Chander Mohan

Artificial intelligence in radiology – Are we treating the image or the patient?

Of late, artificial intelligence has become the buzz word in radiology. It is hard to think of a single term that has led to such serious discussions and debates in our specialty in recent times. Lot of new technology jargon we have not been accustomed to read, let alone understand, are all over the papers, and words like convoluted neural networks (CNN), natural language processing, deep convolutional neural networks (DCNN) have become commonplace. There have been recent talks and articles stating that these algorithms will generate “Heat maps” of the areas for the radiologist to focus on or in other words using the “eyes of the software” to interpret the images.

Turf wars in radiology research: “Are the honoraries ready to come out and defend their territory?”

Every field of science needs continuous innovation and research to maintain its relevance and worth to the society. While doing research to understand complex scientific problems which requires great perseverance and intellect on the part of the researcher, it is prudent for the researcher to be able to disseminate the results of the studies as scientific knowledge for the benefit of the community.

Subspecialization in radiology – Is it time to hatch out of the cocoon?

Medicine for long has been evolving into the realm of subspecialization with specialists dedicated to particular organ system, or nowadays even specific organ, are coming up. Day in and day out we are hearing of new specialties being introduced. From general surgeons to gastrointestinal surgeons to hepatobiliary transplant surgeon, the modern‐day surgeon has evolved to be more and more specialized. Even in specialized fields like oncosurgery, we have subspecialists who are further specializing in surgeries of a particular organ system. Similar trend has been seen in medical specialties too where even patients are increasingly wanting to be seen by a subspecialist like a gastroenterologist rather than a general physician. Even the specialty of pediatrics has been split into subspecialties by organ systems.

Quality program in radiology: Persue or perish

Medical imaging has seen tremendous growth in the past three and half decades with the introduction of various imaging modalities. The continuing growth of technological advances is leading to the introduction of newer clinical applications at a rapid pace. These advances are resulting in precise diagnosis and definitive treatment and have made the specialty of radiology integral to the practice of medicine. However, these technological advances have come at a price as radiological equipment is very costly and radiological investigations form a substantial part of the overall expenditure on treatment. This is seen as a lucrative business opportunity and has led to a mushrooming of imaging centers and taking over of radiology services of hospitals across the country even by nonradiologists and investors. Because the issue of excessive exposure to radiation can lead to detrimental effects for patients, it is important to ensure that patients are not subjected to unnecessary radiations. This can be achieved by a rational approach to investigations with proper indications and well‐supervised studies eliminating the need to re‐investigate because of poor quality. These objectives can be achieved by instituting a quality assurance program in providing cost‐effective, prompt, and accurate diagnosis.

Turf wars in radiology: Need for symbiotic relationships

Over the past few decades, radiology as a specialty has seen tremendous growth, which has been accompanied by encroachment on imaging modalities by nonradiologists. Various specialists have been competing with radiologists for imaging and interventional procedures related to their specialties, and in few cases have completely taken over the imaging and interventions. These turf wars have led to a renewed sense among the radiology community to protect its own turf of imaging from being taken over by nonradiologists. While monetary gain is definitely one of the major factors behind these wars, there are other sides to the problem as well.

Guest editorial: Interventional radiology in India - The road ahead.

Interventional radiology (IR) is the ‘medical specialty devoted to advancing patient care through the innovative integration of clinical and imaging-based diagnosis and minimally invasive therapy.’[1] Over the years, there has been a gradual and steady growth in this exciting radiology subspecialty in India. In the seventies and eighties, IR practice was limited to hospitals in New Delhi, Mumbai, Trivandrum, and Lucknow, but over the years there has been an expansion in the practice of IR in India as a whole. When one looks back at IRs steady growth in India, it is clear that this is not merely an outcome of the growth of diagnostic radiology practices but is due to a combination of factors, which include increasing demands from referring physicians, the widespread availability of imaging equipment for guided procedures, IRs potential to serve as a convenient alternative to open surgical procedures and reduce recovery time, and the tremendous advances in IR hardware. Today, IR is an integral part of various clinical procedures, finding a role in vascular diseases, oncology, stroke management, womens health, pediatrics, and back pain. Available to us in India are a variety of new IR techniques that have been successfully incorporated into clinical practice, which involve the use of catheters, guide wires, glide wires, balloons for angioplasty, coils, liquid embolizing agents, stents and stent grafts, radiofrequency ablation devices, thrombectomy devices, etc. Let us briefly look at the leading causes of death worldwide. In high-income countries the list includes heart disease, stroke, lung cancer, colon and rectum cancers, breast cancer, and stomach cancer. In low- and middle-income countries, in addition to the above, the common causes include HIV/AIDS, perinatal conditions, tuberculosis, and road traffic accidents.[2] The clinical management of these varied entities places a burden on society and drains the exchequer. As interventional radiologists, we should encourage the timely and judicious use of IR techniques in the prevention and cure of diseases. When we look at the future of IR in India, there are two challenges that merit scrutiny and deliberation. The first is the need for vigorous efforts for the motivation of students and radiology residents in all the leading Indian medical institutions so that we can create a second rung of specialists who can gradually step into the shoes of the current practitioners, as is happening in many other countries.[3] The second challenge is clinical gene therapy. This rapidly developing and promising therapeutic modality is knocking on our doors. Gene therapy involves ‘transferring recombinant genetic material (DNA/ RNA) into the host cell in order to change the gene expression in the host cell to gain a therapeutic effect.’[4] Interventional radiologists will ‘play an important role in the transmission of genetic materials to the target cells,’[5] using percutaneous injection or catheter systems. In the times ahead, interventional radiologists will play an increasingly important role in selecting, guiding, and monitoring clinical gene therapy.[6] Research in gene therapy applications is underway in diverse areas, including infections, malignancies, metabolic disorders, and enzyme deficiencies. Besides these, the treatment of ischemia of the myocardium and extremities with angiogenetic growth factors to promote collateral artery development is being evaluated. Similarly, the role of gene therapy in treating stenoses following balloon angioplasty or stenting and in therapeutic angiogenesis are also being evaluated.[5] It is therefore important that interventional radiologists be prepared, continuously updating their knowledge to keep abreast of the advances in molecular imaging and clinical gene therapy applications and issues.[7] The interventional radiologist must know it all: from the awareness of gene therapy terminology to concepts in cloning, vectors, and detection of their expression; from a functional knowledge of molecular imaging and immunology, to understanding the different types of catheters used in the practice of gene transfer technology, such as pressure diffusion, passive diffusion, and mechanical and electrically strengthened catheters.[5] Interventional radiologists should also recognize and be aware of the ongoing advances in the development of novel treatment technologies, commonly used targeted tracers and probes, and of the visualization tools employed to analyze targeted therapy. The time is not far, when catheter-based delivery of tagged stem cells to target lesions becomes an established procedure. Indeed the situation experienced by practicing interventional radiologists today has been correctly summed up by Brian Stainken: IR “… appeals to people who have a creative streak, people who like procedural care, people who like to use their hands, people who want to make a difference.”[1] There are exciting times ahead on the IR road with brightly shining milestones along the way. For those interested in participating in IR academic activities, the Indian Society of Vascular and Interventional Radiology (ISVIR) is a useful professional forum. Its website is http://www.isvir.in/