Cdoctober2013 by Color Doppler

October, 2013

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Interview: Dr. Arjun Kalyanpur | p16

Reaching the Unreached: Focus: Teleradiology and Telemedicine

Chief Pusher of Teleradiology Solutions elaborates on the future of teleradiology and telemedicine in the country

Vol 2, Issue 10, Pages 44

COLOR DOPPLER | OCTOBER, 2013

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COLOR DOPPLER | OCTOBER, 2013

inside scan

COLOR DOPPLER | October, 2013 | Volume 2 | Issue 10

p19 | under the scanner

Healing through Signals A technological marvel, a wonder backed by efficient communication systems, teleradiology has grown leaps and bounds. It has made the interpretation and consultation easy for the radiologists who are physically not present at the transmitting place and, thus, extending medical services to the remote areas. Despite of all the challenges, teleradiology is all set to achieve its full potential offering timely and improved diagnostic services writes Rini Baby Thottil

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p16 | wordsworth

Teleradiology Man Telemedicine is an all-in-one solution for many healthcare challenges in the country. But it needs a lot of efforts to reap the maximum result. Dr. Arjun Kalyanpur, Chief Pusher of Teleradiology Solutions, who knows the pulse of Indian and international radiology market alike, has a solid view on how to fight many of these challenges. Dr. AK is in conversation with Color Doppler on his â&#x20AC;&#x2DC;teleradiologyâ&#x20AC;&#x2122; dreams and vision

p25 | viewpoint

Teleradiology: Challenges and Opportunities Evolution of teleradiology has made drastic changes in the progress of healthcare sector in the country where emergency cases are on the rise. Dr. Amit Kharat explains how to use it for common good

p14

p32 | talking point

MRI to Play a Bigger Role

Columns

Novel Magnetic Resonance Imaging techniques will certainly become routine clinical tools, says Dr. Ponnada Narayana, the Director of Magnetic Resonance Research at the University of Texas Health Science Center, Houston

news scan event scan new product scan market scan

p35 | eventful

Looking into the Future The curtain fell on the second International Congress of the Society of Fetal Medicine at Hyderabad on September 1, widening the knowledge spectrum among the fetal medicine practitioners. Dubbed as FETAL MEDICINE 2013, the event presented an extensive formal agenda of Fetal Diagnosis and Fetal Therapy

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COLOR DOPPLER | October, 2013 Volume 2 | Issue 10 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 chief correspondent Jumana Engineer jumana@colordopplermedia.com copy editors Rini Baby Thottil rini@colordoppleronline.com Ria Lakshman V ria@colordoppleronline.com Purnima Sah purnima@colordoppleronline.com senior designer Sohan V K sohanvishnu@colordopplermedia.com designer, new media Amit Sudhans amit@colordoppleronline.com manager-product & HR Kishore Kumar P S kishore@colordopplermedia.com assistant manager, IT Swetha G swetha@colordopplermedia.com

editor's note Memories and Beyond! ‘Somewhere, something incredible is waiting to be known.’ This lovely lyrical ode by Carl Edward Sagan on the dichotomy of our need to explore and our duty to address suffering crossed my mind when I had entered the venue of USCON XXI, a year back in 2012, in the historic city of Aurangabad. The aura exemplified the innate spirit of the researchers and the industry experts, to bring out the best in the realm, pronouncing the new researches to fulfill the requirements of the needy. Three days were an exploration that kept abreast the light of knowledge and the ardency of enjoyment at an equal pace. Beyond a knowledge journey, USCON 2012 brought back to me the aberration existed between the ancient and the renewed culture of the city. Rock cut architecture of Ajanta-Ellora caves manifested an unparalleled creativity and artistic excellence beyond imagination. It was impossible to return without paying a silent tribute to the talented arms, who brought lives to those earthy stones. The journey was a saga of exploration for Color Doppler team as well. It was during USCON XXI that we published our first daily event newsletter, printed and published from the venue. It wasn’t easy to take scribes, designers and other technical necessities to the venue and print newsletters before the dawns. The voyage through uneven terrains taught us several things, adding a new feather to our publishing experience. USCON 2012 was lightened with the buoyant spirits of veterans like Dr. Bimal Sahani, Dr. Alka Karnik, Dr. S. Suresh and Dr. Mukund Joshi. They represented a bastion that moved together with a deep, united dream. Color Doppler was happy to be part of it. Now, we again join hands for another race with USCON 2013 with an exclusive supplement “USCON UTSAV”. We, along with the organizing committee, are also bringing back the IFUMB Journal, which was long under the carpet. Readers, this is a time, there you expect the unexpected from us. Meet you at Pondicherry. Till then, happy reading!!!

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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 Carestream Soars into List of Top Technology Innovators Carestream Health, a world-wide provider of innovative technologies that deliver exceptional value to both physicians and patients, was recently ranked 23rd on 2013 InformationWeek 500, a list of the top technology innovators in the U.S. Carestream was the only supplier of healthcare imaging and information technology included among the top 50 companies on the list. InformationWeek identifies and honors the nation's most innovative users of

information technology with its annual InformationWeek 500 listing, and also tracks the technology, strategies, investments, and administrative practices of some of the best-known organizations in the country. The theme of this year’s InformationWeek 500 was ‘digital business’. Carestream’s innovative digital healthcare technologies such as MyVue, a web-based

patient portal helped it secure the coveted 23rd position. MyVue portal provides patients security and online access to their own medical imaging data. They can easily store and share information, and makes it possible for them to collaborate with their desired specialists. Patients can play a greater role in their own healthcare with the assistance of MyVue portal. The best part of MyVue is that it is easily accessible and affordable for healthcare organizations to install and operate.

Together for a Noble Cause The employees at GE Healthcare celebrated their spirit of volunteerism by being a convoy of happiness for 150 students at the Sheila Kothavala Institute for the Deaf (SKID). The company also donated $25,000 (Rs.15 Lakhs) to ‘Akshaya Patra Foundation’, an NGO that provides mid-day meal for 1.3 million school children across 9 states and 19 locations in India including SKID. Students at the Sheila Kothavala Institute for the Deaf were in for a visual treat as 50 GE Healthcare volunteers including GE senior leadership team headed by Terri Bresenham, President and CEO of GE Healthcare, South Asia provided the school campus with an invigorating makeover. Using interesting art designs and vibrant colours on the

walls, GE volunteers gave the school facility a refreshing uplift by painting its interiors. The volunteers also led educational sessions with the students on improving personal hygiene and health. GE Volunteers initiative is focused at empowering students through education and community development. It supports four key areas of educations, healthcare, community development and disaster relief. There are over 15,500 GE employees in India across 12 cities who contribute over 27,000 hours towards voluntary service every year. The Volunteers work at schools, old age homes and orphanages. GE Volunteers have been supporting Akshay Patra Foundation for 6 years and SKID for the last 10 years.

Elekta introduces new imaging tools for Versa HD Elekta, a human care company pioneering significant innovations and clinical solutions, introduced ground-breaking image guidance tools for its Versa HD linear accelerator. The new technology enables real-time X-ray monitoring of internal motion during radiotherapy delivery. The new intra-fraction imaging capabilities within the Versa HD’s X-ray Volume Imaging (XVI) system provides the tools to monitor and manage internal motion supporting the clinician's efforts

to increase the therapeutic doses delivered to the tumor while reducing healthy tissue exposure. Uniquely, Elekta’s XVI, which is also available on other Elekta radiotherapy delivery systems, includes 2D, 3D and 4D intra-fraction imaging to support live imaging during sophisticated delivery techniques, such as Volumetric Modulated Arc Therapy (VMAT).

The latest capabilities within XVI include perfect integration with Elekta’s MOSAIQ image-enabled oncology information system. XVI and MOSAIQ work in harmony to provide elegant, highly automated imaging workflow for improved control, efficiency and performance. With image data available within the Oncology Information System, patient images, setup and correction data can be accessed as an integral part of the patient’s electronic medical record. COLOR DOPPLER | OCTOBER, 2013

news scan New CT Scanner Helps ‘Fashion Victims’ in the UK

The number of wearable and fashionable health and wellness technologies is on increase day-by-day. But, still fashion and health do not go hand-in-hand. Many sacrifices are made in the name of

sophisticated shoe-wear. Wearing high heels, more than any other shoe, are the blight of podiatrists. Many conditions such as the corns, Morton’s neuroma and plantar fasciitis can arise from excessive wear. The 2D X-rays were the conventional tool of choice for podiatrists and orthopedic surgeons assessing foot injury. However, a relatively new product called pedCAT from CurveBeam of Warrington, PA is bringing 3D load-bearing CT scanning to the fight against harmful heels. CurveBeam’s pedCAT scanner enables office-based foot and ankle scanning in a load bearing posture. The scan takes

just over a minute, and image reconstruction is complete within 2 minutes. It captures unprecedented diagnostic information not seen in regular x-rays. The easy to use visualization software adds a new dimension to diagnosis and evaluation. The system helps to confidently plan surgeries with precision and speed. Researchers at the Institute of Orthopaedics and Musculo-Skeletal Sciences at University College London in conjunction with the Royal National Orthopaedic Hospital are using the system to treat and manage shoe-related symptoms. The pedCAT puts optimal treatment planning at the fingertips of the user for greater confidence of increased predictability in surgical outcomes.

GE Healthcare Introduces Digital Broadband 1.5T 16 Channel MRI System in Haryana

GE Healthcare, the provider of transformational medical technologies and services that are shaping a new age of patient care and Dr. G. R. Gupta’s Manglam Imaging Centre announced the launch of Haryana’s first 1.5T Digital Broadband MR system – GE Optima MR360 Advance 1.5T. The MR360 Advance Digital broadband MRI provides superior high definition image quality and addresses the demand for, increased patient comfort, increased

COLOR DOPPLER | OCTOBER, 2013

productivity and reduced total cost of ownership under GE’s guiding principle of ‘Humanizing MR’. This novel technology will be a real boon to the physicians and patients of Hisar and surrounding regions. The digital broadband 1.5T 60cm bore MR has a patient appealing design, acoustic noise reduction technology and adjustable patient table which will be a boon to the patients undergoing the radiation free MRI. This system will help us achieve excellent image quality and patient comfort .The system can diagnose brain, spine, musculoskeletal and liver diseases, and enable body imaging and early detection of cancer. MR360 Advance comes with GE’s 16 channel Express coil technology that was designed to be intuitive and easy for technologists to use while improving image quality. This is also paired with a new low-height table for easy patient access, even for larger patients. It is designed to feature the OpTix Optical RF technology,

which offers high channel count, analog to digital signal conversion where it matters – inside the scan room to minimize noise and signal degradation, but away from the patient to enhance comfort and safety. OpTix provides up to 27% higher signal-to-noise ratio (SNR) over conventional, analog signal receivers, improving image quality and clinical confidence. Reduction in signal to noise ratio leads to high definition, superior quality clinical images needed for informed decisions on some of the most difficult patient procedures like neuro, cardiac applications, etc. MR360 Advance is engineered to use ecomagination-certified technologies like efficient gradients, water-cooling, super capacitors, and a Power Distribution Unit, reducing power consumption by 50 percent as compared to similar premium 1.5T competitor MR systems. With all of these ecomagination features, these systems are intended to lower the total cost of ownership while still delivering excellent clinical performance.

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event scan

USCON XXII to be Held in Pondicherry from October 25 October 25-27, 2013

Pondicherry: The 22nd Annual Conference of Indian Federation of Ultrasound Color Doppler is the official media partner at USCON 2013, EMCON, the Annual meet of Society for Emergency Medicine in India, Ultrafest 2014 and INSOUG 2014

in Medicine and Biology, USCON XXII will be held from October 25-27, 2013 in Pondicherry. The conference is organized by the Madras Chapter of IFUMB. The theme of the conference this year is ‘Beyond Ultrasound-Providing Solutions’. The conference will focus on issues in Women’s Imaging, Doppler in Obstetrics, First Trimester Screening, Fetal Anatomy, Muskuloskeletal Ultrasound, Techniques of Intervention and Peripheral Vascular. For details, log on to www.usconxxii.in

CT FEST 2013 to be Held in Mumbai October 25-27, 2013

Mumbai: CT FEST 2013, the 3rd edition of the annual CT program of MSBIRIA

will be held from October 25-27, 2013 in Mumbai. The program will feature sessions on Spine NeuroRadiology and Abdomen. CT FEST 2013 aims to bring together national and international personalities from across the globe to enlighten the participants on various CT and MR applications. The event will also feature comparisons, discussions and forums on imaging of the brain and spine using CT and MRI imaging modalities. For details, log on to www.msbiria.org

15th Annual Meet of Society of Emergency Medicine, India November 16-20, 2013

Kozhikode: EMCON 2013, the 15th Annual Conference of SEMI (Society of

Emergency Medicine in India), will be held in Kozhikode, Kerala at the Vythiri Village from November 16-20, 2013. It aims to bring together national and international personalities from around the globe. The participants will be enriched by 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 will be held from November 29 to December 1, 2013 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 the 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

Are you organizing an event? Inform us, we will give you much-needed publicity. For details: info@colordopplermedia.com

Mumbai: An advanced course in OBGYN Ultrasound, INSUOG 2014 will be held in 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

COLOR DOPPLER | OCTOBER, 2013

new product scan

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Greater Patient Comfort:

Aquilion Prime

quilion PRIME, introduced by Toshiba is a CT system with cutting-edge technologies designed to meet all the current and future clinical needs. The system has the worldâ&#x20AC;&#x2122;s fastest reconstruction speed of up to 60 fps, even with AIDR 3D and sets the smallest footprint in the premium CT market segment. The system has a 780 mm aperture, the largest available in a high-end CT system and ensures greater patient comfort. The unique patient couch is accurate even with a load of 300 kg, and is the only couch in the market with the Tech Assist Lateral Slide feature. Routine 0.35 second ultra fast helical scanning ensures fast examinations with dramatically reduced risk for motion artifacts. The system has integrated efficient dose reduction technologies essential for optimal dose management. Adaptive Iterative Dose Reduction 3D (AIDR 3D) has therefore been effortlessly integrated with SURE Exposure 3D, Toshiba's automatic tube current modulation software. When combined with AIDR 3D, X-ray exposure is automatically reduced before

the scan, up to 75 percent, while maintaining the preprogrammed image quality according to the required level of noise reduction. Aquilion PRIME also includes advanced applications shuttle helical brain perfusion, dual energy and 3D CT fluoroscopy. Multiphase shuttle helical scanning can be used to acquire dynamic volume data in brain perfusion studies. The analysis software performs 3D perfusion processing and 3D CT DSA using the same scan data. Innovative redesigning of Aquilion PRIME has reduced the required installation area to just 14.8m2. This high-end multislice CT system has been made compact enough to meet even the most restrictive spacing requirements. The system also features a hybrid filter and quantum detector. It is available in 80 and 160 slice configuration. The system helps in streamlining the workflow by increasing the patient throughput and reducing the waiting times, simultaneously.

COLOR DOPPLER | OCTOBER, 2013

new product scan

Direct to Digital:

DX–D Retrofit

X-D Retrofit is an affordable DR solution from Agfa Healthcare, a global leader in the fast growing market of integrated IT and imaging systems. The solution maximizes the use of existing equipment while simplifying installation. The healthcare services using either analog or computed radiography (CR) can be upgraded to the benefits of direct radiography (DR) without replacing the existing equipment with the help of this new DR solution. It is an affordable way to go digital. DX-D Retrofit consists of a flat panel detector, a retrofit box and an NX workstation with Agfa HealthCare’s gold standard MUSICA image processing software. MUSICA has been specially adapted and tuned to further improve the excellent DR image quality. It ensures consistent image quality and high contrast detail. The noninvasive installation of the DX-D Retrofit solution poses no risk to the imaging modality, while offering improved workflow, high image quality benefits and speeds up exam time. DX-D Retrofit can be simply connected to the imaging unit’s

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console and does not change the existing functionality of the modality. It can safely function in combination with the original equipment. There is no risk of patients’ cassettes being mixed up and unlimited number of images can be stored and can be sent immediately to the PACS or imager in DICOM format. The 35 x 34 cm image size of the detector helps it fit to any standard bucky tray and can be removed to ensure versatility for all exams. The NX workstation interface shares the same look and feel of Agfa HealthCare CR solutions, offering fast previews and low cycle times, as well as the best connectivity with Radiology Information Systems (RIS), PACS and Hospital Information Systems (HIS). DX-D Retrofit comes with high quality wireless and tethered detectors, either Cesium Iodide (CsI) or Gadolinium Oxysulphide (GOS). The superior image quality of CsI provides the potential for significant patient dose reduction, as well as wireless capability.

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Dr. Arjun Kalyanpur Ria Lakshman V | cd news

India faces a scarcity of radiologists. The country with a population of 1.2 billion people has a radiologist strength of nearly 10,000, which means the ratio between the doctor and the patients is 1:100,000, which is very low. When there is such a huge scarcity of radiologists, the market potential of teleradiology is high

his is the magisterial account of the success and the glory of the one of India’s first teleradiology companies, Teleradiology Solutions (TRS). Being the brainchild of two Yale University trained radiologists, the company is a riveting chronicle of the often sophisticated tale of teleradiology that interprets diagnostic reports such as scans, x-rays, MRIs and more through a remote process wherein the radiologists sit in other locations. The saga has rocked the imaging industry on the whole, and matched it to the extraordinary individuals and institutions who have achieved the impossible. The company was rated as the number 1 National Teleradiology company in United States by KLAS in 2011. The company was also showcased to the US President, Barack Obama as a demonstration of healthcare innovation during his 2010 Indian visit. Today, TRS provides teleradiology services to over 100 hospitals in the US, Singapore, Europe and even to the remote parts of India, where ‘teleradiology’ was an unheard term. Here, its visionary leader, Dr. Arjun Kalyanpur speaks about Telerad Solutions, its products, plans and processes. Being a medical graduate from All India Institute of Medical Sciences, New Delhi, Dr. Kalyanpur has seen the evolutionary traces of teleradiology in India. With the fellowship training in Body Imaging at the Cornell University Medical

Center in New York and in Neuroradiology at the Yale University School of Medicine, New Haven, Connecticut, he is one of the Indian radiologists certified by American Board of Radiology. From his experience as the Clinical Faculty at Yale University and from being the co-author of numerous research papers in the field of teleradiology, he knows the different segments associated with radiology in India and abroad alike. Excerpts from the interview: Studying clinical reports from a distant location is a revolution in every sense. And, you sensed the revolution much before anybody else. A project started while being a student at Yale is now an acclaimed firm of high reputation. Can you evaluate a bit on the evolution of Telerad Tech? It was during my residency and fellowship at Yale University that I first experienced teleradiology, when scans were sent electronically for reporting to the radiology staff from another hospital at the other end of the university. In 1999, I returned to Bangalore, but continued to travel to the US to work at Yale. There was a shortage of radiologists in the US then, and I was asked to remain on the faculty. I wanted to work from Bangalore and ,with the support of the department Chairman, a live project was started with Yale, where I analyzed the images sent to me over the internet from my office in Bangalore. This is how the concept developed and we published several articles on the subject. Later, in FebruCOLOR DOPPLER | OCTOBER, 2013

wordsworth ary 2002, the company was started and a website was designed after which the clients started pouring in. The network later grew through referrals from our satisfied clients. In 2005, our company became the first healthcare organization outside Singapore to be accredited by the Ministry of Health, Singapore. The polyclinics in Singapore had a problem. The turnaround time for reporting of X-rays was three days, which we manage to reduce to one hour by implementing teleradiology reporting. This was a significant achievement that received acclaim from both the leadership and the media in Singapore. By 2006, the company was shifted to its own campus in Bangalore. Since then we have diversified into various other businesses in the same healthcare-technology space. We have Telerad Tech, our technology division that has developed an intelligent Teleradiology workflow named RADSpa; we have RxDx, a multi-specialty outpatient clinic and diagnostic center, we have a radiology teaching portal www.RadGuru.net that provides teaching resources for radiologists across the globe, and we have Image Core Lab which provides specialized reporting and analysis services to pharma and biotech companies conducting clinical trials. We are a managed services provider for Telemedicine. And we also have the not-for-profit Telerad Foundation which provides reporting services free of charge to hospitals in remote locations Having experience in the US, Europe and different Asian countries, how do you see the standards of Indian radiology segment? The standard of radiology in India has significantly improved since the time when I was a medical student. Primarily the access to high end imaging technology has seen rapid development in the past two decades. While in the past, imaging in India was focused on conventional radiology and ultrasound, today it has evolved into sophisticated and advanced imaging technologies including multislice CT, MRI, PET-CT etc. In the 1980s, when I was doing my radiology residency at AIIMS, there were only a few educational programs that gave postgraduates exposure to MRI or even CT. Many of

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the colleges that taught radiology courses had neither of these equipment. So the residents had to travel to private centers for hands on experience on CT and MRI. From such a situation, today the latest technologies in radiology are unveiled in India simultaneously with the West. The standards in India today are thus, equally on par with other developed countries. India is an emerging teleradiology market. From a businessman’s point of view, how did it enhance the medical practice in India? The Indian economy has been growing at a fast pace. One of the benefits of this is that investments are pouring into the healthcare market, resulting in deployment of high end diagnostic technologies across the country. The consumers too are more aware of their healthcare and diagnostic needs. Thus, the need for quality imaging has risen significantly. But, India faces a severe scarcity of radiologists. Our country with a population of over 1 billion people has a radiologist strength of only 10,000, which means the ratio between the doctor and the patients is 1:100,000 which is extremely low. When there is such a huge scarcity of radiologists, the benefits that teleradiology can offer and hence its market potential is high. Hence, teleradiology can not only enhance the level of medical practice in India, but also help to fulfill the radiologist requirement of the industry. Newer hospitals that are coming up in smaller towns are able to receive high quality reports in a short time even if they do not have a radiologist in house at all times. In the coming years, India will witness a rapid market growth in terms of teleradiology.

Started in 2002 as a service provider to the US hospitals in radiology report analysis, what are the major challenges that you and your team have faced during the last one decade? Being the first-of-its-kind company, we had to face challenges initially. People were new to the idea of teleradiology and we needed to educate them about its benefits. We recruited radiologists who were in the US at that time and who were planning to relocate to India. The company started with just two employees. India’s broadband connectivity, which was limited at the time, was another hurdle, as it was unreliable and the need to have multiple backups pushed up the costs. Other infrastructural challenges such as power outages also provided a threat, requiring major costs such as multiple UPS and generator backup. Furthermore at the start, India was still being perceived as a ‘third world country’ and we had to work exceptionally hard to overcome this perception by delivering very high quality of service. What are the significant differences between conventional radiology practices and teleradiology practices? How reliable is the teleradiology services when compared to conventional radiology services? The essential difference between both is the presence of radiologists on site. In conventional radiology practice, the radiologist is present physically at the site of imaging, whereas in teleradiology, the images are interpreted remotely by a radiologist who is not present at the site where the images are generated. Teleradiology improves patient care by allowing radiologists to provide services

wordsworth without actually having to be present at the location of the patient. This is most helpful in the emergency setting. This is also important when a subspecialist such as a musculoskeletal radiologist is needed. Since these professionals are often located only in metropolitan areas, this has the potential to create a delay in patient care. Teleradiology helps here by allowing for trained specialists to be available anywhere, at anytime. Teleradiology services tend to be more focused on quality as they are held to a higher quality standard than onsite radiology groups. Best practices such as peer review, quality checks, accreditation by standards agencies and HIPAA compliance are all features of top teleradiology companies such as Teleradiology Solutions. The services are complementary. However teleradiology has the advantage of timezone difference and better coverage of remote geographical areas. How efficient is teleradiology in dealing the follow up examination amidst the treatment of any complex medical condition? Teleradiology is not just used only in emergency examinations now. It is true that it has made its greatest impact in emergencies, but it has continued to deliver high standard interpretation services even for follow up examinations. In our practice, a significant number of the examinations, both in the emergency and outpatient setting, are follow up examinations, where the prior images are also available to us for comparison. The use of cloud based technologies and long-term archival allow for storage of and access to serial patient examinations in the teleradiology environment. There is a speculation that teleradiology services create a distance between patients and the clinical radiologists. How do you see this? While the radiologist is not present on site in teleradiology, the level of communication still remains high between the radiologist and the hospital. For instance, in our work with US hospitals, even though we may be half a world away, our radiologists communicate telephonically in real time with the physicians at the hospitals to communicate critical results immediately. In fact, many local radiology groups

practice radiology from off-site providing services to 2-3 hospitals or diagnostic centers at the same time. And even within the hospital a lot of the communication between the clinician and the radiologist takes place over the telephone. So in the electronic age, with modern telecommunications, teleradiology is not really that much more remote or distant. There are many ethical issues such as security breach, patient data loss, privacy issues, manipulation of data, etc. connected with teleradiology practice. What is your insight on this? The issue of security breach or data loss is not limited to teleradiology alone, but can affect even the local network at a hospital. Patient data security is dependent on compliance with regulations such as HIPAA which are focused on protecting data integrity. An organization providing teleradiology services cannot have any credibility without demonstrating adherence to such norms and regulations. Overall, teleradiology service providers have (or certainly should have) a significantly higher level of awareness about patient security issues than onsite providers, as their livelihood depends on it. In general, ethical issues depend on the ethics of the radiologist concerned. Any radiologist has to strictly adhere to professional values and the same applies to those radiologists who practice teleradiology. How different are your products such as RADSpa from other similar products available in the market? RADSpa is a unique cloud-based teleradiology workflow Intelligence System with integrated image management (PACS). Unlike the traditional radiology systems with disparate RIS and PACS, RADSpa incorporates several intelligent systems that would maximize the radiologistsâ&#x20AC;&#x2122; productivity and user experience. It is optimized for multi-site, multi-radiologists set up and can be integrated with any existing PACS. With RADSpa, high speed reporting has been made possible, and features such as voice dictation and voice recording are integrated to it. It enables fast downloads even at peak loads and limited bandwidth. Its mobile version makes it easier to report from an iPad or iPhone. Overall, it makes the admin-

istration and management of radiology practice seamless. What will be the future of teleradiology in India? We are facing a real shortage of radiologists in India and hence, there lies the necessity to spread the utilization of teleradiology across the country. Outsourced teleradiology is a growing trend, but there needs to be a constant focus on quality and technological innovation. The recent exciting advancements in technology such as the use of mobile phones and tablets further enhance the delivery of teleradiology, and are set to grow in utilization, especially with the new generation of radiologists who are more technologically savvy. The field of teleradiology is becoming vast and complex. To keep pace, radiologists need to get specialized training in the use of digital technologies. This trend is nascent in India. Furthermore, clinical sub-specialization, such as neuroradiology, pediatric radiology, etc. is important to develop a better clinical understanding of the subject and will enhance the practice of radiology, including teleradiology. In this era of internet technologies, all of radiology is moving towards teleradiology. India is ultimately no exception. Many teleradiology outsourcing centers are sprouting up now. Wouldnâ&#x20AC;&#x2122;t such a scenario affect the quality of the treatment? There is definitely a need for more teleradiology options in India, as the requirement for radiologists is very high, beyond the point where each new hospital that is coming up is able to have its own exclusive radiology staff. So outsourced teleradiology is a necessary and welcome trend. If the centers that come up are well supported through teleradiology provided by competently trained radiologists using secure and robust technology, then it will only make a positive impact on the healthcare industry. However, if centers are built with the aim of only making profits, then you are right â&#x20AC;&#x201C; the quality of radiology will be affected. Ultimately, if teleradiology services are provided in accordance with rules and regulations, with a focus on maintaining quality, then they will provide tremendous value to the medical industry and the public overall.

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under the scanner

Rini Baby Thottil l cd news onders happen when the healthcare system is backed by efficient communication systems. One such wonder is ‘teleradiology’, a branch of telemedicine. The demand for diagnostic and image interpretation need in radiology is on increase across the world. Owing its birth to the imbalance of demand and supply, teleradiology, to a great extent, evenhanded this need by its immense capability to transmit radiological images of patients, generated by all noninvasive imaging modalities such as x-ray, CT, MRI, ultrasound and nuclear medicine from one location to another. This made the interpretation and consultation easy for radiologists who are physically not present at the transmitting place. The initial attempts in transmitting images using a communication medium dates back to 1929, when dental x-rays were transmitted to distant locations with the help of the telegraph. Later digital cameras were used to take clinical photographs and scanners were used to scan radiographs. The digital images were then converted to jpeg images and transmitted via the internet. This system did not guarantee any image quality ensuing in lowering the chances of accurate results. The whole process was time consuming as well. Today, digitized images are transmitted across the globe using high-speed telecommunication systems in no time. With the advent of teleradiology, major challenges such as the lack of adequate staff for providing interpretive coverage and the requirement of specialty expertise were solved to a considerable degree. Teleradiology has grown leaps and bounds and evolved a field with great opportunities and tremendous application potential. It is not anymore a science fiction. It is not anymore ‘prophesied’ or ‘empirical’, but has emerged a crystal clear reality of today. Global Teleradiology Market Different studies conducted by market experts exhibit a healthy growth during the forecasted period of 2011-2015 with a growth rate of 19.3 percent per annum. The advancement in digital technology in

remote patient diagnosis is one of those key factors that accelerated the growth rate of teleradiology market worldwide. The penetration of vendors offering mobile health (mhealth services) has been one of those large movements forward which played a vital catalyst in precipitating the teleradiology market. The rising demand for medical tourism and the increasing number of manufacturers providing mobile healthcare services are two other factors that contribute to the growth of the teleradiology market. Some of the key players in the teleradiology market include AgfaGevaert NV, Teleradiology Solutions Pvt. Ltd., StatRad, American Telecare Inc. and FujiFilm Medical Systems USA Inc. The teleradiology market is geographically divided into North America, Europe, Asia-Pacific and the rest of the world regions. The North American region is the largest market in terms of market share followed by Europe. The Asia-Pacific market is expected to exhibit a faster growth rate in the coming few years due to the future opportunities owing to the economical growth of nations such as China and India. Teleradiology has now become the basis for the sprouting of a number of commercial enterprises that provide outsourcing services for image interpretation. But despite of all its developments and positive responses to the development of e-health initiatives, the inadequacy of common standards still poses a challenge to this emerging teleradiology market. Teleradiology Market in India The healthcare sector in India has been

making very impressive strides in recent times. It is worth more than US$ 79 billion and is expected to reach US$ 160 billion by 2017 with a compounded annual growth rate of 15 percent. India’s huge population represents a greater opportunity for teleradiology market. According to a study conducted by a London-based market intelligence firm – Tekplus, India accounts for 68.6 percent of the global health imaging market. Unlike the conditions existed before a decade and a half such as poor broadband width, inadequate infrastructure and lack of trained teleradiologists, India has emerged a potential teleradiology market with well trained teleradiology professionals, better infrastructure and improved communication system. This, to a great extent, bridged the demand-supply gap between qualified radiologists and those leaving in the remote regions of India. Teleradiology services in India now makes it certain that the teleradiology needs across almost all parts of the country are met efficiently, providing a round-the-clock service. It has also gained momentum as a helping hand in reporting in emergency situations. The current efficient teleradiology practices in India is the reason why teleradiology services across the globe are being outsourced to India. Outsourcing of ‘on-call’ night reporting is popularly called as ‘nighthawking’ and this on-call night reporting is mainly outsourced from countries such as the USA, UK and Singapore. The cost of medical imaging examinations being considerably low, cheap labour, time difference and skilled support staff are some of the binding reasons why teleradiology services COLOR DOPPLER | OCTOBER, 2013

under the scanner are outsourced to India. Besides these advantages, outsourcing teleradiology services to India will not only help them with assurance of competent radiology services, but also provide them with timely professional help. The developments in teleradiology practices is going to transform India to a teleradiology hub in near future. How Teleradiology Works Unlike the radiology equipment in the past, the current medical imaging equipment is completely DICOM (Digital Imaging and Communications in Medicine) compliant. This helps with the acquisition of images from the modality and storing them on a network or workstation in a DICOM format. DICOM allows lossess compression of images and the original images can be perfectly reconstructed from the compressed data. The probability of loss of data is very small and depends on the type of imaging modality. At present, the reconstruction of compressed mammography images remain a blockade to reliable teleradiology as the file size of these images are large. Compressing these images can considerably lower their resolution which can put the accuracy of the result at stake. Once the images are acquired and stored in the DICOM system, the images are transferred using the high-speed lines making it possible for different centers to connect directly or over the internet for transmission of images. Once the images are transferred to the receiving centers, they are viewed using a workstation that has the capability to display high-resolution images. eFilm is an example of workstation which is used for viewing and manipulating medical images and can also be integrated with an institution. Data captured from various imaging modalities can be displayed, analysed, processed, stored and communicated across computer networks using this program. On completion of the data processing and analyzing, the data sent in DICOM format are stored in Picture Archive and Communication System (PACS) and will assist with diagnostic viewing, electronic image storage and distribution. RIS (Radiology Information System) on the other hand comprises of patient tracking and scheduling, result reporting and image tracking capabilities and is used by radiolCOLOR DOPPLER | OCTOBER, 2013

Radiologists need to be aware of the security, privacy and confidentiality issues related to teleradiology so that they can protect not only their own interests, but protect the interests of their patients as well ogy departments to store, manipulate and distribute patient radiological data and imagery. Ethical Issues Teleradiology is now a well recognized part within the healthcare system of any country, but the ethical issues surrounding this practice remain unclear. The technical implementation of teleradiology systems is accompanied by data protection and security issues, which in the past has often been based on the Hippocratic oath, requiring physicians to maintain the confidentiality of the details of their patients. With the widening of teleradiology practices, radiologists must deal with legal and regulatory restraints that include privacy laws, malpractice liability and licensing. Radiologists need to be aware of the security, privacy and confidentiality issues related to teleradiology so that they can protect not only their own interests, but protect the interests of their patients as well. Though it is generally believed that the electronic systems enhance security, even the most sophisticated electronic system cannot be likely to offer perfect security. Hence, there is a need for practicing available privacy laws. Privacy laws vary from country to country, and it remains the responsibility of the healthcare provider to maintain and implement a network security system that may incorporate passwords, encryption, security cards and surveillance software. Mobile Teleradiology Employing mobile telephony to transmit and display images on mobile devices and tablets is what called as mobile teleradiol-

ogy. The availability of smartphones with high display quality on which radiology images can be viewed in high resolution. This capability makes smartphones a mini workstation. The availability of high-speed internet facilities such as 3G in mobile phones allow rapid transfer of images from a PACS server to a mobilephone making cellular teleradiology a reality. With its potential capabilities and ease of access, mobile teleradiology has revolutionized the teleradiology industry by enabling radiologists to access images, evaluate them and dictate a report at the touch of a button. For example, consider an emergency situation when the patient has to undergo a CT scan and the radiologist is not readily available to interpret the images. This delays the whole diagnosis procedure, thereby increasing the the risk of lifethreatening complications. This is where mobile teleradiology shows its potential. Sending the images over a mobile device allows instant consultation and the radiologist can access the images on the mobile device and evaluate them. One advantage of mobile telemedicine is that the raw images are sent to the radiologists and not the scanned ones. This will help him with a better understanding of the images and can plan the treatment procedures accordingly. Several recent studies on mobile teleradiology have authenticated the use of mobile telephony for immediate diagnosis in cases of acute strokes, which consecutively can facilitate early administration of brain-saving thrombolysis. Studies have also proven that iPhones can be used for immediate examination of CT images of acute appendicitis. Telerad Tech, a Benagluru based provider of worldclass radiology automation systems, teleradiology software, radiology workflow solutions, web based PACS and RIS integration, has developed a radiology workflow platform, RADSpa, which has a mobile application that will enable radiologists across the world to function from any location over the iPhone. Technical and Operational Limitations Image data in a PACS are stored separately from other information about the patient. Therefore, even the most basic

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under the scanner collateral information, such as indications for performing an examination, typically must be collected by someone at the sending site and transmitted separately from the images. Patient information, either be faxed or e-mailed after someone at the sending location has redirected it to a manageable form. The point-to-point connectivity for image transmission in no way implies true integration of systems. Even if the PACS system used at both the sending and receiving locations are from the same manufacturer, differences in registration numbers and security issues contradict against an integrated exchange of data. Also, the interpreting radiologist has no direct means of accessing the data stored in the system in the sending location as the receiving system is not integrated with the sending site. Hence, the interpreting radiologist cannot directly access any other data other than the sent ones which may be required for interpreting the case. Another major issue connected with the non integration of systems at sending and receiving locations is that once interpreted, the report has to be sent back to the initiating location. There is no option to electronically generate reports and send them for direct inclusion in the RIS of the initiating site. Rewards of Teleradiology With the advent of teleradiology, radiological consultations were made available in remote areas with no onsite radiological support making its geographical reach limitless. Timely availability of radiological images and radiological image interpretation while in an emergency was made possible. There is a huge pressure on radiologists, given the huge quantity of images being produced worldwide combined with the scarcity of radiologists. Teleradiology has proved a financially advantageous approach to solving these issues. It has facilitated radiological interpretations in on-call situations and provided subspecialty radiological support as needed. It enhanced the educational opportunities for practicing radiologists. Risks associated with Teleradiology Some of the risks related to teleradiology are directly connected to the technical limitations of the field. The chances of

interpreting the examination results in a less complete fashion than they would be in usual practice. The reason why emergency teleradiology reporting usually works well is mainly because of the lack of need to evaluate prior examination results and the limited amount of collateral information needed for interpretation. While conducting a comparison or follow-up examination in the middle of treatment of complex medical conditions such as cancer, it is impractical to incorporate all the image data like the conventional radiology practice. The quality of outsourced teleradiology services is another area that needs to be seriously looked at. Depending on outside teleradiology providers for off-hours can potentially harm the reputation and professional standing of radiologists. A group of radiologists who do not have subspecialty expertise are at risk of having atleast a portion of their practice taken away from them through teleradiology as a number of private groups and commercial companies are now dedicated in providing subspecialty interpretations. Threats and Opportunities Teleradiology, through its immense capabilities, proved an efficient system to transfer radiology data and made possible the consultation and interpretation of data despite keeping a check on time and space. But a trend that is seen growing in recent time is the commodification of the practice in the international market. If not

guided in the right direction, the movement of diagnostic imaging out of the hospital using this technology will result in losing its credibility and reliability. Teleradiology also had a consequent impact on direct clinical care at a potential cost of distancing the patient from the clinical radiologist. Implementing it in the right direction, teleradiology provides the healthcare system with an opportunity to distribute the workload and improve access to competence. A sense of equilibrium can be brought in between the unbalanced distribution of patients and radiologists if practiced efficiently. Efficient use of this system can avoid the referral of patients to a larger hospital and hospitalization can also be avoided in some cases. Another opportunity is that radiologists using teleradiology to support each other in their practices can create new practice models. The Future As an emerging medical specialty, teleradiology can provide a compelling alternative to conventional radiology practices. It is expected to continue to shift healthcare delivery from the hospital or clinic into the home. It is likely that teleradiology will provide timely service, provide access to subspecialist clinical expertise and match supply with demand better. The need for further standardization and better regulation of the financial and legal aspects still exist and have to be addressed in near future to make it more efficient and secure.

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viewpoint

Teleradiology: Challenges and Opportunities Evolution of teleradiology has made drastic changes in the progress of healthcare sector in the country where emergency cases are on the rise

Dr. Amit Kharat Radiologist and Domain Consultant, Cyber Tele Radiology Pvt Ltd.

eleradiology is changing the dynamics of the radiology practice and can be considered as a critical revolution in imaging, which has positively affected the way we are diagnosing and treating patients. Remotely aided diagnosis through the medium of teleradiology prompts rapid patient treatment. Patients can receive the required care and therapy can be initiated instantaneously once diagnosis is made. Itâ&#x20AC;&#x2122;s a boon at places where availability of expert opinion is difficult to obtain. However, there are many challenges before the teleradiology can become the mainstay of radiology practice. We need excellent Information and Communication Technology (ICT) that covers the remote areas of the country, so that images can be transferred into the radiology grid. Our average internet speed is 1.3 Mbps, while the global average is 3.1 Mbps. For the successful practice of teleradiology, we need to have good ICT at Tier II, Tier III cities and villages. Currently, 3G and 4G mobile services do not have a strong presence in the rural areas. Broadband lines do not penetrate beyond 3.5 to 4 km from the exchange. For WiMax, there are far less customers and the terrains are diverse. Hence, implementing it is not feasible. Other options include Wi-Fi, satellite and Balloon technology. Wi-Fi technology is

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limited by range. Satellite technology is high speed and gives good coverage, but is limited by cost. The Balloon technology is experimental and is recently being studied by Google for providing internet is rural areas. The availability of internet in rural hospitals, diagnostic centers with aid from the various government schemes can help transform teleradiology in such setups. Uninterrupted power supply to run the computers, peripherals and internet is again a challenge in rural areas where frequent power disruptions can bring these services to a standstill. It becomes challenging and expensive to run these equipments and maintain them in such situations. Currently, the teleradiology software market is diverse. The software installation may require an engineer to visit the site. The rest of the change, upgrades and modifications in software can be implemented remotely for which stable internet is required. If the programme stalls or connectivity fails, remote access can be used to rectify the problems. There are many software providers, either provided by the imaging company or by a third party vendor. The third party software are popular and compliant. There is always a local preference as scanning centers always expect rapid online support for easy trouble shooting when system fails. However with rapidly evolving technology, centers can directly store images on secure servers and assign to specific radiologist giving them a complete control of the radiology images. The third component in the chain of teleradiology is the radiologist. Since the paradigm shift from hard copy film based case reporting to soft copy reporting on workstations, there has been a tremendous change in the ways studies are being read. The radiologist now has to improvise interactions with the remote centers

and ensure that they follow standard radiology techniques. He also needs to be constantly reachable through emails; live chat accounts or phone to consultants who are far away and assist them in reaching the correct diagnosis based on image interpretation. The radiologist can rapidly alter imaging techniques customizing them to the requirement of the particular study and can advice technologists by providing feedback on the scans. Also, radiologist has the important task of finalizing reports. Radiologists role has therefore, become more global and his workspace more virtual than real. This increases the pressure on the radiologists. The reporting workstation is a vital part of the teleradiology process. The ideal workstation usually replicates the feel and resolution of the console on which the scan images are generated. The radiologist reporting room should follow proper ergonomics to reduce strain and work related ailments. Workstations should have adequate screen luminance which can border between visual fatigues to comfort as the radiologist will be spending a good 8 to 10 hours observing the screen. The pixel strength of the monitor for the CT, MRI reads can be around 2 to 3 Megapixel and 5 Megapixel for the X-ray and Mammography studies. The memorandum of understanding and contract details should mention in details the role of each service provider, the process of report documentation, electronic signature, storage of reports, storage of images and back up services in cases of system failure. In conclusion, the teleradiology revolution in the evolving and mutating digitized world will need a consensus between the vendors, imaging centers, government bodies, software providers and reporting radiologists to standardize the process so that benefits reach a larger section of the society.

under the scanner

Reaching the Unreached Started by two US returnees with the sole intention of serving Indian healthcare, Teleradiology Solutions has survived many unfavorable conditions to achieve the status of one of world’s best teleradiology and telemedicine centres, which serves emergency departments in the US, Singapore and many other countries in different continents and hundreds of rural Indian patients who are other ways deprived of proper care. Joby Joseph and Kishore Kumar P S take a tour to Teleradiology Solutions to understand the keys to its success Scene 1: Monks who live in the wild Chhattisgarh, the 10th largest state of India, is soaked in deciduous forest. The bastion stands aggressively amidst the mountains and green trees of mountain range. In the monsoon, the area is filled with the mist, brilliant green foliage lines the route and waterfalls punctuate the verdant hill sides. A Tibetan monastery is situated between these lustful forests. The land stays away from the hush of cities, with no easy access to the basic necessities. The constant rain makes the Tibetians vulnerable to diseases. Among the chants of prayers, their cries of pain echoes louder, wrapping up the undulating terrain ever. With poverty, lack of knowledge and awareness, visiting physicians for medical treatment is not an easy choice for many of them. But, when they do, they walk down to the specially set up health centre with telemedicine. The operator takes them to the physicians sitting down to South, the garden city, overcoming the inefficient net connectivity and power shortage. The operator connects the specially designed devices in order to check the patient’s weight, blood pressure, cholesterol, ECG, temperature and more. At real time, the doctors sitting at the telemedicine centre at the Teleradiology Solutions check the values, see the patient and talk to them. They even heard the heart beats through headphones. Based on data, medication is prescribed to heal his pain, free of cost. Can you find a better way to treat the unreachable? Perhaps nobody could, except Dr. Arjun Kalyanpur and Dr Sunita Maheshwari – the chief pusher and chief dreamer of TRS.

Scene II: Beyond the boundaries It was a golden Sunday morning of November in Philadelphia. The thick veil of mist and the surrounding dynamic mountains in the dense countryside added a sense of adventure, mystery and romance to the drive through the lush green roads. Weathered by the dense air condition inside the car and the beams of sun penetrating through the plain glasses of the window, the driver failed to sense the anachronistic ghost of death entering inside. The car shuddered. All he could see was a huge white board descending. The beams entering from the window panes have now receded. As the board reached closer, noisily breaking the branches, the view became clearer. The lovely red car has hit a huge white board on the side of the road. The driver could sense the muscles getting tightened, the bones breaking and the creek sounds of the dashboards crushing into pieces. With the sirens of police vehicles and the screech of ambulance filling the air, the memory faded. With stench of chemicals offending the nose and with the walls hearing more prayers than churches, the hospital ambiance was scourged with the fear of death. A detailed report is needed to decide the treatment and the radiologist has left hospital hours earlier. The fear aggravated, the cries grew louder. No time to waste. The reports were sent half across the globe, to the majestic land of India. A young doctor sits in the Silicon Valley of India to read and re-read the reports send from anywhere on the globe. And he, is here to decide the fates - Dr. Arjun Kalyanpur.

“By ‘flat’ I did not mean that the world is getting equal. I said that more people in more places can now compete, connect and collaborate with equal power and equal tools than ever before. That’s why an Indian in Bangalore can take care of the office work of American doctors or read the X-rays of German hospitals.” – Thomas L Friedman, The World is Flat

nowingly or unknowingly, the renowned American journalist-cum-author said what Dr. Arjun Kalyanpur and Dr. Sunita Maheshwari made possible. And, scene I and Scene II are slightly exaggerated description of their innovative treating methods that captured our hearts during our one-day tour to TRS –

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under the scanner

one of the world’s best teleradiology and telemedicine centers. Although outsourcings are prominent and trivial in the so-called Silicon Valley of India, it is not easy for anybody to imagine a doctor networking to different parts of the world, connecting the remote and unreachable areas within his own countries and with the countries across the globe. One has to see it to believe it. We reached Teleradiology Solutions (TRS) on a humid morning of Wednesday. The trees spread the shades around the building, spreading calmness and peacefulness around. Besides being the busiest company, the air in TRS spoke of relaxation and of letting down your hair. A feeling of freedom, the freedom to rediscover the innovator in you, in the timelessness of waiting and watching was felt while we tranquilized ourselves on the sofa in the reception. The wait brushed aside in memory

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Chief Dreamer: Dr. Sunita Maheshwari, Co-Founder of Teleradiology Solutions

the saga of Teleradiology Solutions, which is much beyond a success story. It is a story where a US-returned doctor couple showed the world how a novel idea, implemented systematically with the assistance of technology can improve the healthcare industry in unexpected ways. On returning to India from the US, Dr.ArjunKalyanpur wanted to sustain the connection with his patients and physicians. So he found a system by which he would be able to read and report radiology findings and interact with clinicians on patients’ diagnosis and treatment course. This is how the Teleradiology Solutions (TRS) was born. The idea soon shaped into a pilot project during his work at Sri Sathya Sai Superspecialty Hospital in Whitefield, Bangalore and Dr. Kalyanpur published a paper ‘Evaluation of JPEG and Wavelet Compression for teleradiology transmission’ based on this. Alas! The obstacles began. Plenty of

under the scanner questions were raised about radiologists losing jobs to off-shore radiology to patient safety. The media took over the issue and celebrated it with much reverberation. Dr. Arjun Kalyanpur is not a man who would be down at adversary. He answered them by opening a business that showed the world how a high quality radiology service from a different geographical time zone enable better productivity, therefore better patient service. Through consistent performance over the past decade, the TRS became the best in KLAS in America. In 2005, the company went ahead to become the first healthcare organization outside Singapore to gain accreditation from the Ministry of Health of Singapore. In the same year, the company also gained accreditation from The Joint Commission, a US based organization that recognizes the healthcare facilities. New ventures now extend the services of TRS into oncology with Image Core Lab (ICL), into teaching radiology through Radguru, into clinical service through Telerad Tech and into the greatest effort to improve the productivity of radiologists through RADSpa. Breaking our thoughts on TRS, entered Mr. Robin Philip, the Academic Coordinator of Teleradiology Solutions. He enthusiastically took us to different floors and divisions of TRS from highly-secured radiology rooms, beautifully designed library from where a part of TRS’s radiology education initiative took off to cloud, Radgurukal – the seminar hall where people from across the country join Dr AK and other visiting faculty for monthly and weekly radiology classes and to the presentation hall. Mr Philip explained various radiology education efforts of Dr AK and team. The web portal, www. radguru.net, hosts numerous radiology tutorials besides running weekly e-classes (every Wednesday at 5.30pm). Too far yet too close He took us to the telemedicine centre working on the second floor of the three-storey building. When we entered the floor, a physician was examining a patient from some rural primary health centre located in Karnataka. The doctor was talking to the patient over headphone with the help of an assistant at the PHC who connects stethoscope and other essential equipment to patient through

which the physician recognises what is wrong and what not. The physician sees the patient on a 32” or so monitor. We talked to Dr Sheeba, who was free at the time in front of another CISCO-powered telemedicine system. She told us the story described in the scene I. Her system is connected to the telemedicine centre set up by the Tibetan government for the monks live in the jungles of Chhattisgarh. “The inmates of the monastery have no other source of healthcare. Frequent power failures and bad net connectivity make things worse during most of the working hours. But, for them, something is better than nothing. Examining the patient through video and text chatting and checking the essential health parameters through highly-sophisticated telemedicine systems, we prescribe medication,” Dr. Sheeba said with pride. “Usually, we treat 50 to 60 people a day,’’ she added. The 30-minute wonder From the telemedicine centre, we moved to the teleradiology division, where around 30 radiologists reading reports sent to the systems from different parts of the world. The reports read by the radiologists on desk will be sent to an American Board radiologists working at the TRS or other parts for approval and from there it will be redirected to the source hospital where a physician awaits the report for taking crucial decision on what to do next. The tele-radiology process is actually three-tier report read-

“When we started, we were just a bunch of small group working in a villa. We were just three to four radiologists and three to four medical transcriptionists. Days passed, we expanded our wings, promoted our company on the basis of our good work. Dr. Dharma Prakash

Senior Consultant Radiologist, Teleradiology Solutions Pvt. Ltd

ing with the radiologists associate to the hospital make a final check on the next day. And, over all, it does not take more than half-an-hour! We took a pit stop and talked to Dr Dharma Prakash, a Senior Consultant Radiologist and an early member of Dr AK’s team, to capture the dreams that run them. “I came to know about teleradiology 20 years ago, through an article published in The Times of India. I read about Dr. Arjun Kalyanpur who was into teleradiology services. I became very curious. My curiosity and interest dragged me here,” Dr. Dharma Prakash began. “When we started, we were just a bunch of small group working in a villa. We were just three to four radiologists and three to four medical transcriptionists. Days passed, we expanded our wings, promoted our company on the basis of our good work. We signed many contracts with different countries. We did not limit our services to the US; our focus was also on the Indian market. I am glad to share this feeling that we succeeded in all our experiments.” From his views on Indian medical sector to the perceptional change that has happened among the physicians all these years to the technology on how teleradiology operates, Dr. Dharma Prakash had plenty to share. The next person we met was Dr. Srinivas Meka Rao, Senior Consultant Radiologist at the TRS. He ended up his words through an illuminating note on teleradiology — “This is a continuous learning process. Every single day is a new learning day for us. Our team is scattered across the globe. During the academic sessions, all of us discuss and share the knowledge we gained while attending any conferences. This is a good platform for the new-comers too, a scope to learn,” he ended. Technology matters From there, Robin took us to Mr. Ricky Bedi, CEO of Telerad Tech. Telerad Tech is the technology and services arm of Teleradiology Solutions. The company has to its credit RADSpa, a unique cloudbased imaging workflow intelligence system designed to enhance communication and collaboration among physicians, technologists, IT staff and institutions. With 70 installations worldwide, the system has already established its customer base. COLOR DOPPLER | OCTOBER, 2013

COLOR DOPPLER | OCTOBER, 2013

under the scanner

If big players like IBM comes in, the market will expand. But, you will have your share. And, it is good that somebody will promote it Mr A B Sivasankar Vice President, Sales & Marketing, Telerad Tech Pvt. Ltd

Mr. Bedi was a man who kissed the middle age. He resembled a handsome marketing expert with a vision and brilliance of Steve Jobs (Among the TRS staff, he is the chief enabler!). But what Mr. Bedi shared us was not the plans, rather he answered us more on the misconceptions and apprehensions related to teleradiology. “It’s not about encroaching someone else’s business. Many radiologists always have a misconception that, with the coming in of teleradiology, their

Many radiologists have a misconception that, with the coming in of teleradiology, their businesses are being carried away which is not true.

Ricky Bedi,

Chief Executive Officer, Telerad Tech Pvt Ltd

businesses are being carried away. But the fact that we have many radiologists working with us. They can’t cater to thousands of hospitals. By practicing teleradiology, they are not only improving the quality of the care they deliver, but improving their business as well.” He also played down the alleged security and ethical issues associated with the teleradiology. Our next visit was to Mr. A B Sivasankar. He was a man, who actually knew the pulses of TRS. Mr. Sivasankar had crystal clear views on everything, from the marketing tactics of RADSpa to the working of it. “Our software is a combination of PACS, RIS and Teleradiology body. Since it is a combination of all the three, when we sell we come across people who also have a requirement of PACS, who also have a requirement for remote reporting. How this remote reporting happens is, for example, they may not have a dedicated radiologist with them. This is similar situation like when you go into the radiology segment, radiology centres or hospitals. There, they may not have a radiologist – it may be a part time radiologists. So there we target the telereporting as a backup. We don’t go around and promote teleradiology in

India because the awareness of teleradiology is not much in India. If you go in promoting it, the same will clash with the pitch. Radiologists will feel insecure. Younger generation has understood that it will add to their productivity, but the old generation don’t use monitors. They have little insecure feeling. So we don’t go and promote directly,” he said. Mr. Sivasankar sees the entry of companies like IBM into teleradiology business as a positive sign. “If big companies such as IBM come in, then the market will expand. But, you will have your share. And, it is good that somebody will promote it. We get the advantage as the early bird. In that way, we have taken the deal. We have a credential that we are a radiology company, not an IT company. That will take us forward. If IBM comes in, then that means it is a big market.” Before bidding adieu to Teleradiology Solutions, we met Dr Sunita Maheshwari, the Co-Founder and Chief Dreamer of TRS. She was with Dr. Arjun Kalyanpur since his medical education years from AIIMS and became his better half not only in his personal life, but also in business. With specialised training in paediatric cardiology, today Dr. Sunita Maheshwari is one of the few interventional paediatric cardiologists in the country. Finally, when we were waiting for the cab back home, we felt like we know what is the future of medicine in general and radiology in particular. (Color Doppler will publish detailed interviews of TRS visionaries in the coming issues)

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under the scanner

In detail

Promising Quality Healthcare

n the past couple of years, the world of teleradiology has undergone a tremendous growth with its application potential. A smart way of transmitting radiological images from one part of the world to the other through telecommunication systems, enabling analyzing of all non-invasive imaging studies such as digitized X-rays, CT, MRI, ultrasound, and nuclear medicine studies, teleradiology is still a learning process opines Dr. Srinivas Meka Rao, DNB DMRD, Senior Radiology Consultant at Teleradiology Solutions, Bengaluru. Excerpts from an interview What kind of cases you deal with? We mostly deal with trauma cases. There are non-trauma cases like acute appendicitis, gall bladder obstructions, etc. The one thing common among all this kind of cases is they need emer-

Dr. Srinivas Meka Rao

Senior Radiology Consultant at Teleradiology Solutions

gency treatment and that is what we are doing here. Please elaborate on the three-tier reporting Once we receive the report, we start our reading. We facilitate faster reading for the radiology. If we come across any doubts, we immediately notify the other team for the clarification. They prioritize the case from the list of their cases and send us the report again. How much time will it take to implement complete emergency care

throughout India? It will take time, at least a decade. But the good thing is that many hospitals are becoming aware about this and they are implementing it slowly. What was the picture of radiology world a decade ago and what is it now? Do you feel any changes? If yes, what were the changes you have experienced so far? Time changes everything. There was a time when digital cameras were in use to get clinical photographs. After taking the photographs they were downloaded, scanned and converted into the required format. After that they were transmitted via the internet. It is undoubtedly was a tedious task and there was no guarantee of clear image with accurate data. Since then, the technology progressed to make the task easier and simpler.

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COLOR DOPPLER | OCTOBER, 2013

MRI to Play a Bigger Role Novel magnetic resonance imaging techniques such as MR Elasticity and polarization transfer imaging in nanoparticle based diagnostics and therapeutics will certainly become routine clinical tools, says Dr. Ponnada Narayana - Director of Magnetic Resonance Research at the University of Texas Health Science Center, Houston

s a complete health science university, the University of Texas Health Science Center at Houston aims to educate health science professionals, discover advances in biomedical and social sciences, and model the best practices in clinical care and public health. Dr. Ponnada Narayana, the director of Magnetic Resonance Research at the University of Texas Health Science Center, Houston is an acknowledged leader who dedicates his research projects to model the best diagnostic imaging practices. His major research interests include quantitative magnetic resonance of the central nervous system, development of advanced magnetic resonance techniques and image processing with an emphasis on automatic analysis. In this interview, Dr. Ponnada Narayana, a recipient of the 2013 Distinguished Investigator Award of the Academy of Radiology Research, discloses to Color Doppler about the magnetic resonance researches that are being conducted at the University of Texas Health Science Center, Houston and about the future of magnetic resonance imaging sector. According to him, the segmentation techniques in the MRI segment need to be further optimized and fully automated for improved accuracy and eliminating human bias. He also stressed on the need

to optimize the computational time in MRI. Excerpts from an interview. Being the Director of Magnetic Resonance Research at the University of Texas Health Science Center, Houston, can you give us a brief insight about the ongoing MR researches? As an MRI Center we scan both research subjects and clinical patients using advanced imaging sequences. The research subjects could be either patient volunteers or normal subjects. The research patients we currently follow include Multiple Sclerosis (MS), Traumatic Brain Injured Subjects (TBI), substance abusers, neurodevelopmental disorders, epilepsy, stroke and psychiatric disorders. These subjects are followed serially to better understand the pathophysiological changes, evaluating the efficacy of treatment, and identification of biomarkers for an objective assessment of disease. We also perform studies to understand the normal working of the brain by using functional MRI (fMRI) and diffusion tensor imaging (DTI). These studies not only allow us to understand how the brain works, but helps gain an understanding of how the normal brain function is affected by disease and drugs. We continue to develop novel imaging

sequences for improved sensitivity and specificity. A major research project is to implement near real time image processing on the scanner so that the investigators/clinicians have access to the quantitative MRI information right away. We perform cutting edge MRI to help the physicians manage their patients. For example, we scan patients using fMRI and DTI for neurosurgical planning for identifying eloquent areas so that damage to these areas can be avoided during surgical procedure. Another area is to identify the epileptic foci that are not visible on structural imaging using novel oxygen enhanced fMRI. On MS patients we use advanced techniques such as tissue specific imaging, phase sensitive inversion recovery sequences, DTI, tissue perfusion using arterial spin labeling for better visualization and characterization of pathology. To what extend the researches being conducted by your team go hand-inhand with the industry requirements of the imaging sector? As a part of our research we develop novel imaging sequences that advance the imaging field. We also have regular conferences with MRI manufacturers to discuss some of our ideas that may be of interest to the imaging community. An COLOR DOPPLER | OCTOBER, 2013

example is our idea about pseudo-real time processing that allows the investigators/clinicians/radiologist to review multi-modal quantitative MRI results soon after the scan is done. Our research also involves development of patient specific imaging protocol, rather than â&#x20AC;&#x153;one shoe fits allâ&#x20AC;? philosophy. Your researches emphasize on novel imaging processing techniques. Please elaborate on it. There is a great recognition that quantitative imaging measures would provide objective markers of disease progression and efficacy of therapeutic intervention. This requires robust and accurate image processing techniques that are based on advanced mathematical algorithms. Specifically, my own research focuses on fusing multi-modal MRI for segmenting various tissues, including lesions. These algorithms also allow the estimation of both global and regional atrophy. This provides important information to the treating neurologists for improved patient management. We developed a number of novel segmentation algorithms that are part of an automatic processing pipeline. We published extensively on these techniques. Please elaborate on the novel imageacquisition schemes implemented on your 3T clinical scanner. How is it going to enhance the clinical imaging experience? My research group has been involved in developing novel imaging sequences for a long time. For example, Barry Bedell, one of my graduate students developed a novel sequence, referred to as the AFFIRMATIVE sequence that provides four different tissue contrasts in the same sequence. This sequence, by incorporating the magnetization transfer, helps visualize MS lesions with greater sensitivity and also helped in developing automatic tissue segmentation. Another imaging sequence, quadruple imaging, allowed us to incorporate double inversion into the fast spin echo sequence. This sequence, COLOR DOPPLER | OCTOBER, 2013

now known as double inversion recovery (DIR) sequence, is shown to be the most sensitive sequence for visualizing cortical lesions in MS that are notoriously difficult to visualize on conventional sequences. The phase sensitive inversion recovery (PSIR) sequence that we optimized is shown to visualize spinal cord lesions even when commonly used sequences such as STIR and T2-weighted sequences fail to visualize them. Both DIR and PSIR are now commonly used in MS. Also the DIR sequence is shown to be sensitive in visualizing cortical dysplasia. What are your major image analysis innovations to register brain scans and segment anatomical tissues? Detecting temporal changes in pathology in the same patient forevaluating the progression/regression of the disease requires detection of changes in tissue or regional volumes. However, this is complicated by our inability to position the subject in the magnet consistently and possible alterations in pathology. A solution to this problem is to retrospectively align images acquired at different time points. We and many other groups have developed image registration techniques that are highly nonlinear and can handle large deformations. This is now used for detecting changes in regional and tissue volumes. How efficient are your advanced MRI techniques when compared to the conventional MRI? As indicated earlier, the advanced imaging techniques that we developed and implemented allow us to visualize and quantitate tissues that are not possible with conventional techniques. For example the DIR sequence allows us to detect cortical lesions and cortical dysplasia with significantly higher sensitivity while the PSIR sequence allows the detection of spinal cord lesions that are sometimes not seen on conventional techniques. We develop newer imaging sequences or optimize existing sequences for reduced

scan times and improved sensitivity. According to you, what are the potential areas yet to be explored in the MRI segment? Clearly the segmentation techniques need to be further optimized and fully automated for improved accuracy and eliminating human bias. In addition, the computational time needs to be significantly reduced for pseudo-real time processing. Government regulations for practicing radiology vary from country to country. How different are the regulations in US when compared to India? While I am quite aware of the regulations in the US, I must admit my ignorance about regulations at home. India is an emerging MRI market. How do you evaluate the MRI segment in India? Given the population of the country, advanced clinical management, and increasing affluence in of populace, the future of MRI market is extremely bright in India. We already see a number of state-of-the-art MRI scanners operational both in Government and private clinics in India. What are the futures waves happening in the imaging sector? This is a very general question. Rather than covering the whole imaging sector, I will focus on MRI. As we are already witnessing, high field MRI scanners will become more common. There is also an increasing appetite for speed. With improvement in hardware and high speed computers, MRI scans will approach other imaging modalities such as CT in terms of speed. Novel imaging techniques such as MR Elasticity and polarization transfer imaging in nanoparticle based diagnostics and therapeutics will certainly become routine clinical tools. Quantitative imaging will also become the mainstay in clinical imaging. The list goes on.

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

COLOR DOPPLER | OCTOBER, 2013

eventful

Looking into the Future The curtain fell on the second International Congress of the Society of Fetal Medicine — Fetal Medicine 2013 — in Hyderabad on September 1, widening the knowledge spectrum among the fetal medicine practitioners

Kishore Kumar P S l cd news

vents are meant to be enjoyed! When they are enjoyed with the fruits of knowledge, they are reverberated forever. This audacity of knowledge was reflected at the Second International Congress of the Society of Fetal Medicine, held recently at Marriot Convention Centre, Hyderabad. Dubbed as FETAL MEDICINE 2013, the event presented an extensive formal agenda of Fetal Diagnosis and Fetal Therapy. Fetal Medicine is relatively a newfangled segment in the medical world. Utilizing the expertise and input from various specialties such as perinatologists, pediatric cardiologists, pediatric surgical specialists, obstetricians, neonatologists, geneticists and others, the fetal growth is assessed for its health. The abnormalities

COLOR DOPPLER | OCTOBER, 2013

and illnesses are diagnosed and treated for the birth of a healthy child. The novelty and sophistication of the topic make this specialty a growing branch with a mountain of research evolving everyday from various parts of the world from experts of various specialties. How can these researches be altered into logically defined daily practices? Fetal Medicine 2013 showed this to its participants. With workshops on a wide array of topics, including Genetics and Prenatal Diagnostic procedures, ultrasound and Nuchal Translucency Quality Control, the event did a faithful interpretation of the fetal medicine during its three days of occurrence. Case study presentations, live demonstrations and videos enabled the share of knowledge. And, No scientific programmes can deliver optimum results without a forum of interaction. Fetal Medicine 2013 clutched the same through extensive panel discussions with profes-

sionals and industrial veterans. Delegates from national and international medical panorama visited Hyderabad to impart knowledge to the existing and upcoming physicians. “Opportunities are very less to get exposure to such international faculties. We heard of them only through internet. Thanks to Fetal Medicine 2013 for providing us a high quality level of education,” certified a participant who requested to extend the events even to the interiors of India. Dr. Meera Luthra, a pediatric surgeon from New Delhi went a step ahead by telling why fetal medicine is important in the present population. “I can see that it is growing leaps and bounds. It is the new field that we have to be very careful because we are now dealing with a differ ent population. Now women tend to put career first and the babies are born late, with assisted reproduction. Once they

eventful

Organising Secretary Dr Ashok Khurana at the inaugural function

are born, nobody wants to accept even a little bit of defect. The baby is born after years, so long. So when that baby has a problem or the fetal abnormality, so you can imagine the stress.” “We need to learn more. And, help the public to deliver normal babies. Or, if they do have a problem, guide them which can be curable and treated, and which can be terminated early for those very little hope,” she added. For Dr. Neetha from Hyderabad, meeting Indian mughals of Fetal Medicine and knowing the new developments and techniques of ultrasound is what excited. “Meeting people like Dr. Rabih Chaoui and our own Indian stalwarts, showcasing of all bigs of ultrasound genius, new developments and techniques, there is always something new to learn. I am always exciting to meet and exchange views,” she said. Dr. Ashok Khurana, Organizing Secretary the event said that the event is another leap towards fulfilling the objectives of The Society of Fetal Medicine (SFM). “The Society’s primary objectives are to promote and expand education and research in fetal medicine and facilitate rapid translation of research findings into clinical application. Fetal Medicine 2013 envisions fulfilling this.” Dr. Khurana, who has to his credit, several academic

the success of the event. “I got a huge support from the delegates. So we got together people from ultrasound, people from genetics, people from clinical fetal medicine, pediatricians, pediatric surgeons, pediatric cardiologists, social workers, psychologists and technicians. The ultrasound companies gave us a huge support. They showed us the new equipment and how ultrasound is moving towards automated measurements and automated acquiring of information. We were really able to show a lot in one single meeting,” Dr. Khurana said. “My Special thanks to the delegates and the faculties for being in Fetal Medicine 2013. We also had a local Organizing Committee from Hyderabad that helped us do all these under the leadership of Dr. TLN Praveen, with their presenters from all over Andhra Pradesh who are there on the local Organizing Committee. Thanks to them,”, ended Dr. Khurana. The City of Pearls, which has to its credit, the richness of culture and milestones of history was thus, transformed into a City of knowledge during the three days of Fetal Medicine 2013. Beyond a comprehensive educational platform, the event was also a source of entertainment, reflecting the true meaning of the term “infotainment”.

Dr Sneh Bhargava

and technological firsts in ultrasound and ultrasound guided surgical procedures feels quality academics in a pleasing ambience will leave people inspired and fulfilled. Being the author of two well known medical text books, he is a man who believes knowledge is power. Dr. Khurana’s proficiency in heading different medical associations was apparent in

Prof S Suresh

COLOR DOPPLER | OCTOBER, 2013

eventful

Keeping PACE! PACE 2013 , the three days of gathering and sharing knowledge in the field of Emergency Medicine and Critical Care, was all about ‘Believe and Achieve’

ACE 2013 (Programme on Advances in Critical Care & Emergency) held in one of the most popular and beautiful tourist destinations in South India, Pondicherry. The 5th National Conference of Society of Emergency Medicine of India (SEMI) continued for three days, starting from September 6th to 8th, 2013. The grand event was organized at the JIPMER Auditorium. The theme of this conference was ‘Believe and Achieve’ which emphasized that the belief, training and ability of an emergency physician are what keep the specialty lively and ever changing. The major focus of the conference was to enlighten doctors on the current trends

in Emergency Medicine and Critical Care which helped them to achieve better outcomes at the Critical Care and Emergency departments. Experts from across the globe have delivered lectures at the event. Dr. T Arjun Sundaram, the organising secretary, shared his views with Color Doppler team. “It is a unique experience because it gives us a platform where we could meet experts in their respective fields. This conference brings a lot of opportunity for youngsters, who have many innovative ideas which they want to share with the world. This gathering is also to encourage and bring our future leaders to participate and establish in this field.” There were workshops on Ultrasonography in Emergency Medicine; Operating

a Ventilator; Resucitation and Management in Poisoning; and Poly trauma Life Support. Scientific sessions were organised on the importance of ‘Emergency Medicine’. The main agenda of the session was to promote the growth of emergency care throughout the world. Emergency medicine has been a recognized medical specialty in the United States and other developed countries for nearly forty years, although these countries did not become fully used to this system. At this point of time, practitioners gathered together to develop the importance of emergency medicine though this conference. Dr. Radhika Rani Chandra, MD (A&E), National Faculty in Emergency COLOR DOPPLER | OCTOBER, 2013

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eventful Medicine, Department of Emergency and Critical Care Medicine in Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, from Andhra Pradesh also attended the event. She shared her experience with us, “The conference has been an eye opening experience in the field of emergency medicine. Its importance in critical care as prevention of mortality for all young budding doctors. The workshops conducted have given a practical, hands-on experience for all the youngsters, created a path of interest to take emergency medicine as their choice of career.” There were also jovial moments in the form of oral and poster presentations including a quiz on PACE. The ‘PACE Quiz,’ was for interns, undergraduates, postgraduates and other doctors participating in the conference. Dr. Tausif A Thangalvadi, Consultant in Emergency Medicine department, Sundaram Medical Foundation, Chennai talked in detail about the emergency medicine and critical care. “There are two major conferences in emergency medicine happening in India every year under the aegis of SEMI (Society for Emergency Medicine in India) – EMCON (National Conference on Emergency Medicine) and PACE. While EMCON is aimed at showcasing the cutting edge of emergency medicine with current trends, latest advances and development in emergency medicine and is mainly aimed at practitioners of emergency medicine, PACE focuses on young minds hitherto unexposed to emergency medicine. It aims at educating people about emergency medicine as a specialty by imparting knowledge on common emergencies. It also invites them to further explore the emergency medicine as a career by generating interest. If that was the aim of PACE 2013, then to a reasonable extent, the target was achieved. Awareness on the importance of appropriate emergency medical care is improving with each passing day but we have a long way to go. Doctors are now becoming aware that there is much more they can do in emergency conditions rather than just directing them to specialists. They know that acquiring certain skill sets can help them save lives and do more in the “golden hour” of an emergency.

COLOR DOPPLER | OCTOBER, 2013

coming

issue

What is New in Interventional Procedures?

nterventional procedures possess great significance in the field of medical technology. Interventional procedures, the procedures used for diagnosis or treatment that involve making a cut or a hole to gain access to the inside of a patientâ&#x20AC;&#x2122;s body, especially while carrying out a surgery or inserting a tube into the blood vessel, has been undergoing tremendous changes. It also includes gaining access to the body cavity without cutting into the body, like examining the inside of body using an instrument inserted via mouth. The treatments involving electromagnetic radiation also come under interventional procedures. They typically imply less pain, less risk and fast recovery. Interventional procedures differ according to medical specialties.

Read the next issue of Color Doppler to know all about interventional procedures and its latest advancements

Advancements have come in interventional cardiology, oncology, radiology and more. Next issue of Color Doppler deals with these technological advancements, safety measures and gadgets in interventional procedures. Being the media partner of EMCON 2013, the Annual Conference of Society for Emergency Medicine in India, the issue will also give insight into the area of emergency medicine sector.

Progressions in Interventional Cardiology, Radiology, Oncology, etc Gadgets for interventional procedures Safety guidelines: Need for a system for standardization of radiography machines Featured Event: EMCON 2013, The Annual Conference of Society for Emergency Medicine in India

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