Department of Radiology, Vascular and Interventional Radiology

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Facilities and Equipments :

Radiology department at CIIMS is one of the oldest advanced radiology diagnostic and therapeutic unit of Nagpur city. It has the most experienced faculties and offers advanced services to the patient during both routine and emergency hours.

Early detection is critical in the successful treatment of disease. At CIIMS, our diagnostic radiology department offers outpatient, emergency department, fluoroscopy and inpatient radiology services in a patient-friendly environment with state-of-the-art computerized radiography technology.

It contains four separate subunit

CT Scan
Digital X-ray and fluoroscopy
Sonology unit
Interventional Radiology

CT SCAN

Somatom ARC model is now replaced by spiral CT Scan Emotion DUO power of Siemens, installed on 10.09.2003 Dr.Shirish Deshpande Sr.Consultant in Radiology who has an outstanding experience of more than 15 years in CT Scanning and MRI is looking after the work in this department along with the expert technical staff. Services of this department are available round the clock. The charges for scanning are economical compared to the other centers of Nagpur.

Magic View by Siemens:

This is an additional attachment of CT Scan recently installed in our hospital, With the help of which three dimensional images of any part of the body is possible. The unique feature of this unit is that of editing facility i.e.. the part of 3D images which is not required can be deleted to get additional diagnostic information. Another additional feature of this unit is MPR (ie. Multi Planner Reconstruction) with the help of this one can reconstruct set of images in any plane (i.e.. orthogonal) then conventional, sagittal and corneal planes.

3D images and MPR images enhances diagnostic value. In the whole central India region this is available in CIIMS hospital at very reasonable charges

Machine Name : Siemens SOMATOM EMOTION DUO

Type Multislice Scanner (DUO Scan)

Date of Installation : 10.09.2003

Scan Time : 0.8 sec/scan

Procedure : Special
Perfusion (Cerebral study) Quantitative evaluation of dynamic CT Data of Brain following highly concentrated bolus contrast for differential diagnosis and management of acute ischemic stroke.

Angiography : (Cerebral, carotid, lower limb, upper limb aorta)
4 Vessel cerebral angio and peripheral angiography
3D VRT - Volume rendering technique
SSD - Surface shaded display
MPR - Multiplamer reconstruction
MIP - Maximum intensity projection and volume

Possible Scanning :
1) Head - Orbit, Sinus.
2) Neck
3) Shoulder
4) Abdomen
5) Pelvis
6) Spine - Cervical, Lumbar, Thoracic
7) Extrenuties
8) C T Guided biopsy

Digital X-Ray and Fluoroscopy

Latest techniques:-

Klinoskop 500MA Siemens with Fluroscopy
PLddr 3E 60 MA L 100K v Siemens Portable X-ray
Multimobile 2.5 KW Siemens Portable X-ray
Allengers 3.5 KW high frequency Portable Unit.
Fuji C.R. (Digital X-ray)
Here doing all the routing x-ray from head to toe and being mainly neurology institute x-ray os spine including special view like flexon, extension in cervical and lumber spines are routinely done here. Almost all the investigation procedure including

All routine x-rays, including special view like Stenver’s and optic foramina, (except tomograms)
IVP
MCU
Retrograde
Fistulogram
Sialogram
Barium Swallow
Barium Meal
Hypotonic duodenography
Barium Enema etc are performed here with use of Fluroscope as and when required.
High grade Urography
Retrograde and antegrade Pyelography
Cystography and micturating cystourethrography
Retrograde Urethrography

SONOLOGY UNIT :

Department of SONOLOGY is started in March 2008, Ultrasound is a common procedure at CIIMS that allows medical practitioners to visualize structures beneath the skin. The technique uses sound waves beamed into the body and reflected off of various tissues to develop a picture of the interface between solid and fluid spaces.

There are no known risks to ultrasound, which can be used to screen, diagnose and aid in the treatment of various diseases.

CIIMS's ultrasound department is equipped with state-of-the-art ultrasound technology. Our courteous staff is highly trained.
We provide diagnostic imaging as well as ultrasound guidance for numerous biopsies and procedures.

Ultrasound procedures offered (but not limited to) include:

Abdomen & Pelvis
Small part

Scrotum

Thyroid
Joints

Doppler Imaging

Carotid
Peripheral Vascular Doppler
Trans Cranial Doppler (TCD)

FNAC (Diagnostic as well as Therapeutic ascetic and pleural tapping)
Breast
Extremities (including shoulder)
Pelvis
Thyroid
All portable and bed side USG, Doppler as well as therapeutic procedures are done.

Interventionsl Radiology Unit :

This department was started in August 1987, with 2 Siemens X-Ray machines. The 500 mA machines with image intensifier is used for conventional Radiography and special procedures like barium studies. IVP, Meyelograms etc. And the other is a mobile X-Ray unit (60 MA) for the bed side conventional plain X-Rays.

The second phase of the development of vascular and Interventional Radiology was started first ever in Central India by Dr. Shrikant Kothekar in Oct. 1990. Interventional Radiology has now became a part of treatment of difficult situations. It can be called pin hole surgery/radiology since the procedure involves percutaneous needle puncture followed by guide wire, catheter introduction and manipulation under x-ray control.

Following is the list of indications wherein Interventional Radiology steps in to help relieve condition Non-surgically.

To relieve obstruction drainage and stenting in obstructive Uropathy and Jaundice.
Fallopian tube recanalization in tubal blocks.
To dilate narrowing of stenosis - Renal carotid and peripheral angioplasty.
To control bleeding by occluding abnormal communication as in arteriovenous malformations & fistulae. Embolization in Hemoptysis / hematuria / Bleeding PR/PV etc.
Carotid stenting for preventing progression of ischemic stroke.
IVC filter to prevent pulmonary embolism.
Uterine artery embolization of fibroid.

Interventional radiology represents a mix of adventure, innovation and improvisation and has certainly contributed significantly to the patient care in Central India and CIIMS both. The well-done emobilization of prostatic, uterine, bronchial, coeliac arterial bleeds that have won accolades nationally and internationally, are a testimony to this spirit. Needless is to mention our contribution to hepatic, renal, and peripheral vascular disease.

Catheterization Laboratory		Since the beginning, interventional radiology has performed a large number of different procedures briefly given below - Diagnostic procedures - Cerebral angio, Aortogram and peripheral renal mesentric bronchial etc. Angioplasties/Stenting - Carotid, Renal and peripheral. Embolizations - Bronchial , Mesentric, Uterine, Pelvic, AVM, AVF, Neovascularization etc. Percutaneous drainage - Percutaneous Nephrostomy, Uterine stenting, Biliary drainage and Biliary stenting. Percutaneous nephrolithomy
Catheterization Laboratory		The Department's First Many of these procedures have been done for the first time in Central India notably, Adrenal Transaxillary Angiograms, Embolization in superior mesenteric, Radial, Scalp and Renal artery and AVM. Bleeding uterine, Bronchial, Prostatic & mesentric vessels. Renal, subclavian, Peripheral, Angioplasties Percutaneous Nephrolithotomy, Ureteric/biliary stenting, IVC filters etc.

WHERE INTERVENTIONAL RADIOLOGY SAVES LIMB, BRAIN &LIFE

PROBLEM	PRESENTATION	ETIOLOGY	PROCEDURE
Ischemic Stroke	Hemiplegia/Hemiparesis	Acute Intracerebral thrombosis	LOCAL Intra-arterial Thrombolysis within 3 hours.
Venous infarct	convulsions, unconsciousness, neurodeficit	Sagittal sinus thrombosis	Local intravenous sagittal sinus thrombolysis
Brain Haemorrhage	Unconsciousness,Neuro deficit	AV malformation, Aneurysm	Coil Embolisation or Glue injection
Carotid Artery Stenosis	Transient Ischemic Attack (TIA)	Atherosclerosis	Angioplasty and stenting
Bronchial artery to Pulmonary artery fistulae	Haemoptysis	Tuberculosis/Carcinoma	Bronchial Artery Embolization
Renal Artery Stenosis	Hypertension .	Atherosclerosis, Aorto arteritis Fibromuscular Dysplasia	Angioplasty and Stenting
GI Bleeding	Haematemesis, Malena, Bleeding PR	Ulcer, Tumor, NSAID Aneurysm, A-V-M Angiodysplasia	Embolization
Bleeding PV	Menorrhagia, Pressure Symptoms	Uterine Fibroid, Pseudoaneurysm, Pelvic A-V-M Post Operative	Uterine artery Embolization
Urinary bleeding	Haematuria	AV Malformation,Trauma,Tumor, latrogenicf (Post TURP, Renal biopsy)	Embolization
Peripheral Vascular Disease	Claudication Ulcer Gangrene	Atherosclerosis, Arteritis, Coarctation of Aorta	Angioplasty and stenting, LOCAL thrombolysis in acute cases.
DVT with/without Pulmonary Embolism	Edema feet, Pain in chest, Breathlessness	Hypercoagulable state, Trauma,infection, Post operative	Local thrombolysis and IVC filter placement
Portal Hypertension	Haematemesis Maleana	Cirrhosis	TIPS (Trans Jugular interahepatic Portosystemic shunt)
Obstructive Jaundice	Jaundice/Itching	Biliary stricture/Calculus	PTBD/Stenting
Obstructive Uropathy	Oligouria, Anuria Malaise, Anemia, Pain	Calculus, Stricture	Precutaneous Nephrostomy & D-J Stenting
Female Infertility	Inability to conceive	Cornual block	Fallopian tube recanalisation (FTR)
Osteoporosis of vertebral body	Pain in back Tenderness	Post menopausal, Old age, Immunosuppresion, Haemangioma	Vertebroplasty
Thrombocytopenia	Bleeding	Hypersplenism	Partial splenic embolization
Vertebro basilar insufficiency(VBI)	Vertigo	Stenosis at verebral or basilar artery	Vertebro basilar stenting.
Absent Radial	Syncope	Subclavian steal syndrome (Subclavian artery stenosis)	Subclavian artery stenting.
Pulsatile supraclavicular swelling	Swelling, ischemic pain	Traumatic/latrogenic	Subclavian stent graft.
Swelling over head, neck, face and extrimities	Disfigurement Bleeding pain Epistaxis	AVF, Nasopharyngioma AVM Hemangioma, Vascular tumors	Embolization
Cyanosis	Breathlessness Polycythemia Hemoptysis	Pulmonary AVM, Aneurysm, AVF	Pulmonary artery Embolization
Pulsatile abdominal/Thoracic mass	Pain	Thoracic aortic aneurysm Abdominal aortic aneurysm Middle aortic syndrome	Stent graft/Stent
Abdominal Pain (Normal investigations)	Severe pain/post prandial abdominal pain	Mesentric artery stenosis/Embolic acute mesentric occlusion	Mesentric artery angioplasty/Local intra arterial thrombolysis.
Male infertility/Pelvic congestion syndrome	Pain Menorrhagia	Spermatic/Ovarian varicocities	Coil Embolization
Benign Hypertrophy of prostate	Difficulty in micturation/Retention	Benign prostatic hyperplasia	Embolization of porstatic vessels.
Hypoglycemia	Syncope	Insulinoma	Pancreatic artery Embolization
Malignancy	Cachexia	Hepato/Secondaries in Liver	Chemo Embolization
Acute limb ischemia	Acute pain in extrimity Absent pulsations	Thrombo Embolism	Local intra arterial thrombolysis
Lower motor weakness	Acute neuro deficit	Spinal AVM/AVF Hemangioma of vertebral body	Embolization
Bowel and Ureteric stricture	Constipation/Obstructive Uropathy	Inflammatory/Neoplasia	Dilatation and stenting
Tracheal stenosis	Difficulty in breathing (Stridor)	Extrinsic compression Tumor encasement /Tracheaomalacia	Tracheal stenting