal pregnancy or the risks and benefits of reducing a multifetal pregnancy is warranted. Patient with four or more fetuses should be encouraged to have a MFPR. Patient with triplets should receive very extensive counseling to help them reach a decision.
Connecting Connecting users with manufacturers, sellers, service providers and more, Color Doppler launches India’s first medical imaging device consultancy service. Our well-trained, professional customer care team assists you with all your medical imaging device needs. When in doubt, dial+91 495 2378808/09
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[ eventful ]
Call for Better Imaging Rini Baby Thottil l cd news
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here is something truly fascinating about winter – it freezes our body with cold winds, yet creates the time of comfort, for the touch of friendly hand and for a talk besides the fire. This magical spirit of winter was reflected at 67th Annual Conference of Indian Radiological and Imaging Association. The Conference which was held at Hotel Jaypee Palace and Convention Centre, Agra, New Delhi from January 2326, 2014 brought together more than 2500 delegates including radiologists, students and medical imaging companies from across the country and abroad. Beyond a venue of knowledge sharing, it revived the bonds of relationships, spreading the waves of happiness across.
Fulfilling the theme ‘Better Imaging for Healthier Life’, IRIA 2014 underscored the need for the radiologists to stay alert and updated on recent advances in the field
Off to a Flying Start
The seamless days of infotainment began with the sound of applauses when a few of the medicos presented their award winning papers. The day continued to take beat with academic sessions and orations that focused on topics like radiology in day-today practice and its recent advancements. The much required topic ‘Law and Radiology Practice’ offered the physicians a thorough knowledge about the legal aspects of the profession. The exclusive ‘Dr S K Sharma Ultrasound Symposium’ that covered topics such as Artifacts in color Doppler, HRUS in Nonthyroidal Neck Masses, Role of color Doppler in Obstetrical Decision Making and Dynamics of Shoulder US was another attraction of the day. The image interpretation session added better insights on the topics. The day also marked the beginning of IRIA 2015 when DR Rajesh Kapur inaugurated the early bird registration of IRIA 2015. “The Kerala Chapter of IRIA 2015 is going to be an entirely different experience. God’s Own Country is having the privilege to host the event. I assure to leave you all with the best memories that you can ever have anywhere in India. We are expecting largest delegate participation COLOR DOPPLER | FEBRUARY, 2014
from across the country. Our ‘early bird registration’ is already getting overwhelming response,” said Dr Mohanan K, Organizing Chairman, IRIA 2015. “It is really applauding to see good number of registrations on the very first day at Agra. I welcome you all for IRIA 2015 to be held in Kochi, which is indeed going to be a wonderful experience with fantastic sightseeing in Kerala”, he added.
Merge of Industry and Research
To bridge the gap between the industry leaders and the researchers, medical imaging companies like Agfa, Fujifilm and Philips had their exclusive presentations on different imaging techniques. Chander Sekhar Sibal, Executive VP, FujiFilm Medical Division saw IRIA as an opportunity for the radiologists to witness the latest technologies in the industry. “My expectation, here at IRIA 2014 is to get more customers coming into our booth. I
want them witness the new technologies we are bringing into the industry. This time we are going to launch a new product called AMULET Innovality, a complete digital mammography product. We are expanding our services to the remote areas in India by preparing a team and putting them in the remotest of places for extending our services,” he said. BPL Medical Technologies Private Limited played their card by announcing their entry into radiology through a series of print ads published in the daily newsletter at the event. It was truly a perfect time and venue that enabled them to reach many at a time. Samsung expressed their pride and joy of introducing the 5D ultrasound technology in India through their cutting-edge ultrasound device UGEO WS80A. “We are very excited for being the first company to introduce the 5D ultrasound technology in India. A 3D LED display has been put up
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[ eventful ] with UGEO WS80A so as to offer people with a better 3D experience of the product. We are also delighted to showcase our latest DR system, XGEO GU60”, said Dinesh Lodha, Vice President and Business Head, HME Business, Samsung India Electronics. Fujifilm SonoSite stood proud with the newly launched X-Porte ultrasound system. “This is the world’s first ultrasound kiosk with Sonosite’s breakthrough, proprietary beem-forming technology XDI. We are quite upbeat with the response from the radiologists here”, shared Pavan Behl, Director and GM, India and Middle East, Fujifilm SonoSite India Pvt Ltd. Philips Healthcare was another company that presented new products to the delegates. Rajan Jayaraman, Business Manager, MRI Philips Healthcare shared the features of Multiva 1.5T MRI system. “It has new features when compared to old platform like 16 channel receive platform, 80MHz Direct Digital Sampling, 53cm homogeneous field-of-view, O coil handling, 16 factor SENSE acceleration, etc.” Barco is all set to win the market with their new strategies. “India is important to us. Our team in India comprises of 700 people and among them most of them are for healthcare. We make sure that we are in direct contact with the end users, hospitals, doctors, etc.,” shared Olivier Billiau, Sales Director Growth Markets EMEAI, Healthcare Division – Barco. For Mindray, it was time for to flaunt ‘iLive - For a revolutionary realistic view’. “IRIA is a great platform where we meet
so many esteemed doctors at one venue. Agra is an exciting destination for all of us. It is heartening to see the response at our booth. ‘iLive - For a revolutionary realistic view’ is getting a lot of attention,” said Ashwani Raina, Deputy Director, Ultrasound, Mindray India. The blissful day ended with the inaugural ceremony of the conference. The welcome address was delivered by Dr Bhupendra Ahuja, Organizing Chairman, IRIA 2014. Padmashree Dr Jagdish Prasad, Director General, Health Services was the Chief Guest of the function. The inaugural function also witnessed the induction of the President Elect of IRIA, Dr Bhavin Jankharia. The inaugural ceremony was followed by the inaugural dinner and an exciting entertainment night.
Great Show Continues
The second day of IRIA began with Sir J C Bose Oration, which was chaired by eminent personalities like Dr Bhavin Jankharia and Dr O P Bansal. Talks on abdominal ultrasound, Pulmonary, Cardiac, Neuro Imaging, Pelvic Imaging, Paediatric radiology, imaging in trauma and Dr Ashok Mukherjee awards enriched the day. Exclusive workshops on Abdominal color Doppler and MSK gave a practical outlook to the students gathered. Sessions on writing and reviewing radiology manuscript, critiquing radiology papers, statistics analysis and article writing proved beneficial to students who intended for research in future. The day three continued with talks and workshops on topics such as vascular imaging, peripheral vascular Doppler imaging, breast imaging, gynaecological ultrasound, organ transplant and many more. Irrespective of the time to bid adieu, day four continued with workshops from companies like Mindray and Philips. Talks from the doyens on imaging industry continued as well. Day four also witnessed free papers that provided insights into various topics.
Wrap Ups
On an overall note, the conference presented six academic sessions that depend on different modalities and fulfilled its mission of providing ‘Better Imaging for Healthier Life’. Dr Mohanan K, Organizing Chairman, IRIA 2015 saw the event
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[ eventful ] as a tough competition to IRIA 2015. “IRIA 2014 is an excellent hit. We had delegates from all over India. The most beautiful thing about Agra is the weather. IRIA Agra has given a tough challenge to IRIA Kochi. IRIA Kochi has to stand high in all sense and I am sure it is going to be the one.” The doyens of medical imaging industry were excited to see new ideas sprouting from youngsters. “IRIA 2014 has got wonderful scientific material coming up and the place has a value of its own. The weather has not been to our liking, but the scientific deliberations have been excellent. We expect more youngsters coming with new ideas in the future,” shared Dr Pragati Sinha, Asst. Editor, Indian Journal of Radiology and Imaging. The students, doctors and the company heads equally congratulated the organizers for success of the event. The most frequent comment emanated was “wellorganized”. Dr Asif Momin, National Faculty, IRIA 2014 and Dr Rajesh Kapur, Outgoing President, IRIA 2014 certified this fact. “It was wonderfully well organized and I am so impressed the way it has been handled under one roof. Lot of brilliant international faculties came here and the workshops were excellent. So, overall it has been a good experience”, said Dr Asif Momin. “IRIA 2014 is a very well organized conference from every aspect. As the outgoing president of IRIA, I am wrapping up with nostalgic memories I have and
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Hats Off Prabandhan! ‘Success has a simple formula: Do your best and people will like it’– IRIA 2014 was an archetype of this motto both by its vision and mission. When the curtain fell on this radiological extravaganza, it is impossible to bid adieu without expressing gratitude to Prabandhan Management Services Private Limited. This event planning and management services company hosted IRIA 2014 to this grand success and made the memories precious to cherish for rest of the lives. The quote mentioned above is essentially the commitment of Prabandhan and Mr Rajesh Surana, Managing Director vows that this will always be the foundation of the company. Mr Rajesh Surana is the Conference Coordinator of IRIA 2014 and he appreciated the rising technological tastes among the physicians. “All doctors are very cooperative, they are very friendly with us and they enjoyed each and every service. They were very excited about our IT services like instant messaging and question sessions which we made with the help of a software”, he said. “As an event manager, it is an exciting job. For the last five days, our entire team of 150 is working day and night. There was a great challenge from nature as the weather was not so good. But, finally we met the challenges”, he concluded.
very happy to have done what I did, and I am sure the good work continues,” shared Dr Rajesh Kapur. Dr Bhavin Jankharia, President Elect, IRIA had his word on the expectations about IRIA 2015. He believes the place of conference too played a role in attracting delegates to the conference. “The event has gone really well. Eve-
ryone had a lot of fun. Kochi is going to be a different venue. The place attracts different crowd and we believe that Kochi will be even more successful comparable to Agra conference,” he said. As the crowd applauds the organizers, there is one man who has to be congratulated. Mr Rajesh Surana, Managing Director, Prabhandan Management Services Private Limited. This event planning and management services company hosted IRIA 2014 to this grand success and made the memories precious to cherish for rest of the lives. The word of appreciations never ended. “IRIA 2014 is brilliantly fantastic. I really enjoyed. Particularly, the organization was very good. They have done an applauding job. Very good hospitality. Talking about the scientific sessions, they were wonderful,” Dr N Chidambaranathan, Past Chairman, ICRI. “This is a well-organized conference. Facilities are excellent and venue is superb too. Things have been really improving since my terms as IRIA chief. I believe Kochi IRIA is going to be another successful conference in the history of IRIA”, opined Dr G R Jankharia, National Faculty, IRIA 2014.
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[ eventful ]
Allengers: A Head Turner at IRIA 2014 During IRIA 2014 Allengers has shown their edges towards a bright future with multiple launches in the field of radiology. They have launched ‘DigiX eco’, an eco-model of their fixed Digital Radiography system and also a light weight mobile DR system, RollX DR. Allengers has embarked upon a mission to provide cost-effective imaging solutions such as Allen PACS, the Filmless Radiology Solution with cost effective solution, thereby enabling healthcare centers to adopt them at very reasonable prices. They have also successfully forayed into the segment of manufacturing a range of digital radiography systems such as DR system with Auto-tracking, DR system with U-Arm Stand, Mobile DR system, which has been the most sought-after system. Nine of such systems have been successfully installed at PGIMER, Chandigarh in their trauma and advanced pediatric departments. The advantages of DR far outweigh all other imaging modalities. The future of radiography will be digital and Allengers, an Indian MNC, which has been revolutionizing the medical world since past 26 years with its wide diagnostic range of medical equipments, is
further striding fast to make its mark in the digitalized technology based medical equipments. The other advantages like higher patient throughput, increased dose efficiency and greater dynamic range of digital detectors make DR the most sought-after technology. The new launches by Allengers during IRIA 2014 got very overwelhiming reviews from the radiologists. Most of the specialists expressed that models of DR systems had a space saving design which would be very crucial in the days to come. These systems are assisted by integrated workstations. The enquiries by delegates regarding the purchasing process of these was also seen as a major contributing factor towards what Allengers stands for today in terms of its reputation world-wide. A healthy relationship between Allengers and its customers was very obvious from the feedbacks received by them from various users. Allengers has proved its mettle as a very successful organization by catering to the needs of its customers. To have everything under one roof is really an advantage in today’s scenario as then the user does have all services from a single source and that is what Allengers means to its customers.
Picture Perfect
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[ eventful ]
Listening to the Good Hearts The 3rd National Conference on Echo Doppler Evaluation Techniques, CEDET 2014, addressed various concerns in clinical Echocardiography and discussed the commonly encountered problems in valvular heart diseases, acyanotic and cyanotic congenital heart diseases, cardiomyopathies and pericardial diseases in-depth
Ria Lakshman V l cd news
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he 3rd National Conference on Echo Doppler Evaluation Techniques at Kerala Institute of Medical Sciences (KIMS), Trivandrum popularly known as ‘CEDET 2014’ was an occasion where a group of doctors shared their exquisite pleasure of bringing back innocent lives from the brinks of death. It was a platform where they shared the most tactful techniques to ease the sufferings of innocent hearts to the emerging physicians. The two day conference that held on January 11 and 12, 2014 at Osler Hall, KIMS North was conducted by KIMS Society for Continuing Medical Education and Research (KIMS - SOCOMER), in association with Indian Academy of Echocardiography (IAE) and Indian Association of Clinical Cardiologists (IACC). By spreading the theme ‘Echocardiography for the Practicing Physicians’, the conference attracted a bountiful audience of around 94 medicos. The acclaimed healthcare professional, entrepreneur and strategist Dr M I Sahadulla, who is also the Chairman and Managing Director of KIMS Group lighted the lamp for the event. Being a man who has envisioned new age healthcare to millions and thus, setting standards for generations ahead with his unparalleled experience, he highlighted the necessity to save lives through improved quality healthcare at affordable costs. Major dignitaries, includ-
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ing Dr G Vijayaraghavan, Vice Chairman and Founder Director, KIMS; Dr Rakesh Gupta, Dr K Suresh, Dr Ramesh Natarajan, Dr Satish Govind, Dr S K Parashar, and Dr Sameer Srivastava were present on the dais. The conference featured talks on basic and advanced echocardiographic and Doppler techniques. The event addressed various concerns in clinical Echocardiography and discussed the commonly encountered problems in valvular heart diseases,
acyanotic and cyanotic congenital heart diseases, cardiomyopathies and pericardial diseases in-depth. The featured Echo demonstrations educated the physicians on the practical aspects.
Bridging Gap
The presence of healthcare companies such as Eris Lifesciences, Sanofi, GE Healthcare and USV further reinforced the industrial need for transformational medical technologies and services. To end the day with colors, a gala dinner was organCOLOR DOPPLER | FEBRUARY, 2014
ized for the delegates and faculty members at Hotel Udaya Samudra, Kovalam, Kerala. Every successful event has a saga of crossing hurdles and CEDET 2014 was no different. Dr G Vijayaraghavan, Vice Chairman and Founder Director, KIMS shared us the obstacle in spotting the latest in a vast topic like Echocardiography. “The preparations started from the month of August. Identifying the latest in Echocardiography was the biggest challenge that we faced, and later, identifying the best speakers for the current topics. However, in a month we were able to finalize the speakers and their topics. Invitations were sent to almost 3000 + physicians and cardiologists across India. Cases for demonstration was made available by the doctors in KIMS.” “Every year we have been different. Newer and latest topics are being discussed and presented. This time we were able to incorporate more demonstrations and forums for discussions. We are glad to have more young doctors attending the conference”, he expressed his joy. Delegates too found the event informative and beneficial for the budding cardiologists. “The variety in topics was the most appreciable aspect of CEDET 2014. Many regular clinical aspects were discussed in detail. This is quite helpful for the budding cardiologists,” said Dr Shailendra Dixit, G Kuppuswamy Memorial Hospital, Coimbatore, Tamil Nadu.
“It was the faculty who made the mark”, opined Dr Anand Arumugam, Lister Hospitals, Nagercoil. “The array of faculty were really great. The live demonstrations added up to the theory discussions. I am looking forward for CEDET 2015 with much anticipation,” he concluded. CEDET 2014 was not just another conference, rather it was a reflection of how truly a conference can well focus into the much needed aspects of healthcare.
The presence of healthcare companies such as Eris Lifesciences, Sanofi, GE Healthcare and USV further reinforced the industrial need for transformational medical technologies and services.
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[ event preview ]
Emergency Care to Emergency Care! International Summit on Emergency Medicine and Trauma 2014, to be held from February 14 to 16 at JIPMER, Pondicherry, aims at building a strong base in new specialty of Emergency Medicine by bringing global leaders and their expertise to the prestigious autonomous institution of JIPMER
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he objective behind forming the International Summit on Emergency Medicine and Trauma 2014, to be held from February 14 to 16 at JIPMER, Pondicherry— is to initiate the building of a strong base in new specialty of Emergency Medicine by bringing global leaders and their expertise to the prestigious autonomous institution of
so far with more than 120 faculty travelling to Pondicherry over the conference week. There are 60 different lecture sessions, 10 hands-on workshops and world class musicians for entertainment. To top it all, we have the Union Health Secretary delivering the keynote address, and none other than the Lt Governor of Pondicherry hosting the guests. I believe ISEMT 2014 is going to be a great opportunity for
we found experienced partners to help us with organization and publicity.” ISEMT was on track to be a huge success.
Hurdles and Challenges
While India is developing and advancing
JIPMER is proud to host International Summit as a part of its year-long Golden Jubilee Celebrations
Dr T S Ravikumar JIPMER. This summit would create opportunities for experts from JIPMER and government organisations to sit across the table to work-out on plan for the specialty implementation phase of Emergency Medicine. Now, there are just a few days to go and the challenge is to meet all the expectations. Dr Nanda Kishore Maroju, one of the Organizing Secretaries of ISEMT 2014 shares the challenges, plans they set for the success of the conference and how far they have reached. “The challenge lay in the scale of the conference, the scope of the conference and the short timeframe they have. ISEMT 2014 is planned to be a conference with 100 faculty and 1000 delegates. We have crossed 700 delegates
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everyone.”
Moments from the Journey
Dr Nanda also shared a few moments throughout this journey: The members of the committee met every week over the last five months, on skype, on conference calls, in person (taking out time at other conference venues), across odd time zones, from all corners of the world. The strength of the team is its ability to divide the work and reach targets with a sense of collegiality. In the words of Dr Nanda, “As we worked on the strategies to increase participation in a country saturated with conferences, we realized how unique our conference was. We had a strong team of organizers, a bonanza of global leaders of Emergency Medicine as speakers and
Organizing Chairman, ISEMT 2014
There are only less than 500 emergency physicians to serve more than 1.2b people in India.
Dr Pankaj Arora International Organizing Secretary, ISEMT2014
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[ event preview ] in many sectors every day, it still lacks the basic emergency medical and trauma care in most hospitals. Most of the Indian hospitals do not have the ability to provide emergency care services to the patients. This is the sad story of the world’s second most populous country. JIPMER waited for five long years to introduce their Emergency Medicine Residency Programme. While the awareness of the need developed, also the need for strong leadership, capacity building, curriculum development, involvement of other specialities became clear for the implementation of Emergency Medicine as a speciality. How to develop faculty to teach this new speciality to the residents in a country that had a few trained emergency practitioners is not very clear. The American Academy of Emergency Medicine in India and the Global Academy of Emergency Medicine presented a ray of sunshine to turn these possibilities into realities. AAEMI and GAEM partnered with JIPMER to initiate the mission of faculty building in Emergency Medicine.
I believe ISEMT 2014 is going to be a great opportunity for everyone
Dr Nanda Kishore Maroju Organizing Secretary, ISEMT 2014
The target is to mould well trained Emergency Physicians
Life Saving Mission
Dr Anita Bhavnani , the President of Global Academy of Emergency Medicine and also the International Organizing Secretary of ISEMT 2014 is happy to see the strides of progress that are happening in the field of Emergency Medicine in India. The fact remains that we need more emergency departments in India, more emergency physicians, and more training programs. “When we started the mission, the target was not just to set-up emergency departments all over Indian hospitals, but also to have well-trained emergency physicians manning them. The prerequisite for that is to have strong Emergency Medicine residency programs with emergency medicine faculty to train those doctors. The vision culminated in the idea of starting residency training programmes, initially collaborating with experts around the world to develop a quality faculty. Each GAEM physician is a volunteer. They give up their time and their salaries in their countries, spending their own money to come to India in the spirit of giving back to their motherland and improving Emergency Medical care for their families in India. They bring with them, their expertise and experience and they share the processes that have proven to be successCOLOR DOPPLER | FEBRUARY, 2014
Dr Anita Bhavnani International Organizing Secretary, ISEMT 2014 ful in their residency programs in the US. The Indian residency program benefits hugely from the experience of many different institutions. With the standardization of academic and clinical practices taught in the residency programs, staffing all of India’s Emergency departments with well EM trained physicians will begin.” “In addition to creating more emergencytrained physicians, we must engage our government and medical societies as well as educating our communities about the resource and benefits that an Emergency Department provides. ISEMT will be a good example of how we have taken steps to achieve our target.”
Serving Swades
Dr T S Ravikumar, Director and Senior Professor of Surgical Oncology at JIPMER and also the Organising Chairman of ISEMT 2014 gave up handsome job offers in United States and came back to India, to serve his alma mater. Some
people are born to bring change in the society; Dr Ravikumar is one of them. The core committee of ISEMT 2014 is led by Dr T S Ravikumar. He has representatives from AAEMI, GAEM and JAANA across the world: the east and west coasts of the US, Australia, UK and of course JIPMER, Pondicherry. He brought everyone together on one platform to initiate the change in our thinking and develop Emergency Medicine in our hospitals. Emergency medicine as a specialty in India is at a nascent stage with very few academic programs dedicated to training and capacity building. There is, however, an incredible amount of awareness at the highest levels of the government, the medical fraternity as well as the general public of its overarching importance.
Turning Point
Dr Pankaj Arora, President of American Academy of Emergency for India and also the International Organizing Secretary of ISEMT2014 wishes to see more local people get involved in the wave of Emergency Medicine. “Through this conference, our goal is to make people understand the importance of Emergency Medicine and how this international collaboration can help more than billion lives in India. “One of the activities that our global academy does is that it brings together educated emergency physicians from around the world for a common goal to help pass on their knowledge to emergency medicine trainees who will in turn become trainers of emergency medicine and propagate the education. There are only around 500 emergency physicians in the country to cater to the needs for more than 1.2 billion population. The current need is more than 8000. The Golden Jubilee year also marks the beginning of the Emergency Medicine residency training program at JIPMER. “The first season of program will commence in the month of April 2014. This is the perfect time to support JIPMER with our international collaboration and we are honoured to be a part of the exciting progress,” added Dr Arora. The main entertainment attraction of the event is going to be the musical night with Sangeet Samrat Chitravina Sri N Ravikiran. Do not forget to take this musical shower on the evening of February 15.
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