November, 2013
Rs. 100
Interview: Pavan Behl | p17
Positive Intervention: Focus: Scope of Interventional Radiology
Director and General Manager, India & Middle East, Fujifilm SonoSite India, elaborates on the future of POC ultrasound
Vol 2, Issue 11, Pages 44
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India's First Complete Medical Imaging Magazine
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inside scan
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p14 | under the scanner
The Positive Intervention The IR procedures have set a mark in the modern diagnostic and treatment techniques, by providing faster and accurate diagnosis, greater image quality and bringing down the need for additional tests, writes Rini Baby Thottil. The increased use of digital technology has enhanced the efficiency of the procedures by providing faster and more accurate diagnosis. Besides, the evolution of techniques such as 3-D reconstruction provides a better understanding of the human body
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p17 | wordsworth
Leading from the Front SonoSite has been witnessing significant growth while earning worldwide recognition for its progressive product line, educational programs, and advocacy for a broader understanding of ultrasound’s multiple benefits, says Mr Pavan Behl, Director and General Manager, India & Middle East, Fujifilm SonoSite India Pvt. Ltd.
p19 | special report
The Pink Saga October was the month of breast cancer awareness. Pink decorated the buildings, websites and hoardings around, to spread one message to the women across the country— do breast screening at regular intervals. Here goes a report on how medical device companies celebrated the occasion
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p21 | nobel prize
Biological Cargo is No More a Mystery! James E Rothman, Randy W Schekman and Thomas C Sudhof has been awarded the Nobel Prize in Medicine for the year for scheming the mystery of transportation of vital materials among cells
p38 | eventful
Journal of IFUMB Returns On October 25, Indian Federation of Ultrasound in Medicine and Biology, under the leadership of Dr Chander Lulla, relaunched its Journal at USCON XXII in collaboration with Color Doppler Media, the creative partner of the association. The digital version of the journal was also launched during the event
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Columns news scan event scan featured product new product scan
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COLOR DOPPLER | November, 2013 Volume 2 | Issue 11 KERENG/2012/41766 editor-in-chief Joby Joseph joby@colordopplermedia.com publisher Niranjan Kumar K R M niranjan@indiaultrasound.com design editor Gireesh gireesh@colordopplermedia.com chief coordinator Saraswathy M saraswathy@colordopplermedia.com
editor's note Enjoying the Silent Spring! There are occasions when silence is worth a thousand words. And, working with IFUMB to give rebirth to its journal was one such moment. Moreover, it was a month of academic sharing. I always prefer to be silent when there are sweeter, deeper and sharper voices all around. For me, it is a silent spring — the spring of academic sharing and growing. IFUMB journal is available on www.ifumb.in. Read and Respond. Till then, happy reading.
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
Joby Joseph Editor-in-chief Follow me on twitter @editorjoby
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 manager, accounts Hariharan V V assistant, accounts Shahana P shahana@colordoppleronline.com
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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news scan GE Introduces Silent Scan Technology
Here is a perfect solution to the excessive acoustic noise generated during an MR scan. GE Healthcare, one of the global leaders of medical technologies and services introduced Silent Scan, a revolutionary technology designed to reduce MR scanner noise to the background sound levels. As the noise can create anxiety in patients, especially in elderly, pediatric and claustrophobic patients, this technology heavily helps to improve the patient’s MR scan experience. “Silent Scan is a huge breakthrough for the MR industry and for patients around the world,” says Dr. Richard Hausmann, President and CEO, GE Healthcare, MR. “Excessive acoustic noise is a major cause of patient discomfort during MR scans and GE is addressing that with Silent
A Step Towards Healthier India GE Healthcare started a first of its kind healthcare technology experimental lounge on wheels, ‘Mission Healthier India’. The mission is to introduce high-end-technology to hospitals, nursing homes and medical clinics at their doorsteps and to create awareness on the usage of technology in early detection of diseases. This is an experimental and educational lounge with 20 low cost GE innovations on board. It will offer clinicians a hands-on experience which caters to women, mother and infant care, cardiac disease and critical care. Dr. APJ Abdul Kalam flagged off the healthcare vehicle in the presence of senior leadership from GE comprising Banmali Agarwala, President and CEO, GE South Asia; Tom Gentile, President and CEO, GE Healthcare Systems and Terri Bresenham, President and CEO, GE Healthcare South Asia. GE is looking forward with its six new experiential vehicles to reach 200, 000 clinicians across the country. The technologies consists of ultrasound imaging systems for diagnosing baby and expectant mother’s health, infant care technologies like Embrace for providing mother’s womb like warmth, Lullaby LED Phototherapy system, MAC series of portable, battery operated ECG systems for early detection of cardiac diseases and critical care tools required for monitoring and supporting critically ill patients.
Scan, a new MR advanced application and a major innovation in the healthcare industry. GE is very serious about Humanizing MR and making its MR systems patient-friendly, safe, and without compromise. We have over 200 engineers and scientists in India dedicated for developing MR technologies, both software and hardware. Working together with our engineering team in USA, we have developed this new, novel approach of reducing the noise of MRI from a hammering sound to a mere whisper, ” added Dr. Karthik Kuppusamy, Director, MRI, GE Healthcare South Asia. “Over 50 percent of all software for GE Healthcare equipment from around the world is developed in India,” he shared.
Global DR Market to Cross $13 Billion by 2018 In a recent published report by Transparency Market Research, it is expected that the global digital radiology market is going to hit over $ 13 billion by the year 2018. Predictions are the market which was estimated at $9.7 billion in 2012 will grow by 5.4 percent, hitting $13.3 billion in 2018. The research was specially designed to estimate and analyse the demand and per-
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formance of digital radiology products in the global scenario. This report covers all the major product segments of the global digital radiology market and provides in-depth analysis, historical data and statistically refined forecast for the segments covered. In terms of total volume, the global digital radiology market is expected to reach 158.2 thousand units by 2018. A concern about archiving, storing and
retrieving conventional film images has helped to drive adoption of digital imaging. The strong market competition is driving down prices, making digital radiology devices more affordable. Whereas, it’s increasing presence in application areas are increasing market adoption as well. The report says, the average cost of a device is $50,000, limiting adoption by small clinics and outpatient diagnostic centers.
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news scan Workshop on Bio-Medical Ultrasound Held
National Institute of Electronics and Information Technology (NIELIT), Calicut organized a workshop on ‘Bio-Medical Ultrasound’ in collaboration with Niran-
jan Ultrasound India Private Limited (NUIPL) and IEEE Malabar Sub-section at the NIELIT Calicut campus on October 5.
The workshop covered several topics such as Biomedical USG Fundamentals and USG Scanner Machine Familiarization, providing the students a hands-on experience with USG scanner. The workshop, which was held till 5pm in the evening, was inaugurated by Mr Sasi P M, Associate Director, C-DAC, Thiruvananthapuram. The workshop began with a welcome note by Mr K S Lalmohan, Head, VLSI Design Group, NIELIT, and followed with a keynote speech by Mr Niranjan Kumar, Managing Director, NUIPL. After the felicitation by Dr Abraham T Mathew, Chair, IEEE MSS/NK, the workshop continued its academic sessions guided by radiologists and technicians.
Second Edition of e-Radiograph Launched The first edition of Carestream Health’s e-Radiograph received an awe-inspiring response and now the second edition of this bi-yearly scientific e-book is out. This edition offers an absolute diverse outlook on different topic. The spotlight of eRadiograph is on another critical imaging topic, ‘Imaging of Degenerative Diseases of Lumbosacral Spine’. Dr. Rammohan Vadapalli, one of the renowned radiologists carefully evaluated and researched on the content of this edition. The agenda of this e-book is to enhance the skills of the entire spine enthusiasts. This e-book is an initiative under the Car-
estream’s Radiology Education Services (CRES) in India. It provides a good platform to the radiologists for sharing the best medical imaging practices. It is a reader friendly educational tool that can be easily accessed by busy medical imaging professionals from any nook and corner of the world. The process of accessing this e-book is also very simple. Just log on to www.carestream.in/eradiograph and register yourself to get the easy access of the current and subsequent issues free of cost.
DRX 2530C Now Available Across the Globe CARESTREAM DRX 2530C, the wireless small-format of digital radiography detector has started its shipping to healthcare suppliers across the world. This unique detector offers wide range of high quality, low dose X-rays exams for pediatric, orthopedic and general radiology applications. FDA approved this Carestream Health’s product several months ago. The latest cesium iodide detector’s smaller size (25 cm x 30 am) and high DQE (detective quantum efficiency) can boost up care for premature babies and infants in the pediatric ICU. It can also offer lower dose than computed radiography cassettes or gadolinium scintillator detectors. COLOR DOPPLER | NOVEMBER, 2013
There is a strong belief that this detector could enhance care by increasing the excellence of X-ray images captured of premature babies in its 50-bed neonatal ICU. DRX 2530C detector fits into a tray positioned underneath an incubator, so it allows technologists to get X-ray images to monitor the condition of ill or premature babies without moving them. It is also ideal for tabletop exams such as knee, elbow, skull and other exams that may require a patient to hold the detector or require a smaller field of view. Monash Health in Australia was the first site to receive Carestream’s DRX 2530C
wireless detector. The worldwide demand for this system is growing strong due to the flexibility of the DRX platform. Extra detector benefits: •It is a wireless performance, to eliminate the hassles and hazards of cables and reduce the risk of infection. •The fast performance and instant access to images. •The ergonomically designed handle for fast and safe positioning. •Its compatible with the DRX-1 Detector battery charger. •Fits into the DRX-Revolution small format detector holder.
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event scan Lucknow Ultrasound Course 2013 November 9-10, 2013
Color Doppler is the official media partner at EMCON, the Annual meet of Society for Emergency Medicine in India, Ultrafest 2014 and INSOUG 2014
Lucknow: Lucknow Ultrasound Course 2013 will be held on November 9th and 10th at Hotel Clarks Avadh, Lucknow. The theme of the course in obstetric is ‘Sick Fetus.’ Prof. Simon Ostlere of Oxford University Hospital, Oxford, UK is the star international faculty of the course on MSK ultrasound. For more details, log on to www.yashdeepultrasound.in
15th Annual Meet of Society for Emergency Medicine, India November 16-20, 2013
Kozhikode: EMCON 2013, the 15th Annual Conference of SEMI (Society for
Emergency Medicine in India), will be held in Kozhikode, Kerala at the Vythiri Village from November 16-20, 2013. EMCON 2013 aims to bring together national and international personalities from around the globe, the true leaders in the field, whose passion and fervor drive the development of emergency medicine, the fastest growing speciality of medicine in the world. Emergency physicians, residents, paramedics as well as physicians and surgeons from all walks of medicine will be enriched by the scientific workshops, plenary sessions, and resident-to-resident discussions. For details, log on to www.emcon2013.com
International Telemedicine Conference, Jaipur November 29 - December 1, 2013
Jaipur: The 9th International Conference of Telemedicine of Telemedicine Society of India will be held from November 29 to December 1 at the Mahatma Gandhi University of Medical Sciences and Technology in Jaipur. Telemedicon offers a boosting energy into the existing telemedicine system for improvement in the access remote areas like villages and hard core terrains, where access to basic healthcare is of primary concern. For details, log on to www.telemedicon13.com
Ultrafest 2014 to be Held in Mumbai April 18-20, 2014
Mumbai: Ultrafest 2014 will be held at The Renaissance, Powai, Mumbai from April 18-20, 2014. The focus of the 6th edition of Ultrafest will be on Emergency Ultrasound. Many acclaimed speakers from India and abroad will enlighten the gathering on a wide array of topics such as Emergency Ultrasound Infertility, Gynaecological and Fetal Ultrasound. For details, log on to www.msbiria.org
INSUOG 2014 to be Held in Mumbai May 2-4, 2014
Mumbai: An advanced course in OBGYN Ultrasound, INSUOG 2014 will be held at Hotel Taj Mahal Palace, Mumbai from May 2-4, 2014. The course will be conducted by the current international and national experts of OBGYN USG. The course will be an add on to radiologists, sonologists, OBGYN specialists and Fetal medicine specialists who are interested in acquiring cutting-edge skills in OBGYN Ultrasound techniques. For details, log on to www.insuog.com
67th Annual Conference of IRIA January 23-26, 2014
Are you organizing an event? Inform us, we will give you much-needed publicity. For details: info@colordoppleronline.com
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Agra: The 67th Annual Conference of Indian Radiological and Imaging Associatoion will be held in Agra, from 23rd to 26th January, 2014. The venue of the congress is at Hotel Jaypee Palace and Convention Center, Agra. Scientific discussions, where well-known luminaries in the various sub-specialities of Radiology, from India and abroad will enlighten the gathering with their dedicated work and vast experience. For details, log on to www.iria2014agra.com
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new product scan
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Compact and Powerful:
UGEO PT60A
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amsung recently launched UGEO PT60A, its first diagnostic ultrasound device for the point-of-care market. A winner of iF Design Award 2013, the new tablet-based ultrasound device allows doctors to perform medical diagnoses very closer to the patient care site. A compact and powerful device, UGEO PT60A is a combination of highly competent ultrasound functions. The device comes with many features such as NeedleMate and Auto IMT. NeedleMate enables the identification of the real-time location of the injected needle. This feature ensures accuracy and safety throughout surgical operations such as anesthesia and nerve block. This, indeed, will increase the clinician confidence and enables an improved patient experience. The Auto IMT feature automatically measures the thickness of the common carotid artery and its fast imaging capability allows the quick diagnosis of the chances of stroke and cardiac disorder. The UGEO PT60A also comes with SDMR technology that provides sharp image quality with almost no noise. It offers outstanding contrast resolution along with improved edge definiCOLOR DOPPLER | NOVEMBER, 2013
tion for unrivaled image quality. Another feature, Spatial Compounding Image (SCI) provides better spatial and contrast resolution. It delivers significantly enhanced definition in soft tissue planes and ensures fast diagnosis with higher levels of accurateness even in technically difficult patients. The advanced image processing technology reduces unwanted noise and offers a high-quality display that ensures clarity of images captured. The UGEO PT60A is also equipped with highly durable touchscreen and supports multi-touch with quick reaction time. It can be operated with gloves as well. The touch-screen helps in improving work efficiency for ICU, operating theaters, ambulances and emergency departments. Besides these features, the device offers a tilting monitor, a printer, three probe ports and an adjustable probe holder table. With its high-end performance, slim and compact user-friendly design, the UGEO PT60A is designed and developed to gratify all point-of-care functions.
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under the scanner
The Positive Intervention The Interventional Radiology procedures have set a mark in the modern diagnostic and treatment techniques, by providing faster and accurate diagnosis, greater image quality and bringing down the need for additional tests Rini Baby Thottil l cd news
Interventional Radiology Interventional Radiology (IR) consists of a broad spectrum of procedures to diagnose and treat diseases such as cancers and tumours, blockages in arteries and veins, fibroids, gall stones and gall bladder problems, and thyroid disorders. The procedures help doctors to directly look into any part of the body instead of having to directly look inside the body of a patient through a scope or a surgery. The procedures often involve no or a small incision on skin and the doctor diagnosis the condition by inserting catheters, wires and other small tools into the body.
“The angiographic catheter can be more than a tool for passive means for diagnostic observation; used with imagination, it can become an important surgical instrument.”
T
he speaker’s words echoed at the Czechoslovak Radiological Congress in Karlovy Vary on June 19, 1963. The words won the speaker, Charles Theodore Dotter, a standing applause from more than 300 attendees at the congress. What would have happened if Dotter was never born? What would have happened if he hasn’t revealed his findings on cardiac catheterization and angiographic techniques of the future? The world would have witnessed the increase in number of people undergoing open surgeries. Those with heart diseases, osteoporosis, tumours and many other fatal diseases who cannot undergo surgeries would have been in trouble. The surgical incisions would have been bigger. The hospital stay would have prolonged and the recovery period as well. The stress and strain would have been more. Above all, the medical world would have missed its ‘Father of Interventional Radiology’. Developed by many angiographers, the idea was conceived by Dotter in the early days of 1960s. Interventional Radiology owes its birth to the triumphant dilation of the stenosis of the superficial femoral
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The Father of Interventional Radiology: Charles Theodore Dotter
artery (SFA) in Laura Shaw, an 82 year old woman who was admitted to the University of Oregon Hospital with a painful left foot. Like a magic wand, Dotter’s dilating catheters worked wonder on the patient’s foot and her pain disappeared. This success of Dotter encouraged him to continue to dilate SFA stenoses. By 1966, Dotter is said to have treated 82 lesions in 74 patients. Dotter referred to his technique as ‘percutaneous transfemoral catheter dilatation’, and later changed it to ‘percutaneous transluminal angioplasty, (PTA)’. The technique was christened ‘Interventional Radiology’, by Alexander Margulis in March 1967, the then editor of the American Journal of Roentgenology.
Common IR Procedures A few common IR procedures include angiography, balloon angioplasty, stenting, stent-graft, central venous access, chemoembolisation, embolisation, fallopian tube catheterization, Hemodialysis access maintenance, needle biopsy, Radio frequency ablation, thrombolysis, Uterine Fibroid Embolisation, vertebroplasty, etc. Angiography is an X-ray exam of the arteries and veins by inserting a catheter into the blood vessels to diagnose blockages and other blood vessel problems. Narrow or blocked blood vessels can be opened with the help of balloon angioplasty. It involves inserting a balloon into a blood vessel and inflating it. This procedure is mainly used to diagnose and treat Peripheral Vascular Disease (PVD), blockages in kidneys, brain or in any other part of the body. Many medical conditions such as opening clogged blood vessels or blocked
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under the scanner tumours or obstructions or pathways that have been narrowed or blocked can be treated using an IR procedure called stenting. Stenting involves a small flexible tube which is made of wire or plastic and is inserted at the affected area to treat the condition. Stent-graft is another IR procedure which reinforces a ruptured or ballooning section of an aneurysm. This is done with the help of a stent wrapped in fabric. This IR procedure is also often referred to as an endograft. A tube is inserted under the skin and into the blood vessels in the IR procedure – central venous access. This enables the patient to receive medication or even nutrients straight into the blood stream. Blood clots can be dissolved by injecting drugs that bust the clot using an IR procedure called thrombolysis. Clotting agents can be directly introduced a bleeding area using an IR procedure called embolisation. This procedure also enables the blocking of blood flow to an affected area such as an artery or a fibroid tumour in the uterus. Chemoembolisation is another IR procedure that provides cancer-fighting agents straight to where the cancer tumour is located. The procedure has been widely used to treat cancers of endocrine system including liver and melanoma cancers. Radio Frequency Ablation (RFA) is an effective IR procedure which helps in killing deadly cancerous tumours. The IR procedure fallopian tube catheterization is a treatment for infertility. The procedure uses a catheter to open blocked fallopian tubes without surgery. Use of angioplasty or thrombolysis to open blocked grafts for hemodialysis, which treats kidney failure is another IR procedure known as Hemodialysis access maintenance. Needle Biopsy is another IR technique which is used to diagnose breast, lung and other cancers. It is an alternative to surgical biopsy. Uterine fibroid embolisation, also known as uterine artery embolisation is an embolisation procedure which helps in shrinking painful, enlarged, benign tumours in the uterus. A Boon for Cancer Patients Interventional radiology has proved its efficiency in treating fatal diseases such as cancers. Many interventional procedures are being developed to improve the qualCOLOR DOPPLER | NOVEMBER, 2013
ity of life of cancer patients. For example, symptoms such as accumulation of fluid in the chest cavity in patients with end-stage cancers do not respond to treatment. But, this can be treated with the help IR procedures. Inserting a small catheter into the chest cavity and leaving it in place will drain the fluid. The building up of fluid can be minimized or prevented by inserting chemicals through the catheter. This will save the patients from undergoing painful procedures at the hospital daily. IR Vs Conventional Surgery Interventional Radiology is often considered as a diagnostic discipline rather than considering it as a therapeutic specialty since its development. The differences between IR and diagnostic radiology are often ignored. Just as how a surgeon requires the diagnostic skills of a physician, the interventional radiologist requires the skill of a diagnostic radiologist in order to interpret the image. Hence, diagnostic radiology education is an inevitable component in IR training. IR has many key advantages over conventional surgery. Most of the IR procedures can be performed on an outpatient basis or require only a short hospital stay. The pain and recovery time are often significantly reduced by practicing IR and the risk of infection is low as well. Unlike the conventional surgery, IR procedures require little or no incision. They are often less expensive than surgery. Risks Associated with IR IR procedures can cause pain and discomfort at the place where the needle is being inserted. Bleeding can result at the needle insertion site and there are also chances of injury to the blood vessel or can even cause damage to the organ. Infection is another threat of IR procedures which may lead to the infection of the blood stream or the development of a blood clot or it can even end-up in stroke. The contrast material used in the procedures may cause allergic reaction. It can also result in reduced kidney function. The medications used for sedation can cause aspiration or respiratory depression. Radiation Risks The use of interventional radiology procedures have been considerably increasing over the past few years. But studies have
proven that some of these procedures pose high radiation risks when compared to other radiological examinations. The long screening procedures in IR cause stochastic risks to the patients. They also pose greater risks of deterministic effects to the particular area exposed to the radiation beam. The staffs attending the patients are also susceptible to these risks caused by the scattered radiation. The changes in demography and varying natures of disease will also increase the complexity of the IR procedures which may result in higher radiation doses to the patients. Several studies are being conducted so as to develop low radiation procedures to tackle these issues. The need to provide procedures with low radiation risks is a legal requirement as well. Pediatric IR Pediatric interventional radiology plays a crucial role in delivering safe, reliable, accurate and effective medical assistance to the pediatric population. The minimal invasive nature of IR not only decreases the length of hospital stay, but reduces the risks as well. The important medical benefits of IR made this subspecialty of radiology become increasingly common among the medical field. Pediatric IR procedures vary from that of adult examinations. Patient safety in pediatric examinations can be ensured by providing adequate education and training to the staff and drawing a team approach. Conducting formalized assessment and quality assurance programs will also addon to the safety factor. Children are more susceptible to radiation than adults. As their lifetime is longer than that of adults, the manifestation of changes in them is high. Hence, the dosage of radiation is one important element that has to be kept in mind while conducting pediatric interventional procedures. Hence, tremendous efforts have to be taken so as to provide radiation protection to the pediatric IR settings. IR in India In the past two decades, the number of IR procedures had a steady growth because of their minimally invasive nature, decreased mortality rate and shortened hospital stay. Better awareness and higher acceptability by other clinicians and patients made it a widely accepted specialty.
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under the scanner worth more than US$ 591.3 million in 2012. Studies also estimate the market will exhibit a growth rate of 3.5 percent per annum by 2017. The higher efficiency, technological advances and wide application areas spurred the growth of the market of interventional radiology devices. The rising popularity of IR procedures such as vascular closure, coronary stents and angioplasty balloons guarantees the growth of the IR market in the near future. The increasing incidence of chronic disorders, high demand for minimally invasive procedures, advancements in technology and the changing life styles of people are some of the factors driving the growth of the IR market. The economic fluctuations, less availability and the approaching market saturation are some of the aspects which might obstruct the growth of the IR market. Some of the major players in the interventional radiology market include Abbott Laboratories, Boston Scientific Corporation, Cordis Corporation, Medtronic Inc. and St. Jude Medical Inc. Across the globe, IR has made significant developments in terms of better availability of trained interventional radiologists and paramedical staff; better tools such as catheters, micro catheters, coils, embolic materials, etc. and reliable equipment such as digital subtraction angiography, MRI, high-end ultrasound and colour Doppler machines. Considering other radiology practices, IR is currently practiced only by a few radiologists across the country and hence its benefits are available only to a small number of patients in India. The lack of trained IR specialists and paramedical staff is another reason behind the slow growth of IR in India. The accessibility of IR tools and equipments being low is one another reason. This crisis can be resolved if addressed from the level of post-graduate training of radiologists to increasing the availability of necessary tools and equipments. IR has to be made a part of post-graduate curriculum. Medical Council of India can play a bigger role by introducing post doctoral certificate course in interventional radiology. Competent implementation of all these requirements can bring IR to a level of an
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efficient branch of therapeutic medicine. Market of IR IR has evolved as one of the key trends in the medical industry replacing open surgeries with its minimally invasive procedures. The rise in demand of interventional procedures stimulated the need for hybrid operating rooms equipped with IR devices. Recent market studies show that the IR market in the Asia-Pacific region was
The rising popularity of IR procedures such as vascular closure, coronary stents and angioplasty balloons guarantees the growth of the IR market in the near future. The economic fluctuations, less availability and the approaching market saturation are some of the aspects which might obstruct the growth of the IR market.
What the Future Holds Interventional radiology is witnessing a rapid growth as a subspecialty with its immense contributions to the medical world. The IR procedures have set a mark in the modern diagnostic and treatment techniques. The increased use of digital technology has enhanced the efficiency of interventional procedures considerably by providing faster and more accurate diagnosis. The advanced IR techniques offer greater image quality, bringing down the need for additional tests so as to diagnose the disease. The evolution of techniques such as 3-D reconstruction provides a better understanding of the human body thereby increasing the scope of IR procedures. The novel microscopic electronic devices developed using nanotechnology can be positioned through catheters. The function of these devices can be controlled externally or can be programmed to function accordingly. The rapid strides of interventional radiology indicate that this subspecialty of radiology will emerge as a specialty. IR, with its minimal discomfort and longlasting result will replace the treatment procedures of diseases that present greatest surgical risks for patients. COLOR DOPPLER | NOVEMBER, 2013
wordsworth
Leading from the Front SonoSite has been witnessing significant growth while earning worldwide recognition for its progressive product line, educational programs, and advocacy for a broader understanding of ultrasound’s multiple benefits, says Mr. Pavan Behl, Director and General Manager, India & Middle East, Fujifilm SonoSite India Pvt. Ltd.
Pavan Behl Since its inception, SonoSite’s lightweight, robust products have created and led the point-of-care ultrasound market. From sophisticated urban hospital emergency departments to clinics in remote villages, SonoSite systems are used by over 21 medical specialities and provide clinicians around the world with a cost-effective tool for improving patient safety and workflow efficiency
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ujifilm SonoSite Pvt. Ltd., is the specialist in designing cuttingedge ultrasound tools and world-leading education for access to point-of-care visualization to meet the imaging needs of the medical community including critical care and emergency medicine. A visionary of SonoSite, a person with immense experience in the field of medical technology, Mr. Pavan Behl joined SonoSite India Pvt. Ltd. in October 2005 and is currently leading Fujifilm SonoSite India Private Limited as its Director & General Manager - India & Middle East. With an experience of nearly four decades in the industry and his eight years in the company, Mr. Behl’s leadership skills paved the way for taking the company to the next level. In this exclusive interview, Mr. Behl discloses to Color Doppler about the contributions of the company to the POC ultrasound market in India. He also elaborates on the novel, sophisticated point-of-care ultrasound system from Fujifilm SonoSite, the X-Porte Ultrasound Kiosk.
SonoSite is industry leaders in segments where it is present and it is one of the fastest growing companies in the healthcare device segment. What are the key principles that accelerate the swift growth of SonoSite? Fujifilm SonoSite has been defining and redefining next-generation point-of-care (POC) ultrasound as its recognized market leader. We offer solutions that meet the imaging needs of the medical community. SonoSite systems are designed to help meet the new standards of patient care at the hospital bedside and in the physician’s office. SonoSite has been witnessing significant growth while earning worldwide recognition for its progressive product line, educational programs, and advocacy for a broader understanding of ultrasound’s multiple benefits. The Indian healthcare market is one of the most dynamic and rapidly growing in the world. What are the potential areas to where SonoSite can expand its growth over the due course
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wordsworth of time? The use of point-of-care (POC) ultrasound in India is now not limited to departments traditionally focused on clinical imaging. More and more hospitals are now opting for portable ultrasound systems to widen the scope of point-ofcare treatment in diverse specialities such as anaesthesiology, pediatrics; rheumatology, trauma, surgery, cardiology, etc. are relying on it for diagnosis and assistance with clinical procedures. Indeed, POC units have made the cost of ultrasound technology affordable to more healthcare providers overall, including numerous hospitals and medical facilities. An innovator and world leader in bedside and point-of-care ultrasound, how do the SonoSite devices play an inevitable role in the critical care and emergency medicine? In critical cases like accident and trauma where patients are mostly immobile, POC technology can reach patients where they are, be it along the roadside. The immediate results obtained through onsite ultrasound help speed up diagnosis, which, in turn, can lead to more appropriate interventions. By consolidating and speeding up healthcare delivery as well as minimizing patient transports, such technology can significantly improve patient safety, reduce costly hospital stays and enhance healthcare quality. The awareness about the critical care and emergency medicine is skyrocketing in the country. What changes will this segment under go by 2020? The use of ultrasound has proven to be an effective and rapid tool for noninvasive diagnosis of internal injury or disease for the timely medical decisions can make the difference between life and death in times of crisis. Hence, physicians are increasingly using portable ultrasound devices that can provide POC diagnosis. As a person with extensive experience and knowledge in the field of medical equipment, how do you differentiate the services of SonoSite from other companies offering similar products line in the market? Learning a new ultrasound technique or procedure can be challenging. The ac-
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The use of ultrasound has proven to be an effective and rapid tool for noninvasive diagnosis of internal injury or disease. Because timely medical decisions can make the difference between life and death in times of crisis, physicians are increasingly using portable ultrasound devices that can provide POC diagnosis to the patient curacy of the ultrasound technique and results also rely on one’s skills, experience, education and training. SonoSite recognises the importance of training and education to support the learning needs of the physicians. The company has teamed up with some of the leading specialists in the medical industry to design a series of courses focusing on Point-of-Care ultrasound. Courses are designed to teach those who have little or no experience in the use of ultrasound in their daily practice.
Ultrasound market across the globe is facing a rapid growth. The competition is also intense. How is SonoSite tackling it? Our various products available in the market are dedicated to bring high quality ultrasound to patients. What all major developments can the ultrasound market expect from SonoSite in the near future? This month Fujifilm SonoSite, Inc. is launching its latest point-of-care ultrasound system, the X-Porte Ultrasound Kiosk. The state-of-the-art X-Porte introduces advanced signal processing for high resolution imaging, and a multi-gesture user interface – all unique innovations in point-of-care ultrasound. Created to serve a broad spectrum of users, the X-Porte represents an entirely new ethos for point-of-care ultrasound. Its groundbreaking visual learning guides allow ‘any user, any time’ operation, enabling simultaneous live scanning to maximise in-the-moment imaging performance.
How are the SonoSite products engineered to address different medical specialties across the diverse Indian healthcare environment? Since its inception, SonoSite’s lightweight, robust products have created and led the point-of-care ultrasound market. From sophisticated urban hospital emergency departments to clinics in remote villages, SonoSite systems are used by over 21 medical specialties and provide clinicians around the world with a cost-effective tool for improving patient safety and workflow efficiency.
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special report
The
Pink Saga October was the month of breast cancer awareness. Pink decorated the buildings, websites and hoardings around, to spread one message to the women across the country— do breast screening at regular intervals. Here goes a wrap-up on how the imaging device companies fulfilled their role of social responsibility of spreading awareness on breast cancer
Ria Lakshman V | cd news
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eathered by the wind and dusky fog, the walk along the majestic roads of India during October 2013 boasted a pink avalanche. It was indeed a feast for the eyes. Neither the roaring shouts of traffics, nor the screechy whistles of roadside vendors seemed to matter. A calm feel of compassion and love was spread in the air. The intense thirst for unconditional love and understanding emanated from those pink, feminine and romantic hoardings rose next to the buildings. The pink festival was not a part of any entertainment events; rather it was a reminder for all women across the country to have their breast screening done at regular intervals. Breast cancer is perhaps the most fearful nightmare for the women across the world. Beyond the fear of death, it is a wound that leaves an inerasable scar on their womanhood. According to Inter-
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national Agency for Research on Cancer, breast cancer is the most frequently diagnosed cancer among women. To have a count of the Indian scenario, breastcancerindia.net presents statistics that say breast cancer is the most common form of cancer in most cities in the country while it comes second in the list among the rural population. PBCR 2006 to 2008 report -- the most recent data on the same -- says that breast cancer accounts for 25 percent to 31percent of all cancers among women in cities. Another interesting change is seen in the age shift. The average age of developing breast cancer shifted from 50-70 years to 30-40s. However, the future is such that breast cancer can be overcome and outlived. Early screening is all that is needed to stay away from this fatal disease. Do a breast examination - mammogram or ultrasound scan, core biopsy and/or fine needle aspiration of any potential tumour, and there you are, walked fifty steps closer to your
life. The detections are easier with ‘n’ number of imaging devices available in the market. Global players, such as Philips, GE, Hologic, FujiFilm, Siemens and more are on the ground to produce the most efficient screening devices. These market lions made their marks last October, with numerous awareness programs and campaigns that targeted cities and rural India equally. Most of their websites turned pink, new advertisement campaigns sprouted up, awareness talks were spread across. Developing World Faces a Breast Cancer Surge GE is one company that played a significant role in spreading breast cancer awareness this year. They commissioned a global study that said developing world faces a breast cancer surge. The blame is put on the increase in life expectancy and life style changes of
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special report social responsibility to ensure healthy life to women. This October, Hologic inaugurated the beginning of breast cancer awareness month by the company’s President and CEO, Jack W Cumming, presiding over the NASDAQ Stock Market Open-
women. The study has some interesting insights into the Indian scenario. Breast cancer is found to be the second most commonly diagnosed cancer in India. Also, the country seems to have an early grasp of disease than the women in Western countries. The study predicts that by 2030, the number of breast cancer cases in India will rise from 115,000 to reach under 200,000 per year. The need for educating the consumers is highlighted in the study, as Asian Pacific Journal of Cancer Prevention hints that only less number of urban women in India are actually aware of breast cancer. Among those who knew of the disease, only a half of them can recognize symptoms/risk factors. And, it is an added fact that many women feel uncomfortable or worried about undertaking a mammogram. In addition to the study, GE had a first of its kind, healthcare technology experiential lounge on wheels. Dubbed as “Mission Healthier India”, the vehicle was flagged off by Dr. A. P. J. Abdul Kalam, the Former President of India. Carrying 20 low cost GE innovations on board, the lounge intends to provide hands-on experience on technologies catering to women, mother and infant care, cardiac diseases and critical care to the clinicians around the country. With six vehicles, the company expects to cover 200,000 clinicians. In another effort to fight the breast cancer, the employees of GE undertook a wellness walk around the campus and heard inspiring stories from the cancer survivors. Through the social media
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campaign “#CodePink” ran during October, GE further reached to millions of women and provided access to white papers, quick stats, factoids and tips on self-examination. Husband Initiated Movement (HIM) against Breast Cancer Is breast cancer a women’s affair? Philips said ‘No’ through their creative imprint against breast cancer this October. The company launched a campaign ‘Husband Initiated Movement’, that say husbands can encourage wives to fight breast cancer through self-examination. The campaign went viral on Twitter, reaching millions at the moment of its launch. Philips went further through awareness talks at Philips office, by Mrs Indra Jasuja from Indian Cancer Society and Dr Vedant Kabra of Fortis hospital, who presented inspiring and informative insights on breast cancer, prevention and treatment to the gathering. At its global healthcare headquarters in Andover, Massachusetts, the Company kicked off its breast cancer awareness campaign by driving a mammogram truck that visits hospitals and clinicians in more than 13 US markets. In its a few markets such as South Africa, Serbia, Philippines, Spain, Russia, Netherlands, Singapore Brazil and United States, the company decorated landmark buildings in pink.
ing Bell Ceremony on 1st October. During the ceremony, Cumming emphasized the value of Hologic’s 3D mammography (breast tomosynthesis) in finding more invasive cancers and decreasing unnecessary recalls. Two videos, “Get One” and “1 of 8”, published on their websites intends to educate and inspire the community about the significance of screening at regular intervals to fight against this disease. When there are companies that exhibited strenuous efforts to spread awareness about the disease, there are also few manufacturers who left it under the veil. Whatsoever, the campaigns that ran silently, yet sternly told the public, “The time to act is now.”
An Opening Bell Ceremony for Awareness Being a women’s healthcare device company that runs promisetome.com, a global women health initiative, Hologic is already well known for its corporate COLOR DOPPLER | NOVEMBER, 2013
nobel prize
Biological Cargo is No More a Mystery! Purnima Sah | cd news
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rofessor of Biomedical Sciences at Yale University, James Rothman; 64 years Randy Schekman, professor of molecular and cell biology at University of California; and physiology professor at Standard University, Thomas C Sudhof were honoured with Nobel Prize for 2013 for scheming the mystery of transportation of vital materials amongs cells. This discovery has given a new ray of hope in the medical world. The scientists solved the mystery of how the cell organizes the process of its transport system from one part to the other like one organized factory house. The process happens in such a way that the cells transfer the essential materials such as hormones and brain chemicals to other cells, giving an insight into fatal diseases like Alzheimer’s, autism and diabetes. Things didn’t happen in one night. It was years of ongoing research and dedication that brought this huge change in the life of Nobel Prize-winning scientists. Trials and experiments all happened. They separately mapped out one of the body’s critical networks in which tiny bubbles or vesicles enable cells to secrete chemicals such as insulin into the surrounding environment. The process of cells transferring materials from one part to another elucidates on how insulin (the important substance to control glucose levels) is made and released into the blood at the correct place with correct timing. Human body is a mystery. When beautiful and important discoveries happen it generates a good amount of curiosity to know and know more. For instance, look at the discovery of Rothman, Schekman and Sudhof. They have shown that how important it is to understand a human body and the obvious implications for various diseases in various organs such as the nervous system, diabetes and immune disorders. It will help to understand in a COLOR DOPPLER | NOVEMBER, 2013
better way that how vesicle system takes up nutrients, move substances around and releases chemicals such as hormones and the growth factors of the body. The mystery does not end here. There are many more organs and functions going on within us yet to be exposed and known. We have billions of nerve cells and they communicate and have to communicate with each other every second, minute and hour. It is happening all the time and they perform this function with the help of vesicle transport system. Before the discovery, it was not known to us that this can be also important in for instance diabetes, Alzheimer’s or autism. But now the world knows that insulin is released by these vesicles and the immune system is also regulated by vesicle transport mechanism. The discoveries possibly have clinical implications in psychiatric diseases but it will help to understand the function of different cells present in our body. Schekman’s curiosity on protein transportation from one cell to another took him to another level and he began working on single cell microorganisms. From his findings the same formula was applied to human cells during the research. Schekman’s research was basically based on Alzheimer’s disease. The study was whether the accretion of the Amyloid Precursor Protein (APP) in the brains of Alzheimer’s disease patients are due to disruption of the vesicle system. Neuroscientist, Sudhof focused his research on finding out variation in human behavior. How neurons in the brain control the human thought, insight, sentiment and actions? Neurons are the cells that constitute the foundation of the nervous system. The way brain communicates with neurons, is all a very quick process. The research of Sudhof was to explore the mystery of how all these processes get established during development. The research and discoveries have been done but the heights of implication and impact are still a mystery.
Meet the Laureates James E Rothman
•Born: 3-11-1950, Haverhill, MA, USA •Field: Cell physiology
Claim to fame:
Our cell contains very minute membraneenveloped vesicles. It carries a large variety of proteins between different compartments in the cytoplasm. The transporting process involves vesicle flow and membrane fusion. This is very essential for growth and division of every cell. It was a great mystery to come across the facts of how this whole process comes about. It won’t be wrong to say that it was one of the great unsolved questions of biochemistry and cell biology.
Randy W Schekman
•Born: 30-12-1948, St. Paul, MN, USA •Field: Cell physiology
Claim to fame: Randy Schekman was fascinated by the transportation process of cell. He identified three classes of genes that control different facts of the cell’s transport system, thereby providing new insights into the tightly regulated machinery that meditates vesicle transport in the cell.
Thomas C Sudhof
•Born: 22-12-1955, Goettingen, Germany •Field: Cell physiology
Claim to fame: Sudhof was curious to know how cells communicate with one another. He identified molecular machinery that responds to an influx of calcium ions and directs neighbour proteins rapidly to blind vesicles to the outer membrane of the nerve cell. His discovery explained how temporal precision is achieved and how vesicles contents can be released on command.
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featured product
A Cloud Based Solution for Cardiologists Modalities that are commonly used in Telecardiology are:
Sri Krishna Seshadri
Project Manager, Teleradiology Solutions
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he principal causes of mortality and morbidity in the world are cardiovascular diseases, occurring in 80% of cases in lower and middle income countries1. There are 9.4 million deaths each year, or 16.5% of all deaths can be attributed to high blood pressure2. This includes 51% of deaths due to strokes and 45% of deaths due to coronary heart disease3. According to a recent study by the Registrar General of India (RGI) and the Indian Council of Medical Research (ICMR), about 25 percent of deaths in the age group of 2569 years occur because of heart diseases. If all age groups are included, heart diseases account for about 19 percent of all deaths4. Above all India, with more than 1.2 billion people, is estimated to account for 60 percent of heart disease patients worldwide, added to this is a nationwide shortage of cardiologists and getting a diagnosis to a patient can become a major challenge. Imagine a cardiologist in a city traffic jam or spare time between the ‘physical’ patient consultation at the clinic/hospital utilizing his or her time well to review an electrocardiogram or echocardiogram of a patient in a remote town and giving a diagnosis and directing therapy. With wider adoption of Telecardiology this is now possible. Modern telecardiology consists of: Real time as well as recorded transmission of electrocardiograms (ECG) for interpretation. Transmission of cardiac images and patient data to provide help at distance from a specialized cardiologist in diagnosis and therapy of cardiac diseases. Providing information to the cardiologists who make the referral for the results of the tests. Provision of distance help in the therapy of patients who have emergency cardiac diseases.
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Tele-electrocardiography: The electrocardiogram (ECG) is the most used cardiologic exam5 as it is cheap, noninvasive, easy to perform, and has good sensitivity and specificity for the diagnosis of the principal heart conditions. Tele-electrocardiography extends the capabilities of the acquisition machines of the electrocardiograms (ECG) to allow real-time transmission of electrocardiograms (ECGs) of a patient using a network to an expert cardiologist apart from forwarding a stored image (JPEG or PDF) of ECG recording. Tele-echocardiography: Echocardiography is a precious diagnostic tool for cardiologists to determine problems of the structure and function of the heart. Smaller, lighter portable ultrasound units are finding utility for remote telecardiology programs in rural areas. The echoes can be recorded at remote clinics and sent via secure websites to a central hospital/ clinics to be read by an Cardiologists. Esaote promoted this concept in its booth at ACC.13, featuring presentations by cardiologists from Iowa Heart Hospital, which created a rural telecardiology program using Esaote’s portable systems [6] An ideal tool for Telecardiology Solution Any telecardiology information system must guarantee the Quality of Services and the capability to collect and evaluate the results of tele-care. Keeping in view the unique requirements of Telecardiology, EchoSpa built by Telerad Tech, a technology partner of Teleradiology Solutions has been designed to securely transmit different modality images from different patient touch points to the network of Cardiologists anywhere in the world for interpretation and consultation
seamlessly. (Fig.1) Using telecardiology solutions for single doctor or single hospital is not an optimal option as there is an overall paucity for the Cardiologists; the optimal solution would be to have a network of cardiologists to interpret the Cardiac images and ECG’s sent from different centres by adequate and timely scheduling. EchoSpaTM is a solution to harness networking of doctors, imaging centres and the coordinating centre, as the software allows the providers to receive ECG’s and Echocardiography images from various users, assigned by the command or coordinating centre to the available panel of cardiologists for interpretation through a well-organized and highly customizable work list. Electrocardiography: As ECG is a low cost medical device there are multiple vendors providing this solution at a wide range of costs, so the challenge is in interfacing these equipment with the software solution. Unlike a unified standard for medical images (DICOM), ECG output comes out with a variety of standards suited to the region. E.g. SCP-ECG (*.scp), DICOM (*.dcm), aECG file (*.xml), HL7 XML FDA, ISHNE. In this case, EchoSpa helps as it has a built-in feature to interface as well to accept the ECG images without even interfacing with the machine for the Cardiologist interpretation. However, for enhanced service levels some medical devices allows extraction of an initial di-
(Fig.2) TeleECG workflow
(Fig.1) EchoSpa
agnosis for the electrocardiography signal that is stored within them, with various different interpretations and before its transmission to the distant expert, this data forms part of the DICOM field.
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featured product EchoSpaTM allows the patient centres/ clinics to get these ratified by qualified Cardiologists by sending this information along with the other clinical data for their opinion. Fig. 2 EchoSpa & Echocardiography: The echocardiograms can be digitised at local places, transmitted for evaluation in a distant medical centre or hospital and stored using DICOM format in optical discs (CD/DVD). EchoSpaTM has the ability to interface with any DICOM and HL7 compliant Echocardiography machine and technicians can upload the images onto the platform, these DICOM images are interpreted remotely by the network of cardiologists and the results are captured in the software (EMR), which allows the patients as well as the provider to access the reports at any time. (Fig.3) Issues of lower/ unpredictable bandwidth, limits its use for live view, wherein
hardware requirements especially in remote areas who cannot invest in such IT infrastructure due to high capital and maintenance cost and unreliable power backup. Moreover, it gives the flexibility to access patient information and reports anytime from the cloud for retrieval by the care provider. Fig. 4 EchoSpa Router is a fast and intelligent DICOM gateway that route the images coming from various modalities connected in a hospital enterprise to the PACS Servers, Workstations or any other configured destination nodes. EchoS-
(Fig.4) Data management Architecture
(Fig.3) TeleEcho workflow
the cardiologists views the images live from a distant location while the Echocardiogram is performed on the patient, which should be the ideal situation, however “store and forward” method with extensive training (for Technicians) and standardized protocol can still prove as a valuable tool for Telecardiology. Considering the Indian market, another innate issue with Tele-echocardiography is the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 unlike other countries which restricts the use of Echocardiogram in a setting without a Cardiologist, putting a limitation on the diagnostic centres using this diagnostic tool and getting those interpreted by Telecardiology network. Data management: EchoSpaTM uses, cloud storage and computing thereby removing the heavy
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paTM router uses proprietary algorithms to route the images in an efficient manner that makes maximum utilization of the network (bandwidth) and hardware (computer) resources. EchoSpaTM router supports TLS communication such that the image transmission happens over secured encrypted layer. EchoSpa proprietary routing algorithm route the images from modalities in parallelized manner. Destination nodes can be configured to set the high/low priority such that the routing algorithm accommodates more associations for the high priority nodes. EchoSpaTM router is a web based product and can be monitored and administered from anywhere and from any system including the mobile devices (iPAD, iPhone, etc.). These features have been designed for the Telecardiology model of managing network doctors and hospitals/clinics, where prioritizing cases is crucial for a speedy diagnosis. Conclusion The need for Cardio Vascular disease management is ‘written on the wall’ and the need of the hour is to identify an optimal solution, operationalizing it and bringing the benefit to the patients for its prevention and management. Having derived experience of serving the
Teleradiology market for over 10 years, Telerad TechTM has leveraged its experience in addressing the issue of image compression, cloud computing, customizable workflow and providing agility to seamlessly integrate with different medical devices has resulted in designing EchoSpaTM as an ideal solution for Telecardiology needs given the burgeoning disease burden due to lifestyle changes, increasing risk factors leading to Cardiovascular diseases across the world, which if intervened can be treated and in many instances lifesaving. Future holds a challenge, with the lack of regulatory requirements and standardization in Health Information Exchange (HIE) protocols, can Telemedicine become a “Virtual Hospital” catering to different needs of the patients, independent specialists, hospitals and public health networks. With Information and Communication Technology scaling newer heights and public awareness and access to such technology is a great propeller to surpass this challenge. In coming years the concept of fully functional “Virtual Hospital” augmented by demand for self-care and home-care treatment can become a reality. In our constant endeavours to reach out to people, our passion is towards inventing newer possibilities in the e-health space to cover the gaps in the present healthcare system.
Reference [1] World Health Organization, “The top 10 cases of death. Fact sheet n. 310,” June 2011 [2] Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2224–2260. [3] The global burden of disease: 2004 update. Geneva, World Health Organization, 2008 [4] http://www.aapiusa.org/news/article/heart-disease-emerges-as-top-killer-among-asian-indians.aspx [5] T. P. Pereira, C. P. Souza e A. P. L. Protásio, “Um método de compressão de sinais eletrocardiográficos para uso de SMS em sistemas móveis,” em Novena Conferencia Iberoamericana em Sistemas, Cibernetica e Informatica, Orlando, 2010. [6] http://www.itnonline.com/article/markettrends-cardiac-ultrasound-systems
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Teleradiology Gaining Popularity
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“Initially, there was some hesitance by a number of hospitals in India to avail this facility. Today there are many centers providing Teleradiology services, proving the viability and dependability of these services beyond doubt,� says Dr Dharma Prakash
e shared our readers the saga of how Teleradiology Solutions Private Limited (TRS) created waves in Indian teleradiology segment in our previous issue. Their facets are many. Beyond being one in the array of outsourcing companies in Bangalore, TRS has an unravelling commitment to provide the beneficiaries, services that otherwise could have been alien to them. Now the horizons are spread to academics, clinical trial radiology, 3D labs and Emergency Nighthawk. With the efforts of sleepless radiologists, who combine their passion to social responsibility, TRS pens the right answer for the problems of radiology solutions, in a country which faces severe lack of radiologists. Dr Dharma Prakash, Senior Consultant Radiologist, Teleradiology Solutions Pvt. Ltd shares about the system, his journey with TRS, about the future of teleradiology in the country, with his gratifying enthusiasm. We are featuring on how Teleradiology Solutions is creating waves in the segment of teleradiolgy in the country. You were here since the inception. Can you brief the journey so far? 12 years ago I read an article in the Times of India about Dr. Arjun Kalyanpur, an American board certified radiologist providing Teleradiology services , the first of its kind in India. One of my colleagues, Dr. Puttanna, introduced me to this organization. When I joined, there were four radiologists and medical
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transcriptionists and we were reporting from a couple of rooms. Today we are an organization of over 150 people comprising of both US and Indian radiologists, supported by medical transcriptionists, sales and marketing personnel. To how many countries your services are extended? Apart from the North American continent, we provide services to Africa, Singapore and, Maldives. Are the services provided in India free of cost? There are a number of hospitals, to whom we provide free service like the Ramakrishna Mission Hospital in Arunachal Pradesh. Others are Gulbarga Government general hospital, and Brindavan hospital. How far has the perception on teleradiology changed since 2002? When I joined many of my colleagues were enquiring how I adapted to this new method of reporting, given the fact that there is no interaction with the patient. If a radiologist is inclined to interact with other physicians, surgeons and patients, then he or she needs to work from a hospital environment. While providing Telradiology services the radiologist gets to interact only with the referring physician. Initially, there was some hesitance by a number of hospitals in India to avail this facility. Today there are many centers providing Teleradiology services, proving the viability and dependability of these services beyond
doubt. How does this system works? Is it like the hospitals take appointment and send the scans for report? Once the interested hospitals and diagnostic centers contact us, our IT department helps them get the connectivity. Once it is done, the scanned images/ studies are sent to our center. The cases are distributed to our radiologists as and when they arrive. Once the study is interpreted, the scans are again reviewed by an American Board certified Radiologist. If the study is complex then opinions from other radiologists in our centre are sought. The report is dictated within thirty minutes, and faxed back to the hospital. We maintain a very low turnaround Time (TAT). A radiologist here reads approximately 50 to 60 cases a day. Our short reporting time and panel of radiologists are our two main advantages. You were associated with many hospitals. How do you see the change from a hospital experience to the present scenario? It is a totally different scenario in the hospital. In hospitals after the CT or MR scan, the patient gets the report later in the day or next day. But in Teleradiology, once we receive the images, the report goes out in few minutes. Both patients and doctors are benefited by this. The patients can get treated on the same day. Are the patients aware that their scans are sent across the globe to get report-
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ed? Does this develop any ambiguity in the patient’s mind? Patients are aware of this service and everything is legal. Patients don’t interact directly with the radiologist. Only the referring physician interacts with the radiologist. What the patient requires is an accurate diagnosis, and the location of the radiologist is not a primary concern. The advantage of this emergency service is the scans are re-read by the consultant radiologist of the concerned hospital on the next day. If there is any discrepancy in the report, we get the intimation immediately. How acceptable are the services in India? Teleradiology services are still not popular in India. There is a dearth of radiologists in India. In India, only the major cities have round the clock radiology services. But, there is severe shortage of radiologists in the district headquarters and in the villages. To overcome this, hospitals should get motivated to obtain Teleradiology services for better care of the patient. Teleradiology services are normally provided round the clock. The reports are obtained within an hour, enabling treating physicians to take decisions faster. The technicians in the remote areas should be trained to perform the scan effectively and send the images out to the reading centers. There are ethical issues related to teleradiology. What is your insight on this? There are several protocols followed by us to maintain the ethical issues. Here, the patient data is transferred from the hospital to the reporting center. Ethically, we are supposed to maintain the privacy of the patient illness and should not talk about the patient’s data anywhere outside without consent from the patient/relatives. If the patient images are used for the teaching programs or in the conferences, the patient data is completely deleted from the images and
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the privacy is maintained. Are there any chances of manipulation of data? No, there are no chances of manipulation of data. Sometimes, there are transmission issues where the data is corrupt before it reaches us. In such cases, we call back and ask them to rectify the problem and send the images again. There is no compromise on the quality of the images. The monitors which we use for reporting are of high quality. The internet is so fast that we get the cases downloaded within few minutes. Mr. Robin Philip, the academic coordinator of Teleradiology Solutions told us that you are looking into the academic part/e-learning of TRS. This e-learning is a new thing, which is the future trend for the teaching programs. This is very helpful to discuss the interesting cases and small topics. When we conduct a session, we send the login details in advance to the radiologists/PGs who are registered with us. This method is very helpful for the post graduate students or consultants in remote places, where they even can show their interesting cases and also can discuss about the difficult case they have. The problem in India is that it takes some time for the radiologists to adjust to the e-learning process as it requires computer and internet. This e-learning is not an alternative for the conferences. This online e-learning programme is conducted 3 times a week in the afternoon between 12:30 to 1.00 pm. Every week on Wednesday evening at 5 pm, we have e-class on one dedicated topic for 45 minutes. We do conduct Continuing Medical Education (CME) once in 6 months on Emergency Radiology and general radiology. Lots of PGs and consultants attend these CMEs. We have a dedicated auditorium to serve this purpose. The faculties are usually from inside. We conduct monthly academics on last
Wednesday of every month. During this, there will be one guest lecture followed by lectures from our faculty and interesting cases presentation by the PGs who come to attend these sessions. Does the team have some sort of experience in the direct patient consultation? Yes. In India, post graduation is provided only in medical colleges and some big private hospitals and it is a must that every PG should interact with the patients during the training programme. After the completion of PG, it is better to get experience in a bigger hospital with all modern facilities for a couple of years before starting the private practice. Are there any chances of you to go back to your old hospital system? It is a bit tricky question. One working with the Teleradiology services should not get bored of this sort of system by saying that I don’t have any interaction with patients or the doctors. Always remember, this is not a hospital set up. The working environment is entirely different from the hospital. So, what I strongly feel is that the Teleradiology will be the next future in India. I still do my private practices outside this organization and it is allowed. Do you depend on the background history of the patients to report? The clinical history of the patient is of utmost impost in our diagnosis. The hospitals usually provide this along with the images they send. Without the clinical history, we do not interpret the images and hence ascertain the details by calling the physician. You have no interaction with the patients. Psychologically, will this affect the patient? That question arises only when I am treating the patient. Here, I am diagnosing the patient’s disease and hence an interaction is not necessary, as the patient’s physician will treat him based on the radiological findings. COLOR DOPPLER | NOVEMBER, 2013
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CT ‘BEST’ 2013! CT FEST 2013, the 3rd Edition of Annual CT Program of Maharasthra State Branch of IRIA, was held at The Westin Mumbai Garden City, Goregaon, Mumbai with exclusive session on Spine NeuroRadiology and Abdomen part of the country, as they seek assistance on technical error/problem during the diagnosis. The Quiz for delegates at the end of the second day brought joy and excitement in the crowd and gave away prizes to the winners. The event premises witnessed the presence of Sanrad, Siemens, and Philips, Icons, Imaging products, Myrian from the diagnostic industry, and displayed their products at the event.
Sarika Suryawanshi, Kishore Kumar PS | cd news
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n the dazzling city of Mumbai, and at one of the luxurious hotels, The Westin, the CT FEST 2013 was held on the note of delivering the best of CT-MRI diagnosis covering neurology, abdomen and liver. The festival was a scientific carnival for radiologist using CT and MRI as a major modalities in their practice. The advancement of the scientific technology is taking new heights in the field of medical diagnostics, and CT-MRI is like the direction lamps, discovering the path of darkness to deliver correct diagnosis. The international faculty, Dr Jonas Rydberg, Dr Alison Smith and Dr Parvez Masood delivered clinical lectures on topics like stroke, brain tumours, and on
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hepatocellular carcinoma imaging. The panel discussion raised several diagnostic thought processes on, ‘thrombolysis for ischemic stroke critical hours’, giving various insights to the delegates. The national faculties including Dr Malini Lawande, Deepak Patkar, A Anbarasu, Karthik Ganesan delivered series of lectures touching several case studies. The CT/MRI technology has been used in diagnosis of TB, stroke and in tumours including brain, liver, and abdomen etc., as well as in distinguishing tumour mimics. Dr Ashwin from Rajkot, Gujarat said, “The lectures were very informative and I earned the knowledge of both the modalities, CT and MRI, at a single conference! Few delegates from Maharashtra expressed their dissatisfaction over poorservices of big companies to the remote
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‘CT FEST, A Wonderful Concept’ Color Doppler is in conversation with Dr Parvez Masood and Dr Jonas Rydberg, the international faculty, at CT FEST 2013 Dr. Jonas Rydberg
Professor of Clinical Radiology at the Indiana University School of Medicine, Indianapolis, United States How was your experience at CT FEST 2013? Dr Parvez: It was wonderful, and the arrangements were very good in a way it was carried out. The one major difference I can point out about the conferences in the US and India is that in the US it is more sub-specialised unlike the events being held in India. Dr Jonas: I have been attending CT FEST for past 10 years in Colorado where there are focusing on CT, and MRI lectures. I liked the CT FEST concept here in India. How do you find the user-friendliness of the CT-MRI technology in your practice? Dr Parvez: CT is always easiest to work with. Ultrasound technology has to know the patho-physiology whereas CT & MRI has nothing to do with the disease. We have stationary images not the dynamic images unlike ultrasound. We are not trying to see how something is behaving; on the other hand, sonographer has to know the pathophysiology of the disease, and has to make decision on what he/ she sees. In my opinion, Ultrasound is very popular in India. Physicians are doing sonograpy, they know the disease, they have probe in their hand. On the other hand in the US, the sonographers don’t know the pathophysiology and hence, it becomes difficult. Dr Jonas: If I was put on a small island with a small population, and I was allowed to buy only one piece of equipment either ultrasound, MR or CT. I will always pick a CT scanner for it can cover neuro, abdomen, chest and trauma sub-specialities. I believe it is a universal
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instrument; as it is a quick examination and safer with less expensive than MRI. We use CT very much for screening, no matter what is the problem is, because CT is the first modality but then depending on what you find then we turn to MRI as a problem solver. One can always stratified your patient starting with ultrasound, but in some cases it becomes difficult to diagnose then in that case you can select CT-MRI. Ultrasound will not help with Neuro, Cranial and Chest. As skull bones stop ultrasound to penetrate; and at Chest, air stops the ultrasound, but for abdomen it is good, and for joints it is good-soft tissues. I believe there will be a shift to CT-MRI in India from ultrasound. Ultrasound may be absolutely okay when it becomes a modality in combination with interventional; with MRI one can characterise the diagnosis. I prefer to start with CT then l look at the MRI that’s how I create teaching environment for myself, and build my opinion. What are the limitations in dealing with this advanced technology so far CT and MRI is concerned? Dr Parvez: Yeah at some point of time, we face challenges in dealing with the technology. Consider, for example, if a patient has pace-maker or electronic devices in the body then we can’t do MR but do CT. Sometimes there are issues with contrast; it is better to give CT contrast in kidney failure patients than MR contrast; at one point MR contrast was used to give to these patients, but now it is completely switched to CT. It is better to give CT contrast than MR contrast in certain cases. Dr Jonas: Sometimes patients can be allergic to contrast media. For MR contrast media, which is being used for past 15-20 years are almost safe, but you have to be more careful in patients with abnormal renal function. A limitation, I can say is the cost, not having access to the contrast media; lack of contrast media; large size of the patients are eliminated
Dr. Parvez Masood
MD, Neuro-radiologist, Cleveland Clinic, Department of Diagnostic Radiology, Ohio, United States with modern MR. MR has still better soft tissue distinction. Cost to purchase the equipment is the only limitation to MR as per my opinion. What is your expectation from Technology; what inputs do you expect from CT-MRI manufacturers? Dr Parvez: Radiologist survival has always depended on technology change. The biggest healthcare cost has come down because of imaging. If you look at 30 years ago for appendicitis, number of patients used to go for surgery and have been cut down for 95 percent just because of CT scan. In seizures, we are already using by robotics; there is equipment for the cardiac surgery at the Cleveland clinic where procedures have been merged with imaging. So procedures/surgeries can be done with imaging guidance. Dr Jonas: The biggest challenge I think for neuro, brain, liver and pancreas is low contrast resolution. You can find very small difference in densities of these tissues. In brain we have grey and white matter that are closed to each other. Therefore CT has the problem and hence you have to increase the dose. In case of liver, you can have metastases as low contrast resolution. Now for the last 3-4 years, there is something called iterative reconstruction that has brought down the noise in the images very much, and there is more coming that will improve the low contrast resolution and I have seen images from liver or brain which are really high quality. These techniques are based on science and expected outcomes. I think there must be some accountability we have to manage with these resources in a reasonable way.
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‘Wonderful Event, Awesome Response’ help them enhance their skills. So, we can say that the program met the expectations of most who attended.
Dr Sanjeev Mani, the organizing secretary of CT FEST 2013 told Color Doppler that the event became special with the wonderful participation of delegates and the presence of internationally acclaimed speakers. Excerpts from an interview: As the Organizing Secretary of CT FEST 2013, please share your experience about the whole event. This event was a well attended affair with more than 350 delegates from across the country, and predominantly from Maharashtra, Gujarat and the southern states. Dr Parvez Masood, Dr Alison Smith and Dr Jonas Rydberg were the international faculty along with Dr Deepak Patkar, Dr A Anbarasu and Dr karthik ganesan from India, amongst others who delivered lectures on various topics in Neuroradiogy and Abdomen. How was CT FEST 2013 different from that of CT FEST 2012? It was the first time probably that an event was held across 3 days on systems rather than modalities. Lectures on stroke, tumors, spine were delivered by the faculty describing both CT and MR protocols and advantages of each mo-
We have received a very positive feedback from residents and consultants who have described the program as a wonderful teaching experience that will help them enhance their skills
Dr Sanjeev Mani
Organizing Secretary, CT FEST 2013 dality for each disease. An interesting panel discussion was held with international Faculty, Dr Sunanda Anand (neurologist at Nanavati Hospital, Mumbai) and Dr Rajeev Mehta with discussions on stroke evaluation and management decisions based on imaging findings. Was the three-day event able to meet its expectations? We have received a very positive feedback from residents and consultants who have described the program as a wonderful teaching experience that will
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How did you find the scientific sessions, workshops and paper presentations of the delegates? Good material was presented by resident doctors, especially those from MP Shah Hospital, Jamnagar under Dr Nandini. The help of their professors in planning the slides and abstract presentation helped them win most of the prizes at stake in the abstract and poster competition. What are your plans for CT FEST 2014? How different is it going to be from that of CT FEST 2013? The theme next year is neck-chestabdomen and the venue is the Marriott, Pune from November 7-9, 2014. Since Pune is well connected, we hope to expect a good response from our MSBIRIA members. Dr Amit Kharat, Dr Vijay Kadam and Dr Ritu Lokhande are the local team for managing this event with Dr Sanjay Vaid and Dr Anbarasu part of the national faculty on board for this event. Details of this program will be up soon on our website www.msbiria.org
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‘A Great Event for Better Future’
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anrad Medical Systems is an organization specializing in delivering affordable medical imaging equipment and providing impeccable after sales and maintenance service since the last fifteen years. Sanrad, with its immense support at the CT FEST 2013, proved its mettle at the event. Mr Som Panicker, Vice President, Sanrad, talks to Color Doppler about the company’s contribution to the CT FEST 2013. Please share your experience about the whole event. Sanrad has been actively involved in various quality radiology education initiatives highlighting latest topics in CT and MRI in India in the recent years. We have realized a very important fact that only by spreading awareness and educating medical fraternity about the latest updates and high-end technology, we can achieve our goal of becoming the most respected medical imaging equipment company in India. As part of this vision, we have been partnering with MSBIRIA for the last few years to design a novel education program covering all hot topics in CT and MRI. In a country like India, not every doctor can travel abroad every year to attend international conferences or can listen to eminent radiologists from all over the world. In order to make this happen, Sanrad supported MSBIRIA for organizing a quality conference like CT FEST where many internationally reputed radiologists and scientists are brought in to deliver lecture in a world class ambience while maintaining high quality of teaching. This year, more than 350 residents participated from almost across the country and a large number of postgraduate residents were also present. All of the participants were very attentive and all the lecture halls were packed during the three days of the event making it a great learning experience. The event was graced by internationally acclaimed speakers like Dr. Alison Smith and Dr.Pervez Masood, both from Cleveland Clinic, Ohio, USA , Dr.
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In a country like India, not every doctor can travel abroad every year to attend international conferences or can listen to eminent radiologists from all over the world. In order to make this happen, we supported MSBIRIA for organizing a quality conference like CT FEST where many internationally reputed radiologists and scientists are brought in to deliver lecture in a world class ambience while maintaining high quality of teaching
Som Panicker
Vice President, Sanrad Medical Systems Jonas Rydberg from Indiana University School of Medicine, USA. There were also many distinguished national faculty members such as Dr. Deepak Patkar, Dr. Rajeev Mehta, Dr. Anbarasu, Dr. Malini Lawande and Dr. Karthik Ganesan. The CT FEST 2011 was based on the theme ‘Chest and Abdominal Imaging and the CT FEST 2012 focused on ‘Neck, Chest (interstitium), and Cardiac CT’. The focus area of CT FEST 2013 was on Stroke, Brain Tumors, Spinal lesions and Base of Brain. It is worth quoting the comments from our CEO , Mr. Ratish Nair about the success and tremendous response of CT FEST 2013. “It was the organizational skills of Dr Sanjeev Mani, Dr Shailesh Singh, Dr Jignesh Thakkar, Dr Deepak Patkar, and other team members of MSBIRIA along with the international faculty which made CT FEST 2013 a grand success”. Being the main partner of the event, how fruitful was CT FEST 2013 for
you? In short, a focused success. Thanks to the meticulous planning made by excellent team of MSBIRIA. We are so glad to see the response from the new generation radiologists and postgraduate students whom we see as our future customers. We do not expect any quick magical business growth, but being a part of a an event like CT FEST 2013 itself is a great satisfaction and the number of visitors at our stall itself show what the name Sanrad is meant for them. There were good responses for our 16 and 64-slice CT models and also surprisingly many enquiries of our recently launched compact and light weight 0.45T Open MRI device, ELIXBO despite of the common belief that there is no demand for permanent MRI in India. Above all, a very large number of our CT and MR customers attended CT FEST 2013 this time and it was wonderful to spend some time with them. Sanrad is always proud of our happy customers and most of our new orders are happening through references of our own satisfied customers. What can the imaging industry expect from Sanrad the year ahead? We see a tremendous growth for medical imaging industry over next few years as Indian healthcare industry is growing and is becoming a major destination both for investors and health tourists. In CT, 16-slice and 64-slice CT are going to make lot of demand in India and 1.5T MRI will continue to dominate the Indian MRI market. Despite the demand for 0.3T and 0.45T permanent Open MRI, India still needs such low cost, low maintenance MRI units for making viable investment in many small and medium cities. We are in the final stage of launching our high-end Helium less 1.5T MRI and will announce the first installation in Mumbai very shortly. We also have a plan to venture into CT-PET and MRI-PET in the next few years. To sum up, CT FEST 2013 ended with a very positive note for all of us.
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Caring People.. Bridging the Gap... 16th, 17th - Pre-Conference Workshop 18th, 19th, 20th - Conference November 2013 Venue: Vythiri Village, Wayanad
Biggest Emergency Medicine Conclave in India Global participation Higher end scientific sessions Guidelines and protocols Scenario based problem solving sessions Live web casting Interactive audience response system Mob: 09544055511, Email: secretaryemcon2013@gmail.com www.emcon2013.com
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An Event Like Never Before Pediatric imaging sessions, resident education programme and clinico radiological sessions were the highlights of the 11th annual meet of ISPR
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he 11th Annual Conference of the Indian Society of Pediatric Radiology (ISPR), 2013 held at Ahmedabad, the financial capital of vibrant Gujarat, on October 5 and 6. It was organized in JB Auditorium, the beautiful auditorium of its class venue, ‘The Ahmedabad Management Association’. There were fifty registered pediatrician delegates along with ten faculties. The unique part of this year’s conference was that there were eight combined sessions on both pediatric and radiological faculty. All the sessions were very lively and well discussed. Dr. Mansukhbhai Shah was the chief
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guest at the inaugural function. He is also an educationalist, academician, and also the Chairman of Sumandeep Vidyapeeth, Pipariya, part of Central Gujarat. He solely sponsored the scientific sessions. Dr. Bharatbhai Shah, the Dean of B J Medical College, Ahmedabad was the guest of honour in the inaugural programme. There was a planned interactive film reading session by experts particularly focusing over post-graduate students. The conference was focused on pediatric imaging sessions, resident education programme and clinico radiological sessions. The main objective of this year’s ISPR conference was to create a great deal of
awareness about radiation doses to the children. The discussion happened in the presence of international faculties in detail — ‘How can we minimize the radiation dose and get optimum information out of the imaging procedure.’ Another important topic discussed was ‘How to improve the standard of paediatric radiology in our country?’ This issue was well discussed by Dr. N Khandelwal from PGI of Chandigarh and President Elect of ISPR. Dr. Y T Patel, the Conference Secretariet said, “Being an Indian citizen, I believe that a healthy child represents a healthy nation, a prosperous nation. As we all know that, today’s child is the fu-
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(From left) Dr Harshad Shah , Dr Y T Patel, Dr Sunil Puri and Dr Rohtas Yadav during the inauguration of the annual meet
Dr Mansukhbhai Shah, the chief guest delivering the inaugural speech
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Dr Harshad Shah, the President of ISPR, addressing the audience
ture of tomorrow. It is our responsibility and duty to take special care and provide the best to him/her. All the flowers of tomorrow are in the seeds we sow today.” There were excellent scientific sessions on academic topics, ‘Need of the day’. Dr Patel sounded very excited to share his happiness with Color Doppler team, “For the very first time, we successfully organized a good number of scientific sessions. We have received a registration of more than fifty paediatricians. And we could also manage to bring in ten renowned faculties who were actively involved in ISPR.” The 11th edition of ISPR was a great academic treat to all those who attended the event. More than 150 post-graduate students attended the sessions who aspire to be the future radiologists. The active involvement from students was another highlight of the event which takes the meet to the future. Dr Anirudh Shah, Senior Pediatric Surgeon, Ex. Professor and Head Paediatric Surgeon Department V S Hospital expressed his gratitude, “I really congratulate Dr Y T Patel for organizing the excellent meet with a record breaking attendance. I gained loads of knowledge. I am glad people liked my lecture on, ‘Acute abdomen in children’ and I am ready in future as well for any such knowledgeable gathering.”
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INDIAULTRASOUND SALES ‘N’ SERVICE www.ultrasoundindia.com
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The pride moment: The officials of Indian Federation of Ultrasound in Medicine and Biology, organising chairman and secretary of USCON XXII, the chief guest and guest of honor with IFUMB journal during the official launch at the USCON XXII in Puducherry
Journal of IFUMB Returns
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Dr. Chander Lulla, President of IFUMB, at the relaunching cermony
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ndian Federation of Ultrasound in Medicine and Biology (IFUMB), the foresightful organization that includes a bastion of ultrasound practitioners from various medical specialties, added another feather to their mission of spreading the message of safe and effective ultrasound in medicine. On 25th October 2013, the organization, under the leadership of Dr. Chander Lulla, President of IFUMB, relaunched the Journal of IFUMB at USCON XXII in collaboration with Color Doppler Media, the creative partner of the association. The grand launch function was attended by more than 500 delegates. The journal was long under the carpet and its relaunch was truly a much anticipated one. With highly-placed research articles from experts in respective fields, the journal is all set to scale new academic heights and has marked the beginning of a new era.
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Staging a wonderful platform of academic sharing and socializing, P4 | Message from the President curtain falls on USCON 2013 “Name one of the most fabulous ultrasound event happened this year, it would be USCON XXII.” “The interactive sessions were really informative. I congratulate the organizers for bringing together such wonderful faculties.” P5 | “The fruit of knowledge mixed with the thrills of entertainment was what USCON XXII”
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entioned above are the comments received from the venue of USCON XXII, Hotel Anandha Inn, Puducherry. As a looker-on and media partner of the event, Color Doppler too certifies that the above comments are P7 | never exaggerated. From 25th to 27th October 2013, USCON XXII, the 22nd National Conference of the Indian Federation of Ultrasound in Medicine and Biology (IFUMB) was held at Hotel Anandha Inn in Puducherry. With more than 500 delegates from across the world, the event presented a remarkable coalition of scientific sessions, workshops, presentations, new ultrasound device launches and gala dinners. The event, organized by the Madras Chapter of IFUMB, had the presence of several dignitaries from the ultrasound world. The Chief Guest of the function was Sri. K. V Raman, Director, Department of Health and Family Welfare Services, Puducherry. The Guest of Honor was Dr D Gurumurthy - Mission Director-NRHM, Puducherry State Health Mission. Other veterans such uscon utsav as Dr S Suresh, Dr Indrani Suresh, Dr. Chander Lulla, Dr Y T .Patel, Dr Rahul Sachdev, Dr P K. Shah, Dr. Alka Karnik, Dr Narendra Bhag and Dr Ashwin Lawande were also present at the inaugural function. After the inaugural function, USCON
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Through organizing constant events, academic programs and conferences at various parts of India, Indian Federation of Ultrasound in Medicine and Biology successfully launches. remains XXII witnessed the revamp of Journal committed to its mission. I am also proud to organize ISPR On the first day of the event, a gala of IFUMB. The journal, which was long 2013, the 11th National Annual Conference of the Indian night was conducted by Wipro-GE, under the carpet, was brought into light Society of Pediatric Radiology on October 5th and 6th, 2013 during which GE introduced Logiq F8, during this committee tenure, under the at the Ahmedabad Management Association, Ahmedabad
a new product line to their F-series ultraarduous effort of Dr. Chander Lulla, sound devices. On the second day, Philips President of IFUMB. The Journal, with From articles the Conference Secretariat made their mark by launching Epiq 7 research from clinicians across system, a machine that claims We are pleased to invite you tothe USCON XXII, 2013. ultrasound With India, aims at the educating medicos the concept perfection in of imaging, interpretationto and possess the most powerful architecture around withofinformation new chaldiagnosis in mind, we have chosen this year's theme to be ever applied to ultrasound imaging. It has lenges and case studies. "Beyond Ultrasound - Providing Solutions". USCON is an said that the machine was developed been interactive for sonologists and sonographers who “It was a session good effort from both sides, after a strenuous research of nine years. perform andfrom will also provide value for medical from our ultrasound side and as Color Dopprofessional who utilize scan reports to plan treatment Knowledge is wisdom pler’s side. We hope we can index the strategies Various interactive sessions for sonolojournal and see it in a better light. I am gists, sonographers and other medical quite confident that we will be able to professionals who utilize scan reports for Knowit Pondy achieve with the excellent clinical matedecisions was another attractive rial we receive the quality ofabout the 160 printkms attreatment Situated on theand Coromandel Coast, the South feature of USCON XXII. There were Chennai, this beautiful Territory, Pondicherry. asofwell”, Dr.lies Chander LullaUnion commented. exclusive sessions on women’s imaging, Known for its vast cosmopolitan, Pondicherry is one of the Launch Pad most sought after tourist destinations with stunningdoppler beaches,in Obstetrics, musculoskeletal USCON XXII was not a mereand acaexotic sightseeing opportunities tantalizing ultrasound, techniques of intervention, Frenchevent. cuisines demic It was also a venue for the peripheral vascular, OBGYN ultrasound industry leaders to join hands with the and 3D/4D ultrasound. clinicians. Major companies like GE, Dr. Abhay Avhad from Dr. Vikeh Patil Samsung, Philips, Trivitron, Esaote, Medical College and Hospital, Maharastra Toshiba, Hitachi Aloka, Magnuss, sees USCON XXII as a perfect exposure Sonoscape,Sonocare, Mindray etc. put for the post graduate medical students up their stalls at the event. Among them, who specialize in radiology. “This is GE and Philips had their new product indeed an informative and fruitful event.
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eventful Beyond learning new aspects of ultrasound, we could also take lessons from the experienced doyens of the ultrasound sector. I congratulate the organizers for bringing up such a wonderful event”, he shared. Dr Arindam Shah from Kolkata had a suggestion to share when asked about the scientific sessions. “The sessions were fabulous. It would have been better if the sessions lasted little longer”, he said. Dr Chander Lulla, President of IFUMB sees USCON XXII a fulfillment of organization’s vision. “It has been a wonderful experience, with a great team. Our team could achieve a lot by imparting medical education which was our main goal, with two mid-term CMEs with Dr Arun Kinare and Dr Y T Patel. USCON XXII was a grand success with more than 400 participants. We are also happy that we made it to the areas which need more exposure to ultrasound other than urban metros,” he said.
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IFUMB President Dr Chander Lulla with President Elect Dr Rahul Sachdev
“It was a wonderful experience with Color Doppler to bring a journal and a website. This is going to be very far reaching and important, because at the end of the day, people want clinical output from all the conferences and so
it’s a good forum for people to send their research articles. We want people to participate in by providing interesting cases. It is going to be beneficial for the entire ultrasound community,” he concluded. Dr Rahul Sachdev, President-Elect, feels IFUMB needs more representation in PNDT, towards which he intends to work during his tenure. “We should improve our academic standards to be of international quality and we should also have representation in the international arena such as how IFUMB had organized the Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) Triennial Conference in New Delhi in November 2010. It’s time we should be looking at the World Federation of Ultrasound in Medicine meetings,” he said. By all means, USCON XXII was a fabulous event that imparted knowledge to all delegates who attended the event and it sheds light to the future.
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coming
issue
2013: A Review
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t is time to bid adieu to 2013! During this one year, the imaging industry saw significant changes, both technology wise as well as market wise. This was the year when regulations like PNDT and Drugs and Cosmetics Act got renewed. This was the year Indian market showed a considerable boom in the imaging industry. This was the year when events like IRIA, USCON, Fetal Medicine, EMCON and PACE spread their knowledge wings to better horizons. Color Doppler could bring to you various facets of imaging industry through diverse sections. The coming issue will be a review of all what we have given you. Features of best imaging technologies/equipments, preview of 2014 stories, exclusive market focus and a complied list of the
best companies or equipments will provide you a complete 5 course menu. In addition, the one topic which we have exempted for long – Sports Medicine, an emerging field will also be featured. The articles intend to refresh our readers about what has been and what would be the imaging industry.
Read the next issue of to know more about the findings, technology updates and new machines introduced in 2013
Featuring the best imaging technologies/equipment in all imaging modalities Preview of next year’s stories Feature: Sports medicine– an emerging field Year-end review: Best of 2013 list IRIA 2014 preview
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