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

Development of Neuroradiology at Shree Chitra Tirunal Institute for Medical Sciences & Technology

Sree Chitra Tirunal Institute for Medical Sciences and Technology, located at Trivandrum in South India, is a unique institution that combines quality, state of the art health care with medical research and postgraduate teaching.  The hospital serves as a tertiary referral centre for treatment of cardiovascular, thoracic and neurological disorders.  It has been established itself as a center of excellence in patient care and centre of excellence in patient care an caters to patients coming not only from all corners of the country, but also from neighboring countries like Sri Lanka, Bangladesh, Maldives and the Middle East.  The biomedical technology (BMT) wing of the hospital has played a vital role in the indigenous development of various biomedical devices and participates in the various clinical research projects performed at the institute.  The institute has projects performed at the institute.  The institute has developed postgraduate medical training programs of the highest quality in advanced medical specialties and health science studies.

The department of radiology at the institute, from its inception, has not only strived to maintain the highest standards in patient care, but also has carried out research in fields related not only to diagnostic and interventional procedures, basic neurological sciences, basis vascular sciences, medical applications of lasers and computer in radiology.

On 21.8.03 

HISTORY

Department of Radiology at Sree Chitra Tirunal Instlitute for Medical Sciences and Technology was established with the inception of Institute in 1974 with a routine X-ray machine and a multipurpose image intensifier-  Diagnose 73 equipment from Philips.  Prof. Mahadevan Pillai whose association with the doywn of neurosurgery in India- Dr. B. Ramamurthi, saw the introduction of several neuroradiological procedures for the first time in India, oversaw the establishment of the department. 

The year 1976 saw the expansion of the department with the joining of of Dr. Sashidharan.  He was very keen in practicing cardiac and vascular radiology.  He was spending most of his time in this field.  In 1977 Dr. V.R.K. Rao joined as assistant professor and was subsequently promoted to the post of Professor and Head in 1986, In the year 1982, Dr. K.Ravi Mandalam joined the department.  The main area of interest of Dr. Rao was diagnostic and interventional neuroradiology while Dr. Ravi was interested in diagnostic and interventional cardiovascular radiology.  With their dedication and keen interest, the department of radiology has achieved national importance in the practice of interventional neuro and vascular radiology. 

Mimer III from Siemens was added in 1979 for neuroradiological workup of the patients. During this period other than routine plain X-rays, aortograms, selective renal and visceral angiograms, four vessel studies, venogram IVC grams myelograms, pneumoencephaloframs, spinal angiograms, barium studies were routinely done.  The year 1983 saw the installation of a whole body CT scanner CT W4 from Hitachi, in the department.  Using this equipment, computed tomographic studies of the head, spine, chest, abdomen, pelvis, joints and limbs were routinely performed.  This caused a significant drop in the number of four vessel angiograms, ventriculograms, pneumoencephalograms and pneumomyelograms performed.  In 1989 a biplane DSA system was installed, which boosted the Neuro and Vascular Interventional work being performed in the department. 

For the first time in Kerela, in 1993, a 1.5 T MRI system from GE medical systems was installed.  Since then, the entire range of neurological and body MR imaging studies arte being performed routinely by this unit.  The year 1995 saw the addition of a single plane DSA system Advatix LCV.  This DSA lab is used mainly for interventional radiology work. 

A PACS (Picture Archival and Communication System) which was developed in collaboration with Electronic Research and Development Corporation (ER & Dc, Govt. of India) was installed in the department in 1995.  In 1997, a new spiral CT system Hi speed CT with Advantage windows which is the state of the art top of the line CT system, was installed.  A new colour Doppler ultrasound system Logiq 500 form GE Medical system was another addition in the department. 

Presently, all the imaging systems in the department have been networked with Advantage Windows and Radworks workstations for efficient analysis, retrieval and presentation of images.  The Department is proud to be one of the first departments in India to start performing interventional neuroradiological procedures.  With a modest beginning in 1984, interventional procedures were performed on a routine basis form 1986.  Over the years thanks t the commitment and efforts of Dr. V.R.D. Rao and Dr. Ravi Mandalam, the department has been responsible for the popularization and wide acceptance of the interventional vascular and neuroradiological procedures.  The department played a vital role in the formation of the Indian Society for Vascular and Interventional Radiology and currently houses the headquarters of the society. 

MENTORS 

DR. MANADEVAN PILLAI was born in Kayamkulam (Kerla) in 1908.  He took his medical training at Vizag Medical College, after completing a Diploma in Medical Radiology from UK, he worked in the Dept of Radiology at Madras Medical College (Barnard Instiutute).  It is here that in association with Dr. Ramamurthi, he popularized the use of neuroradiological investigations.  After short stints as Professor of Radiology at NIMHANS and Medical College, Trivendrum, he joined the institute as the head of the department of radiology.  He was the head of the Department from 1975 to 1979.  During his stint at his department, he set high standards of quality for radiological investigations. 

Dr. SASHIDHARAN who graduated form Banaras Hindu University and also completed his postgraduate training in radiology at the same institute joined the institute as an assistant professor in 1976.  He was later promoted to the post of associate professor and headed the department from 1981 1983.  He later moved on to the Regional Cancer Centre, Trivendrum as the Professor and Head of the department of raidiology. 

DR. V.R.K. RAO (VEDULA RAJANI KANTH RAO) was born at Ankapalle in Andhra Pradesh in 1948.  He graduated from Andhra Medical College, Vishakhapatnam in 1970 and pursued his postgraduate program in Radiology at Safdarjung Hospital, Delhi University and at Banaras Hindu University.  He took the position of Assistant Professor in Radiology at this Institute in early 1977 and later was in charge of the department in 1986 till 1993 as Professor and Head.  Presently he is working as Consultant and Head of the Department of Radiology and Imaging at Al Jazeira  Central Hospitals at ABU Dhabi.  He is an active member of the Indian Radiological and Imaging Association.  French Society of Neuroradiology, World Federation of Interventional and Therapeutic Neuroradiology and National Academy of Medical Sciences, besides being on the editorial board of prestigious journals like Neurology India and Indian Journal of Radiology and Imaging.  He contributed to the birth and growth of Interventional Radiology at this Institute with recognition of the Institute at National level.  Simultaneously useful efforts were made by him to develop biomaterials for Therapeutic Endovascular Neurointervention.  Close to 90 articles were published by him in various National and International Journals and he delivered more than 100 lectures at various places.  Currently the chapter on Neuroimaging is being revised by him in various National and International Journals and he delivered more than 100 lectures at various places.  Currently the chapter on Neuroimaging is being revised by him for the Indian Text Book of Neurosurgery.  He was honoured duly for Achanta Lakshmipathi Oration at Madras Medical College. 

DR. KOLATHU RAVI MANDALAM was born in New Delhi in 1954.  He graduated from Maulana Azad Medical College, New Delhi and completed his post graduation in radiology from the same institute.  After a short period of residency at Safdarjung Hospital.  New Delhi, he joined the Department of radiology at SCTMST.  As a team with Prof. C.R.K Rao and later as the head of the department, he has guided the department to national fame in the field of diagnostic and interventional cardiovascular radiology. 

DR.ARUN KUMAR GUPTA who completed his graduation and post graduation from G.R. Medical College Gwalior, joined the first batch of the Post Doctoral Certificate Course in Vascular and Interventional Radiology when it was introduced at Sree Chitra Institute in 1985.  He later joined the department as faculty and presently heads the department as faculty and presently heads the department.  He underwent a high level French government fellowship in Interventional Neuroradiology in 1994.  Under his leadership, the department has seen introduction of several innovative techniques in neurointerventions.  Coiling for intracranial aneurysms, Venous route embolizations for intracranial lesions such as dural AV fistulas and Venin of Galen malformations were introduced by him.  Other interventional lesions such as dural AV fistulas and Vein of Galaen malformations were introduced by him.  Other interventional procedures such as percutaneous vertbroplasty, percutaneous laser disc decompression and Laser abliation fo osteoid osteoma were started at the department under his guidance.  He was instrumental in starting the three year post doctoral training program in Neuroradiology (DM Neuroradiology) presently being offered by the institute. 

CLINICAL ACTIVITIES 

The Activities of the department can be broadly classified into the imaging studies and interventional procedures. 

On 22.8.03

IMAGING: 

The department has two 800n mA Xray units that function round the clock to cater to the radiographic requirements of out patients and inpatients.  Three portable X-ray units cater to radiographic of sick immobile inpatients.  The ultrasound department routinely performs the entire range of abdominal, obstetric, small part scanning an dneurosonography.  The entire range of vascular studies like neck vessel, transcranial, visceral and peripheral colour neck duplex Doppler studies are performed.  Ultrasound guided interventional procedures including diagnostic procedures like aspiration / biopsy as well as therapeutic procedures like US guided drainage procedures, alcohol injection into visceral tumors, percutaneous ultrasound guided therapy of peripheral pseudoaneurysms and so on are routinely performed. 

The spiral CT unit at the department performs the entire range of conventional CT studies of the brain and the rest of the body as well as vascular studies like spiral CT angiography.  CT guided interventional procedures including diagnostic procedures like aspiration / biopsy and therapeutic procedures like CT guided drainage procedures, ablation of tumors, CT guided alcohol injection into vertebral tumors, CT guided laser ablation of ostroid osteoms etc are performed. 

The MRI department performs the entire range of imaging studies for the brain and the body.  The MRI unit also performs imaging for stereotactic neurosurgical procedures, deep brain stimulation as well as epilepsy surgery.  Specific protocols have been developed for these as well. 

The entire range of diagnostic vascular procedures including 4 vessel angiography, aortography, peripheral angiography, bronchial angiography, venography and so on are performed routinely at the cath lab.  Functional studies like balloon occlusion tests and Wadas test are also performed to help in decision making before manor surgical / interventional procedures. 

INTERVENTIONAL PROCEDURES: 

The entire range of vascular, neurovascular and non vascular interventions are performed at the department.  Peripheral vascular interventions such as percutaneous transluminal angioplasty and stenting, thrombolysis, graft revascularization and peripheral AVM embolization are carried out routinely.  Embolization of pulmonary AVMs, visceral and head and neck tumors and other peripheral vascular malformations are performed.  Emergency embolization for uncontrolled hempotysis.  GIT bleed, epistaxis and uterine artery embolization for post partum hemorrhage are also performed.  Venous interventions like IVC filter placement are also being performed by the department. 

Neurointerventions such as coiling of aneurysms, embolizations of cerebral AVM and AVfs, Vein of Galen malformations, DAVMs, CCFs, Spinal Vascualr malformations, craniofacial vascular malformations, vertebral tumours, angioplasty and thromobolysis for stroke and for dural sinus thrombosis, stmeing of cerebral and intracranial vessels are also being routinely performed. 

Nonvascular interventions performed at the department include vertebral interventions such as percutaneous vertebroplasty and steroid injections for facet joint syndromes, oesophageal and tracheal interventions such as dilatons and stenting for oesophageal stricture and tracheal stenosis.  Laser Assisted Interventions such as percutaneous Laser disc decompression, Laser ablation of osteoid osteoma, Laser ablation of oesophageal tumor & Laser ablation of bronchial tumors are being performed at the department. 

The department is one of the few in the country to run and interventional radiology out patients clinic for initial assessment, admission and follow up of patients.  This provides for direct referral of patients to the department for interventional management. 

RESEARCH ACTIVITIES 

Being a part of an institute that has always promoted research as a culture, the department has actively participated in various experimental and clinical projects.  The department has carried out research in the field of interventional radiology with projects to develop intravascular stents, covered stents and microspheres.  Clinical studies on balloon catheter techniques, transcathetert intravascular stent grafting, prevention of resteonosis following angioplasty and coiling of intracranial aneurysms have been performed.  Various studies on imaging in epilepsy, movement disorders, craniovertabral junction, aortoarteritis etc, have also been performed studies on medical uses of LASER such as percutaneous disc decompression, LASER ablation of osteoid osteoma, Laser welding of blood vessels etc. have been performed.  A study on detection of cancer using LASER based techniques is under way.  Research in the development of an animal model of chronic vasospasm, studies on role of papaverine and urokinase in vasospasm, thrombolysis in acute stroke. 

ACADEMIC ACTIVITIES 

The department has recognized the need for providing high quality training to enthusiastic radiologists in the fields of diagnostic and interventional radiology right from its infancy.  Wishing 8 years of its inception in 1984 the department has started a one year Post Doctoral Certificate Course (PDCD)in Vascular and Neruoradiology.  This was the first attempt by anyn department in the country to start an organized training program of this sort.  The first radiologist to undergo this training, Dr.A.K.Gupta, presently heads the department.  The success of this program in popularizing interventional radiology is reflected in the large number of students applying to undergo this training every year.  Alumni of this department have been responsible for establishing interventional radiology departments in almost all major institutes of the country and in a few centers abroad.  

Considering the rapid expansion of the scope of diagnostic and interventional neuroradiology, there as a widely perceived need for providing specialist training to radiologists in this field.  With this requirement in mind, for the first time in the country, the department has started a three year postdoctoral program in Neuroradiology in the year 1999. 

As a department that has been involved in providing quality interventional radiological care to patients, the responsibility of popularizing this mode of therapy was felt by it.  Towards this end, apart from the structures training programs, many workshops and conferences were organized by the department.  Over the years, the department has seen several visits by international faculty including Prof. Luc Picard, Prof. Moret, Anne Osborn, Harold Coons.  Kieren Murphy and Dervin.  Faculty of national repute have also participated in the various workshops conducted at the institute.  The consultants at the department regularly are regularly invited by medical colleges and other institutes to introduce various interventional techniques.  This has reaped rich benefits in helping interventional radiology to gain wide acceptance.