INDIAN SOCIETY OF NEURORADIOLOGY
                            Regd. No:781/99-2000

Development & Growth Of Neuroradiology & Imaging As a Discipline In India With
Special Reference To AIIMS

Specialized health care in India started to develop after Independence in all corners of the country.  With the establishment of the All India Institute of Medical Sciences (AIIMS) hospital in 1959, by an act of the parliament of India, it not only got a boost but also a direction to develop medical education, research & patient care activities of the highest order.  With the completion of the permanent regular hospital building in 1965 & joining of the clinical professors, Prof. Baldev Singh in Neurology & Prof. P. N. Tandon, in Neurosurgery, it became necessary to establish of neuroradiology.  In the new building with a munificient grant form the Rockefeller foundation, a Lysholm skull table was acquired and a conventional fluorosocopy fixed in the Beuroradilogy room.  A manually operated 3 film changer & manual processing was the mainstay of diagnostic armamentarium.  Direct needle puncture of the carotid artery in the neck was the rule. Burrhole myodil ventriculography with conventional fluoroscopy was used to stdy the opisteruir fossa.  The lumbar route pneumo-encephalogram with auto-tomography to study the cistern, ventricular system displacements & cortical sulci was routine.  Spinal studies were done with oily contrast media myodil. 

These studies were jointly performed under supervision by the residents of neurology, neurosurgery & radiology by rotation because of the felt need to train them so that when they leave the portals of AIIMS they should all be competent to carry out these procedures on their own.  It was the mandate of the institute to produce manpower of the highest order for the country. 

As an important part of the clinical training a daily neuro-radiology conference was organized, first thing in the morning, to review the previous days work & permit intense interaction between physicians, surgeons & radiologists.  This interaction between faculty and residents of neuroscience greatly helped all the disciplines to grow & contribute to growth as well. 

Prof. A. Bhargava, the then head of radiology, soon realized that it was difficult to practice neuro-raidology, as a part of general radiology because it was focussed involvement of the radiologist, not only for reporting but also for technical purposes, if meaningful quality was to be attained, maintained & passed on.  Prof. Bhargarva was instrumental in teaching & traning the residents & maintaing a high standard of academic discussions in the daily morning neuroradiology conferences.  Dr. S.K. Ghosh had joined the department on the faculty & he spent most of his time in neuro-radiology .  He was assisted by Dr. R.K. Goulatia as his resident & later as a lecturer.  Dr. Goulatia took over neuroradiology exclusively following Dr. Ghoshs departure in 1973.  Due to the hard work & vision of Prof. P.N. Tandon the creation of a clinical Neurosciences Centre at AIIMA was approved by Govt. of India in 1975. Hounsfields discovery in 1972 made it clear that the practice of neurosciences and particular neuroradiology would have to take on more responsibility as part of clinical teams. 

It was a sheer co-incidence that Prof. s. Bhargava. While visiting the Mass General Hospital in Biston in the summer of 1972, was suggested by Dr. J.M. Taveras to attend a neuroradiology course at the Albert Einstein Medical Centre in New York.  At this course Dr. james Bull a neuroradiologyst from the Neurological Institute, Queen Square, London brought Dr. G.W. hounsfield with him, who announced his spectacular discovery of the CAT at this meeting.  The audience was struck with awe & excitement, considering the potential of this technique which would spare the patient, discomfort associated with conventional methods & moreover it would be an outpatient procedure & relieve the pressure on hospital beds, which was a constant worry because of our galloping population. Prof. Bhargave was acutely aware of this country specific problem and realized the relief it would bring to patients & doctors alike, though she had not bargained for the increased workload it would entail & source for funds required for procuring the machine.  She returned home determined to acquire the system, now christened, The CAT, short for computerized axial tomography, knowing it could only help contribute towards patient care & safety of our large volumes.  The visit by Prof. Torgny Greitz in early 1978 to the institute, helped obtain a substantial Swedish International Development Agency grant to acquire a second generation CT system (EMI CT1010) in 1978, manufactured then only by EMI of England. 

From 1978 to 1980 this was the only CT available in this part of the world & we provided services not only to all parts of our country but also to the neighbouring states of Nepal, Bhutan, Srilanka, Bangladesh etc.  Side by side trained manpower from this institute took their expertise to all parts if our country and widen their horizons.  From 1980 onwards purchasing CT scans passed into the hands of the private sector who provided hobs to doctors and services to patient sector who provided hobs to doctors and service patient in every state.  Government funding for CT systems was not available till mid eighties and till today large majority of public hospitals still do not have ct scanners, though they cater to very large patient population.  This is due largely to the poor state of our economy with meager budget for health services. 

As a developing nation, this country is burdened by infectious diseases & infestations.  The newly acquired CT was exploited to study more extensively intra cranial tuberculosis & neurocusticercosis.  Our studies confirmed many of the findings earlier authors had suspected, such as of multiplicity of foci of infection, coexistence of various stages of development of the disease, the form & shape of the franulomas based on pathology & immume respone of the hosts.  But more important was the discussion these findings provoked, the lessons we learnt & finally stumble onto the the disappearing CT lesions.  There was appreciable increase in the range & extent of diagnostic services & this alerted the faculty to the need for preserving & enhancing the skills acquired during the pre-Hounsfield era by improving further the diagnostic set up.  Thus started the quest for manpower to shoulder the responsibility to develop interventional skills. 

On 20.8.03 

Dr. N. K. Mishra was a resident in late seventies & provided support then to Dr. R. K. Goulatia in neuroradiology.  Soon he was inducted as a faculty & was instrumental in developing & establishing neurointerventional work at the institute.  He was helped to a great extent by visits to the institute in 1983 by a team from London, Ontario, Canada, comprising of late Prof. Charles Drake, Prof. A.J. Fox, Prof. Fergusson etc.  Subsequently Prof. Luc Picard visited Kem Hospital  in Mumbai, where a workshop was conducted by him with live demonstration of interventional cases, which Dr. Mishra attended & was very impressed.  During the international Congress of Neurological Surgery, held at New Delhi in 1989, Prof. P. Lasjaunias visited the department at AIIMS.  Few more such meetings were conducted at various centers in the country by Prof. Picard & Prof. J. Moret & Prof. K.Terbrugge, which have helped immensely the neurointerventionists of this country to finetune their skills & has attracted more professionals to this field.  

While these developments were going on not only in Delhi, but also in Trivandrum, Lucknow & Mumbai a critical mass of manpower was now available to take over more responsibility.  Chairs in neuroradiology were created in AIIMS, New Delhi & subsequently at the National institute of Mental Health & Neurosciences (NIMHANS), Bangalore.  For the first time in history of this country, a full fledged neuroradiology department was set up at the Neuroradiology department was set up at the Neurosciences Centre, AIIMS in 1996, headed by Prof, R.K.Goulatia & with all the equipment, including a DSA system (then a novelty), required to provide diagnostic & therapeutic interventional services.  Today the department is headed by Prof. N.K.Mishra and the departments expertise is sought by patients from all parts of this country as well as many of our neighbouring countries.  Intensive training to residents to create manpower, growth & development of the faculty is ensured & research contributions are made both open ended as well as targeted in collaboration with other departments of the neurosciences centre.  MRI has been introduced into clinical practice at the AIIMS in 1993 & it has contributed significantly to the development in this field.  Many more systems are in pipeline, besides a large number of installations in the private sector.  For endovascular work, the continued interest & enthusiasm across the country has resulted in installation of quite a few state of art DSA systems, though some interventionists in the country have to still contend with small units. 

Consequent to these developments in 80s & 90s, two societies were formed in 1997 The Indian society of Vascular interventional Radiology (ISVIR) & The Indian Society of Neuroradiology (ISNR).  In its first news letter, the welcome address by Prof. N.K.Mishra, as President of ISVIR acknowledges the untiring efforts of colleagues who have helped to arrive at this historical moment & cautions against the tough road ahead, related to the issues of the consumer act, ethics, costs, training & accreditation etc., that they would have to address & solve in this demanding discipline.  Shortly the 4th annual congress of the two societies will be held in Mumbai in December 2001.  There is now a body of very active professionals carrying forward the discipline of neuroradiology & rightfully they are claimants to a very bright future in this country.