Monday, 7 November 2016

Monash Imaging: from x-rays in a dark room to saving limbs and lives

Dr Chandra with a stent retriever
The field of radiology has come a long way since Wilhelm Conrad Roentgen’s discovery of X-rays in 1895. Ultrasound and nuclear medicine, computerised tomography (CT) and magnetic resonance imaging (MRI) are all commonplace techniques that aid in the diagnosis of disease.

What is not commonly known is that radiologists now do far more than sit in a dark room interpreting images and writing reports for other doctors.

Many of the Monash Imaging radiologists
(Prof Stuckey front, centre)
Monash University’s Dr Ronil Chandra is an interventional radiologist at Monash Imaging, the largest academic imaging department in Australia.  Monash Imaging is also unique with its own university department, at Monash University’s School of Clinical Sciences at Monash Health.

Dr Chandra did his medical training in Melbourne, before specialising in radiology at Massachusetts General Hospital, Boston and Harvard Medical School.   Having trained and worked with some of the world’s best radiologists, Dr Chandra believes the imaging services provided at Monash Health are as good as anywhere in the world.

 “We do amazing work here but very few people know about it,” says Director, Monash Imaging at Monash Health and Head of Department of Imaging at Monash University, Professor Stephen Stuckey.

“We have more than 430 staff including radiologists, imaging technologists, nurses and support staff who support, perform or interpret over 325,000 imaging examinations every year at Monash Imaging—and we also publish over 50 peer-reviewed papers annually, making us one of the most academically productive imaging departments in the country.”

“More than half of all Monash Health Emergency Department patients and almost all patients admitted to our hospitals are serviced by our Department of Imaging,” says Professor Stuckey.

There are a number of sub-specialists in the Monash Imaging team, including nine specialist interventional radiologists.  When not interpreting an image, interventional radiologists may be found inserting a stent into a patient’s brain to remove a blood clot or to treat a brain aneurysm.

Professor Stuckey says interventional radiologists use minimally invasive techniques to treat patients for a range of conditions including cancer, stroke, brain aneurysms and spinal injuries.

”We navigate the body’s natural highways to stop a bleed in the brain, remove a blood clot or to deliver chemotherapeutic agents directly to a cancer site,” says Dr Chandra. “Recent advances in imaging technology are driving this rapid change in clinical practice.”

“Five years ago, a standard CT scan for an emergency patient with acute stroke had fewer than 100 images—now standard CT imaging contains 3000 images,” says Dr Chandra.  “Radiologists need to analyse those images extremely fast to determine the best treatments.”

Radiologists are critical members of the medical team, facilitating rapid diagnosis of cause of illness with imaging techniques, and are increasingly integrated into treatment paradigms using minimally invasive interventional radiology techniques,” he says.

“Our team has become so clinical we see patients in clinic, do ward rounds in ICU and run infusions in the ICU.”

“The reality these days is patients don’t always have a surgeon—they have an interventional radiologist.”

In recognition of their expertise, Monash Medical Centre has recently been designated the second endovascular clot retrieval site in Victoria, with the largest patient catchment area.

“Stroke patients arriving at Monash Medical Centre are met by a multidisciplinary team of specialists including interventional radiologists and stroke physicians, who aim to remove a clot from a patient’s brain in under 60 minutes,” says Dr Chandra.

“We remove clots by inserting a stent retriever into the femoral artery in the patient’s groin and navigating up the neck and into the head.”

“Patients come in unable to speak or move, and as soon as we pull out the clot, they’ve recovered.  Their paralysis is gone.”

“The bottom line is we convert these patients from severe stroke to no stroke or mild stroke, and then they recover,” says Dr Chandra.

Before these techniques were available, patients either died or were left significantly disabled— these minimally invasive techniques not only save lives but patients are usually eligible to go home after 24-48 hours.

Dr Chandra says that while the procedures are costly, the economic benefit to the community is enormous.

“We’re saving on rehabilitation costs and reducing nursing home admissions. Most importantly, we’re returning people back to their families and back to normal life—that is priceless.”

International Day of Radiology is 8 November, the anniversary of Wilhelm Conrad Roentgen’s discovery of X-rays in 1895.

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