Radiology and Imaging
The Radiology & Imaging Department at Asgar Ali Hospital is one of the best equipped radiology departments in the country with a range of state-of-the-art equipment supporting a high quality clinical service delivered by a specialized clinical team and support team.
We provide clinical services in:
Angio / Interventional Radiology
Trauma & Emergency Radiology
Our services include:
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
True Digital X-Ray DR Systems
Full Field Digital Memmography
Colour Doppler (CD)
MRI (Magnetic Resonance Imaging):
Our centre is equipped with the latest high-definition 1.5 Tesla MRI system from Siemens and all MR examinations, including ultrafast sub-second scans are routinely performed. Even uncooperative patients who move in the MRI machine can be scanned using special sequences.
MRI is a non-invasive modality using magnetic resonance to render images from inside an object. It is primarily used in medical imaging to demonstrate pathological or other physiological alterations of the living tissues.
MR imaging uses a powerful magnet, magnetic field, radio frequency, radio waves and a computer to generated pictures of organs, soft tissues, one and other internal body structures in exquisite detail. No harmful ionizing radiation is used in MR imaging. The 7 usual applications of MRI are in:
Diagnosing tumors or inflammatory granulomas in brain
Diagnosing infections in the brain, spine or joints
Visualizing torn ligaments in the wrist, knee and ankle
Visualizing degenerative disease of spine and bulging discs
Visualizing shoulder injuries and tendonitis
Diagnosing stroke in the earliest stage
Visualizing blood vessels without contrast agent
MR imaging is based on the relaxation properties of excited hydrogen nuclei in water and lipids when the object to be imaged, is placed in a powerful magnetic field to form of a large cylindrical magnet. The spins of atomic nuclei arrange in a particular manner parallel or anti-parallel to the applied magnetic field. After these orthogonal magnetic gradients are applied in X, Y & Z axis to selectively image different volume picture elements of the subject. This data is created in a 2D or 3D images are created from this matrix.
MR Angiography (MRA)
MR Spectroscopy (MRS)
Functional MRI (fMRI) measures signal changes in the brain that are due to changing neural activity and is also referred to as BOLD imaging (Blood oxygen level dependent).
A person’s brain is scanned while he or she is performing a certain physical task such as squeezing a ball or looking at a particular type of picture. When the neural activity is increased, there is increase in oxygen demand and the vascular system actually overcompensates for this, increasing the amount of oxygenated haemoglobin relative to deoxygenated haemoglobin.
Such techniques are being used in pre-surgical planning and in basic neuroscience research in areas such as memory, expressive and receptive speech, visual spatial processing and other cognitive processes.
Diffusion weighted images are very commonly used in the assessment of acute stroke and are also widely used in oncology.
Diffusion Tensor Imaging, also known as MR Tractography non-invasively maps white matter tracts. Diffusion parallel to nerve fibers has been shown to be greater than diffusion in the perpendicular direction. This provides a powerful tool to study in vivo fiber connectivity in the brain in a noninvasive manner and preoperative planning of resectability of brain tumors. Application of this technique for stroke, Alzheimer’s disease and paediatric brain development are being investigated.
MR Spectroscopy (MRS)
MR spectroscopy is a noninvasive method providing metabolic information about the brain. MR spectroscopy enables tissue characterization on a biochemical level surpassing that of conventional MR imaging. MR spectroscopy is also able to detect abnormalities that are invisible to conventional MRI because metabolic abnormalities often precede structural changes. It helps to differentiate Tumours between Benign and malignant without any invasive procedures like Biopsy and Surgery.
MR defecography is a technique to study disorders of Ano-rectal function. It is indicated in patients having constipation, rectal incontinence, painful defection and rectal prolapse. It permits analysis of the ano-rectal angle, opening of the anal canal, function of the puborectalis muscle and descent of pelvic floor during defecation. It provides good demonstration of the rectal wall, intussusceptions, enteroceles and rectoceles with excellent demonstration of the perirectal soft tissue. It allows assessment of spastic pelvic floor syndrome and descending perineum syndrome. No radiation hazard is associated with this procedure like fluoroscopic X-ray defecography. Images are obtained with patient at rest, at maximal sphincter contraction, during straining and during defection.
Although X-Ray Mammography remains the primary imaging modality in the evaluation of breast disease, the mammogram can some times be inconclusive for the presence or location of an abnormality. MR imaging has been used as an adjunct to mammography, particularly for patients with equivocal mammographic findings. The main advantage of breast MR imaging is its high sensitivity, with reported sensitivities for cancer ranging from 91% to 100% with varying specificity. Multiple investigators have shown that MR mammography may be useful to verify multifocality and multicentricity of breast cancer differentiate scars from recurrences after breast-conserving therapy, screening high-risk groups who have a family history of breast cancer, investigate breast implants, examine breasts in cases of histologically proven breast cancer, metastasis with unknown primary.
What do I do if I am pregnant, is MRI safe?
What should I wear to my MRI appointment?
What is MRI?
How does MRI work?
Can anyone have an MRI?
How long does it take?
What will happen during the MRI exam?
What if I feel anxious or claustrophobic?
128 Slice CT Scanner (Computed Tomography):
Radiology and Imaging at AAH is equipped with the latest 128 slice CT scanners from Siemens Healthcare, Germany. The machines, combined with our CT specialists, expert radiologist are able to provide the highest level of accuracy for diagnosing all types of illness in the body. These equipments are capable of performing cutting edge tests like Coronary Angiograms (Heart Scans), Pulmonary Angiograms, Brain Angiograms, CT colonoscopy, abdominal and peripheral Angiography.
The state of the art 128 detector row (500 slice) CTs from Siemens Healthcare, Germany provide ultra-fast volume imaging with a capability of a five beat heart scan. Further all routine CT scans are done using ultra-thin 0.625mm slices with volume acquisition and isometric reconstruction can be obtained in any plane. 3D-CT examinations are routinely performed along with virtual colonoscopy, virtual bronchoscopy and whole body scanning. Patients pay the same charges for routine CT scans as those at any other centre not having these high quality machines.
Non-invasive CT Angiography: Non-invasive CT Angiography is a technique that shows the blood vessels of the body in great detail, without any discomfort to the patient. The scan hardly takes a few minutes to perform but the information it provides is very precious. It can show the functioning of the heart, the blood vessels of the legs, thigh, arms, abdomen, lungs etc in great detail.
Precautions to be taken before a non-invasive CT angiography:
We need the patient’s kidneys to be working fine. For this we need the patients Kidney Function Tests to be done. We need the patients Blood Urea Nitrogen and Serum Creatinine reports
The patient would need to be fasting for 4 hours prior to the test.
Non-invasive imaging technologies continue to revolutionize every subspecialty of medicine.
This scanner has a special x-ray tube and rotation speed, capable of performing 64 rotations in a second. In each rotation, 64-slices are produced, giving us approximately 194 slices per second. This is the fastest scanner in the industry, currently.
The introduction of 128-slice cardiac CT allows nearly all patients to be scanned with very high resolution. Scan times are now on the order of several seconds (usually 5-13 seconds); this means that even patients with severe pulmonary disease and congestive heart failure can hold their breath for the required length of time. Reduced time translates to minimal or no motion artifacts.
Furthermore, higher number of slices means higher resolution; Such high resolution allows visualization of the entire coronary tree with extremely high accuracy and detail. Individual atheromatous plaques can be detected and characterized. Calcification can be visualized and used as an added variable in disease management.
The 128-channel configuration also provides breakthrough performance in advanced pulmonary imaging, multi-organ trauma evaluation and low-dose paediatric applications to boost your clinical capabilities to the highest level attainable.
In cardiac CT all scans are gated to the ECG trace. This allows us to position our data acquisition accurately in specific phases.
Using this modality we can perform the following procedures as part of a cardiac CT examination:
Coronary artery imaging
Calcium scoring is a technique where the extent of calcification in the coronary arteries is measures and scored. There is a direct correlation between the extent of calcium in the coronary arteries and the risk of a future cardiac event. For example, a calcium score of more than 400 is considered severe and it would be necessary to take steps to prevent further advancement of atherosclerosis and plaque formation. The higher the calcium score, more likely is there a chance of severe stenosis as well. A calcium score of 0 does not rule out soft plaques, but statistically rules out significant coronary artery disease. Though the calcium score does not show soft plaques (which however are best seen on a CT angiogram), the higher the calcium score, the more is it likely that there are soft plaques as well. Rupture of a soft plaque is the commonest cause of an acute coronary syndrome (i.e. a heart attack). Calcium scoring is offered as a separate stand-alone test, but this is routinely performed as an initial part of the entire cardiac CT examination.
Indications of CT coronary angiography:
Asymptomatic patient with family history of coronary artery disease
Patient with high risk factors
Prior to non-coronary surgery in the adult population, e.g.,
– Pre – ASD repair
– Pre – Valvular repair
– Pre – Tumour surgery
Follow up post CABG
Atypical chest pain with doubtful coronary origin
Evaluation of coronary anomalies
Exclusion of coronary stenosis in symptomatic high risk patient
Assessment of cardiac neoplasm
Assessment of stent patency
Detection and characterization of congenital heart disease
Diagnosis of pericardial disease
Prior to major (non-cardiac) surgery
Non-conclusive stress tests
CT Scan FAQ’s:
What is a CT Scan?
How will I prepare for my CT Scan?
What will happen during the exam?
True Digital X-Ray DR Systems:
Radiology and Imaging at AAHhas a wide range of Digital X-Ray systems which are a mark of the global quality that we strive to provide. We have the world’s most advanced X-Ray system, SHIMADZU FLEX VISION 1000 MA and the latest in DR technology for all special procedures and X-ray Guided procedures. We also have a range of DR System SHIMADZU Routine X-ray with Bucky Table 1000 MA.
DR Systems provide unparalleled image quality and drastically lower the radiation exposure to the patient. They also improve the workflow of a radiology department by digitizing the entire process of taking an X-Ray.
Digital imaging has led to similar improvement and renaissance in X-Ray just as it has in home and professional audio. Music albums and recordings now sound sharper and better than ever because of a digital compact disk (CD) player than on an older analog record player, similarly digital X-Rays often look sharper and clearer than its analog version.
The X-Ray passes through the patient’s body and the digital camera (located on the other side of the patient) and captures the resulting image. A main base station stores the pictures on a hard disk for image retrieval and processing.
All routine plain X-rays and special procedures, including barium studies, intravenous urography. HSG, MCU, etc. are conducted using SHIMADZU flexi-vision 1000 MA.
Full Field Digital Mammography:
A mammography scan is a High-Resolution X-Ray of the breasts. It is done with the intention of early detection of breast cancer. Many studies done all over the world have shown time and again that breast cancer has a much better survival rate if detected early. It is a simple procedure and requires no special preparation.
Full Field Digital Mammography System
In keeping with our tradition of introducing world-class medical imaging services our Radiology and Imaging is proud to introduce the country’s first 50 micron Full Field Digital Mammography system – AMULET INNOVALITY from Fuji Company.
Soft Gentle Design
Complete with arm-rests, chest padding and arm-pit padding, the AMULET Mammography system provides the highest level of comfort for the patient during the scan.
Automatic Scanning System
The machine automatically controls the degree of compression applied to the breasts for optimizing the amount of radiation exposure. It automatically releases the compression once the scan is done.
Highest Resolution – Clinical Efficiency
FUJIFILM’s exclusive amorphous flat panel detector combined with their innovative Direct Optical Switching technology leads to 50u resolution, the best currently available in the world.
Ultrasound is the safest way of looking inside the human body. It involves the use of high-frequency sound waves which are harmless to the human body. In our radiology and imaging department, we have highly trained ultrasound specialists working on the highest-end equipment available in the world today. Our fleet of ultrasounds includes the GE Voluson E-8, PHILIPS Affiniti 70G, SIEMENS Acuson X 700. Amongst other high-end upcoming USG Epic 7 (Phillips) & GE Voluson E-10.
Ultrasound scanning can help in almost any domain of disease identification. It is useful in pregnancy; it can be done for the breast, lower abdomen, upper abdomen-liver, pancreas etc., heart, bones, joints, neck etc. Ultrasound is a valuable tool and in the right hands can clear out most doubts related to the diagnostic queries that we are faced with.
A duplex ultrasound is a test to see how blood moves through your arteries and veins. The test combines traditional ultrasound with Doppler ultrasonography. Regular Ultrasound uses sound waves that are bounce off from blood vessels to create pictures. Doppler looks at how sound waves are reflected off from moving objects, such as blood.
There are different types of duplex ultrasound exams. Some include:
Arterial and venous duplex ultrasound of the abdomen examines blood vessels and blood flow in the abdominal area.
Carotid duplex ultrasound looks at the carotid artery in the neck.
Duplex ultrasound of the extremities looks at the arms or legs.
Renal duplex ultrasound examines the kidneys.
Duplex study of transplant kidney, pre and post-transplant evaluation.
Duplex study of predialysis fistula and post AV fistula maturation assessment.
Penile color Doppler for erectile dysfunction (ED)
Fibrosis Scan of Liver by Shear Wave Elastography with Ultrasound:
1. Quantitative measurement of tissue stiffness:
Shear Wave speed (m/s)
Young’s Modulus (kPa)
2. 2D colour coded visualization of tissue stiffness
3. Image guidance with B-mode ultrasound images, allows for:
Instant visual quality assessment of spatial stiffness, useful for detection and characterization of focal lesions
Better diagnostic interpretation with overlaying of shear wave stiffness images on the B-mode images
Optimal placement of Regions of Interest (ROI) for quantitative stiffness measures
Sampling within the ROI provides tissue stiffness measures at any location in the ROI, unlike conventional fibro scan which measures only the average stiffness within a ROI in a blind manner
4. Assessment and comparison of the degree of fibrosis in the same site of the liver on follow up imaging using this technique, which was not possible earlier.
We have the most advanced DEXA machine to rule out bone density from the GE health care known as LUNAR PRODIGNY ADVANCE with its latest Version, to rule out all sorts of bone diseases with high accuracy.
DEXA Scan (Bone Density Testing):
The DEXA scan is most often used to diagnose osteoporosis, a condition that often affects women after menopause, but may also be found in men and rarely in children. Osteoporosis involves a gradual loss of calcium, as well as structural changes, causing the bones to become thinner, more fragile and more likely to break.
DEXA scans also are effective in tracking the effects of treatment for osteoporosis and other conditions that cause bone loss.
The DEXA scan also can assess an individual’s risk for developing fractures. The risk of fracture is affected by age, body weight, history of prior fracture, family history of osteoporotic fractures and life style issues such as cigarette smoking and excessive alcohol consumption. These factors are taken into consideration when deciding if a patient needs therapy.
Bone density testing is strongly recommended:
Post-menopausal woman who are not taking estrogen
Someone with a personal or maternal history of hip fracture or smoking
Post-menopausal woman who are tall (more than 5 feet 7 inches) or thin (less than 125 pounds)
Men with clinical conditions associated with bone loss
People who use medications that are known to cause bone loss, including corticosteroids such as Prednisone, various anti-seizure medications such as Dilantin and certain barbiturates, or high-dose thyroid replacement drugs
People who have type 1 diabetes (formerly called juvenile or insulin-dependent), liver disease, kidney disease or a family history of osteoporosis
Someone with high bone turnover, which shows up in the form of excessive collagen in urine samples
Anyone with a thyroid condition, such as hyperthyroidism
Someone who has a parathyroid condition, such as hyperparathyroidism
Anyone who has experienced a fracture after only mild trauma
Individuals who have X-ray evidence of vertebral fracture or other signs of osteoporosis
Benefits of DEXA Scans:
DEXA bone densitometry is a simple, quick and non-invasive procedure.
No anesthesia is required.
The amount of radiation used is extremely small — less than one-tenth the dose of a standard chest X-ray, and less than a day’s exposure to natural radiation.
DEXA bone density testing is the most accurate method available for the diagnosis of osteoporosis and is also considered an accurate estimator of fracture risk.
What is Osteoporosis?
Osteoporosis is a metabolic disease affecting the skeleton, which causes a reduction in the amount of bony tissue. Bones are weakened as these tissues are reabsorbed or taken up by local cells. At the core, bones become less dense, on the perimeter, cortical bones lose thickness. Complications from osteoporosis arise as bones become thinner, more porous and susceptible to fractures.
Types of Osteoporosis:
Type I or Post – Menopausal Osteoporosis
Usually occurs in women menopause. At this time the ovaries produce less estrogen, a female sex hormone. In the absence of oestrogen, bone re-absorption decreases, dropping overall bone mass below the maintenance density level, leading to a high risk of fractures.
Type II or Age Related Osteoporosis
Age Related Osteoporosis – Inflicts both women and men aged above 70 years. Older people have added risk of low bone mass, because bone density peaks at the age of 35 and decreases gradually. The ability to absorb calcium from the intestine decreases, thus reducing the calcium inside the body. Also, older people are slightly Vit D deficient, leading to decreased calcium absorption from the intestine. Bone formation responds to physical stress and thus, less activity also decreases bone strength.
Effect of Osteoporosis:
Osteoporosis may go unnoticed if it is asymptomatic. Signs that there has been a reduction in bone mass include:
Lower back pain.
Loss of teeth and height over time often accompanied by a stooped posture.
Minimal trauma fractures, i.e., fractures occurring without the application of significant force. As bone density decreases the risk of fracture increases.
PACS (Picture Archiving and Communication Systems):
PACS are computers that acquire store, retrieve and distribute images. PACS has been developed to increase image reliability and decrease physical storage of films.
This system allows for nearly filmless process due to all images being transported through a computer system and viewed digitally. PACS handle various medical imaging instruments including ultrasound, MRI, CT, PET, endoscopy, mammograms, and more.
PACS is a benefit not only to patients but to radiologist as well. Digital imaging allows for a faster delivery of images, increased quality, the ability to manipulate an image, and the ability to collaborate with other radiologist because of numerous viewing terminals.