What is Radiology?
It is a specialty of medicine that uses ionizing and nonionizing radiation for the diagnosis and treatment of disease , by using imaging technologies, such as X-ray radiography, magnetic resonance imaging (MRI), nuclear medicine, ultrasound, computed tomography (CT), and positron emission tomography (PET) - A consultant specialized in this branch of medicine is called a Radiologist.
Neuroradiology - Diagnostic radiology that focuses on the central nervous system, head, neck, and spine -
Paediatric radiology - Diagnostic radiology that focuses on the unique techniques used to create images of children's bodies, their organs, and internal structures.
Breast imaging - Diagnostic radiology that focuses on the diagnosis of breast diseases.
Cardiovascular radiology - Diagnostic radiology that focuses on the diagnosis of diseases of the heart and blood vessels (including the arteries and veins).
Chest radiology - Diagnostic radiology that focuses on the diagnosis and treatment of the chest, specifically the heart and lungs.
Gastrointestinal radiology - Diagnostic radiology that focuses on the diagnosis and treatment of the gastrointestinal (GI) tract or digestive tract.
Genitourinary radiology - Diagnostic radiology that focuses on the diagnosis and treatment of the organs of the reproductive and urinary tracts.
Musculoskeletal radiology - Diagnostic radiology that focuses on the diseases of the muscles and skeleton.
Emergency radiology - Diagnostic radiology that focuses diagnosis of trauma and nontraumatic emergency conditions.
Interventional radiology - A subspecialty of radiology that focuses on the diagnosis and treatment of patients utilizing minimally invasive interventional techniques - These include imaging and treatment of blood vessels (such as angiography), biopsy procedures, line and tube placement, and fluid abscess drainage.
Nuclear radiology - A subspecialty of radiology that focuses on the diagnosis and treatment of patients with trace doses of radioactive material -
In radiology several techniques are used and they are;
Projection (plain) radiography
Radiographs are produced by the transmission of X-Rays through a patient to a capture device then converted into an image for diagnosis.
Fluoroscopy and angiography are special applications of X-ray imaging, in which a fluorescent screen and image intensifier tube is connected to a TV monitor which allows real-time imaging of structures in motion or augmented with a radiocontrast agent. Radiocontrast agents are administered, often swallowed or injected into the body of the patient, to delineate anatomy and functioning of the blood vessels, the genitourinary system or the gastrointestinal tract.
This technique uses X-rays in conjunction with computing algorithms to image the body. In CT, an X-ray generating tube opposite an X-ray detector in a ring shaped apparatus rotate around a patient producing a computer generated cross-sectional image.
high-frequency sound waves are used to visualize soft tissue structures in the body in real time. Ionizing radiation is not utilized in the technique, but the quality of the images obtained using ultrasound is highly dependent on the skill of the person performing the exam.
MRI (Magnetic Resonance Imaging)
MRI uses strong magnetic fields to align atomic nuclei within body tissues, then uses a radio signal to disturb the axis of rotation of these nuclei and observes the radio frequency signal generated as the nuclei return to their baseline states plus all surrounding areas.
- Nuclear Medicine
Nuclear medicine imaging involves the administration of radiopharmaceuticals consisting of substances with affinity for certain body tissues labeled with radioactive tracer into the body of a patient.
The main radiology department is sub divided into three sub departments as Diagnostic Radiology, Therapeutic Radiology and Interventional Radiology.
The aim of this type of surgery is usually to improve function of the affected body part, but may also be performed to give a normal appearance to the patient - Cosmetic or aesthetic plastic surgery is performed to repair or reshape normal parts of the body, usually to improve appearance.
History of the NHSL Radiology Department and the current status:
Today Radiology has become an integral part and plays a central role in diagnosing and treating diseases. At a time when the premier healthcare institution of the country, the National Hospital of Sri Lanka is celebrating 150 years of service to the nation it is just appropriate to review the contributions made by the Radiology Department of this hospital.
Documented history starts from 1926 with Dr. H. O. Gunawardena assuming duties as the first Radiologist in the hospital. A beginning of an X-Ray Department in NHSL was in three rooms located in the Administration Block of the hospital. Equipment available at the time were one induction coil apparatus and a few accessories. Under the able guidance of Dr. Gunawardena and with the assistance from authorities, soon a transformer type of X-ray machine and a mobile X-ray machine were imported.
Next addition of equipment was in 1937 when an X-ray machine modern for that era was purchased. It is noted that there has been a long gap of 14 years until improvement of this status with commissioning of six â€˜ultra modernâ€™ X-ray plants including two ward units.
Fluoroscopy with Image Intensification facility was introduced in 1977 and from the following year the Radiology Department was able to perform double contrast gastrointestinal studies. Gradually hepatobiliary, genitourinary and vascular contrast studies done under fluoroscopy guidance were added to the diagnostic procedures carried out in this hospital.
Including cross sectional imaging to the radiology service was made in 1982 when first ultrasound scanner was brought in. Scanners with Doppler sonography and endo-rectal and endo-vaginal transducers were purchased six to seven years later. Now a separate section is available for diagnostic ultrasonography and ultrasound guided biopsy and drainage procedures.
Nuclear Imaging Unit was established in 1984 as an IAEA project facilitated through Ministry of Health. Initially only a probe system was available for image acquisition. Soon a rectilinear scanner was provided, with which better coverage of body scans was done. The Unit acquired a gamma camera in 1989. At present a dual headed gamma camera with SPECT facility and capable of doing cardiac studies is being installed in the Main X-ray Department.
First CT scanner in the hospital started functioning in 1989. Today CT scans constitute a major fraction of imaging done in the hospital. With advancing technology and refinement of technique more and more diagnostic functions become possible with CT making a continuous increase in the demand for CT procedures. The available two 16-slice CT scanners in Main X-ray Department and in Neuro Trauma Unit are not sufficient to meet the challenge.
We notice a quiet period for introduction in new technology until 2000 when a 1.0 Tesla MRI scanner was installed. Public too contributed largely to meet the expenditure for this machine which was an essential tool for management of Neurosurgical and Neurological patients. With opening of the Neuro Trauma Unit one 1.5 Tesla MRI scanner was fixed there in 2009.
In 2000, first mammography unit in hospital was acquired by University Surgical Unit. Radiology services were provided by Consultant Radiologists, medical officers and radiographers from Main X-ray Department. Today breast sonography, mammography and guided biopsy and localization procedures are done at Main X-ray Department.
Year 2003 saw addition of a dedicated angiography machine. Diagnostic angiography and endovascular procedures are done to date using this machine. Plans are ahead to have a biplane angiography machine in the Neuro Trauma Unit.
Catheter angiography was a well established diagnostic imaging method in Main X-ray Department for nearly four decades. Therapeutic endovascular procedures were started in late 1980 s treating lower limb arterial segmental stenoses using vascular dilators. Subsequently radiologists moved towards percutaneous balloon dilatation. Venous interventions were started in 2004 with IVC filters placement. Today numerous non-vascular and vascular interventional procedures are offered as part of the radiology services.
Radiology block of the then Colombo General Hospital was opened in February 1951 where Main Radiology Department is housed today. Over the years according to the service obligations X- ray units had to be started in Out-Patient Department, Accident Service and Neuro-surgical Unit. Radiology Division of Neuro Trauma Unit is a special unit catering mainly for Neuroradiology. Proposed epilepsy project of NHSL supposedly includes a state of the art radiology section with more sophisticated equipment.
Under the patronage of Dr. Gunawardena, radiotherapy section too developed in par with diagnostic radiology facilities. Radium therapy was started in 1929 . This treatment facility was expanded by purchasing two new therapy plants and an apparatus for contact therapy. This section was declared open in 1944 by Mr. George E de Silva, then Minister of Health. When National Cancer Institute started in Maharagama, radiotherapy was shifted there. Daily morning Oncology clinic held in a section of ground floor of Main X-ray Department by Consultant Oncologists from National Cancer Institute is a reminiscent of that past connection.
When Dr. Gunawardena assumed duties as the Radiologist he was the only medical personnel. He was able to have his first medical assistant fifteen years later, in 1941. Owing to tremendous progress made in undergraduate and postgraduate medical education in Sri Lanka, the Department now functions with ten Consultant Radiologists and thirty to forty medical officers including postgraduate trainees and medical officers in Radiology. Since 1926 about 12 Consultant Radiologists have given headship and guidance to this evolving service area in the leading hospital of the country.
At the start the Radiology Department was run with part-time staff loaned from the Colombo Medical College. Two permanent technical assistants were appointed in 1928. It will be interesting to note that at the end of first quarter century there were a total of 41 senior technical assistants and permanent technicians working in Radiology. Presently sixty three years later from then onwards only sixty six radiographers are working in different sections of Radiology Department of the NHSL.
It shows that the nursing officers were a part of radiology service team from the beginning. The Department had two nursing sisters and two nurses by 1951. Currently one nursing sister and about twenty nursing officers are helping to deliver more efficient radiology care.
A medical physicist who is important to a radiology service is incorporated to NHSL with the inception of Nuclear Imaging Unit in 1984. Though there were times the hospital did not have the services of these specially trained personnel we have regained a medical physicist stationed at the Main X-ray Department.
About thirty five members of minor employees and a few volunteer workers are included in the workforce positively contributing to the service requirements of the Radiology Department.
Main X-ray Department not only provides diagnostic and image guided minimally invasive therapeutic services to the country but also is the hub of radiology training for the whole of Sri Lanka. Local post graduate training in radiology started in 1982 with NHSL Radiology Department as the central point. In-service training, lecture programmes and other learning activities for future radiologists were carried out there. Initially practical components of radiology examinations too were conducted in the reporting room. So far about 155 board certified radiologists were nurtured through the portals of NHSL Radiology.
Radiography training too was closely associated with Main X-ray Department. School of Radiography started in 1957. The lecture hall and the Principalâ€™s office were situated in current day reporting room. Annually twenty five to thirty trainees were enrolled. In July 2014 the first group of graduate radiographers absorbed into Ministry of Health completed their six month practical training component of the orientation programme at NHSL.
The known history of Radiology at NHSL is the story of hard work, dedication and struggle by many. Staff of Radiology, hospital Directors, other administrative officers in hospital, officials of Ministry of Health, Sri Lankan Government, patients, people in Sri Lanka and well-wishers from overseas; all can share the pride and gratitude of a job well done.
Radiology is an equipment based service. With increasing service requirements more and more machinery based on modern technology is required to provide good radiology care. When we study the history of radiology at NHSL we notice that addition of equipment has been a slow process with unacceptable prolonged intervals. Some of the possible reasons would have been comparative high costs of equipment, adverse financial situations of the country related to global and internal armed conflicts, scarcity of adequate space for expansion and lack of due recognition about the importance of introducing recent advances into local practice. However, the fact remains that now as well as in the past, Health Ministry is doing commendably utmost to accommodate requests for expensive new technology.
NHSL Radiology is subtly subdivided into different technique based areas such as CT, nuclear imaging, ultrasonography, DSA, fluoroscopy, MRI and plain radiography.System based special areas are breast imaging section and radiology divisions in Accident Service, Neuro Trauma Unit and proposed Epilepsy Unit. This kind of division is acceptable because it makes further development easier and service delivery more efficient. Employing trained staff to handle these special areas is equally important.
How to get the services
By Appointment system