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The Department of Diagnostic Radiology in The Madras Medical Mission Hospital offers a broad range of Radiological services related to Ultrasound,Colour Doppler, Computerised Tomography (CT), Mammography and X-Rays. The department is equipped with technologically advanced medical equipments to render early and accurate diagnostic output.

The department consists of highly trained and experienced technicians and skilled Radiologists committed to providing quality patient care.

The department offers radiology services to patients of all age groups including the new born, elderly patients along with ambulatory patients and inpatients. The department actively pushes boundaries in the world of Radiology and Imaging through various research activities. The Department works closely with almost all the other specialties to ensure that all the malignancies related to patient’s condition are attended to.

The department of conventional radiology is equipped with two Fixed X-ray machines and 3 Mobile conventional X-ray machines. The work load on an average is 400 patients per day. Portable radiographs are being carried out in the ICU patients and patients who cannotbe mobilized. The Fixed X-ray units are mainly for all the OPD patients.

How X-rays work?

An X-ray is a quick and painless procedure commonly used to produce images of the inside of the body.X-rays are carried out in the hospital X-ray department by trained Radiographers.

X-rays are a type of radiation that can pass through the body. They cannot be seen by the naked eye and you cannot feel them.As they pass through the body, the energy from X-rays is absorbed at different rates by different parts of the body. A detector on the other side of the body picks up the X-rays after they have passed through and turns them into an image.

Dense parts of the body that X-rays find more difficult to pass through, such as bone, show up as clear white areas on the image. Softer parts that X-rays can pass through more easily, such as your heart and lungs, show up as darker areas.

Preparing for an X-ray

You don't usually need to do anything special to prepare for an X-ray. You can eat and drink as normal beforehand and can continue taking your usual medications.

For all X-rays, you should let the hospital know if you are pregnant. X-rays arenot usually recommended if you are pregnant, unless it is an emergency.

It is a good idea to wear loose comfortable clothes, as you may be able to wear these during the X-ray. Avoid wearing jewellery and clothes containing metals (such as zips), as these will have to be removed.

Having an X-ray

During an X-ray, you'll usually be asked to lie on a table or stand against a flat surface so that the part of your body being examined can be positioned in the right place.

The X-ray machine, which looks like a tube containing a large light bulb, will be carefully aimed at the part of the body being examined by the radiographer. They will operate the machine from behind a screen or from the next room.

The X-ray will last for a fraction of a second. You won't feel anything while it is being carried out.

While the X-ray is being taken, you will have to keep still so that the image produced isnot blurred. More than one X-ray may be taken from different angles to obtain as much information as possible.

The procedure will usually take only a few minutes.

What happens after an X-ray?

You will not experience any aftereffects from a standard X-ray and will be able to go home shortly afterwards. You can return to your normal activities straightaway.

The X-ray images will often need to be examined by a doctor called a radiologist before you are told the results.

Are X-rays safe?

People are often concerned about being exposed to radiation during an X-ray. However, the part of your body that is to be examined will only be exposed to a low level of radiation for a fraction of a second.

Generally, the amount of radiation you are exposed to during an X-ray is the equivalent to between a few days and a few years of exposure to natural radiation from the environment.

Being exposed to X-rays does carry a risk of causing cancer many years or decades later, but this risk is thought to be very small. For example, an X-ray of your chest, limbs or teeth is equivalent to a few days' worth of background radiation, and has less than a 1 in 1,000,000 chance of causing cancer.

The benefits and risks of having an X-ray will be weighed before it is recommended. Talk to your doctor or radiographer about the potential risks beforehand, if you have any concerns.

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An ultrasound scan is a procedure that uses high-frequency sound waves to create an image of a part of the inside of the body.

How ultrasound scans work

A small device called an ultrasound probe is used, which gives off high-frequency sound waves.This image is displayed on a monitor while the scan is being carried out.

Preparing for an ultrasound scan

Before having some types of ultrasound scan, you may be asked to follow certain instructions to help improve the quality of the images produced.

For example, you may be advised to:

• drink water and not go to the toilet until after the scan – this may be needed before a scan of your bladder, pelvic organs,unborn baby etc.
• avoid eating or drinking for several hours before the scan – this may be needed before a scan of your digestive system, including the liver and gallbladder

Abdominal Ultrasound (Liver, spleen, gallbladder, kidneys, pancreas,biliary system)

• (Procedure time: 30 min; visit time about 1-1/2 hours)
• Adults: Do not eat or drink eight hours before procedure.
• Children: Do not eat or drink four hours before study or skip one meal.
• Take medications with a small sip of water.
• If you are diabetic, please take your insulin.

Pelvic Ultrasound(Uterus, ovaries, fallopian tubes, urinary bladder)

• (Procedure time: 30 min; visit time about 1-1/2 hours)
• Our protocol is to include transvaginal ultrasound for females.
• Eat normally.
• One hour before your procedure, drink 32 ounces of water.
• Do not empty your bladder before your procedure.

What happens during an ultrasound scan ?

Most ultrasound scans last between 15 and 45 minutes and are performed by either a doctor or a sonographer.

A small handheld probe is placed on your skin and moved over the part of your body that is being examined.

A lubricating gel is put on your skin to allow the probe to move smoothly. This also ensures there is continuous contact between the probe and the skin.

You shouldnot feel anything other than the gel on your skin (which is often cold).

There will be a toilet nearby to empty your bladder once the scan is completed.

What happens after an ultrasound scan?

In most cases, there are no aftereffects and you can go home soon after the scan.

You may be told the results of your scan soon after it has been carried out, but in most cases the images will need to be analysed and a typed report will be provided.

Are there any risks or side effects?

There are no known risks from the sound waves used in an ultrasound scan. Unlike some other scans, such as CT Scan, ultrasound scans donot involve exposure to radiation.

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The latest computerised tomography (CT) technology scan machine Twin Bean Dual Energy SOMATOM go.Top from Siemens is available in MMM Hospital. It comes in a 128-slice configuration with 4 cm of anatomical coverage per rotation. It uses the stellar detector and tin filtration to eliminate low-energy photons and help lower dose. It can be programmed to aid workflow by automatically removing bone, creating cured planar reconstructions, lung CAD and other post-processing features so that more time can be spent on reading scans.SOMATOM go.Top offers AI-powered scan automation and innovations and comes with excellent image quality and dose-reduction technologies for all age groups.

A CT scan uses X-rays and a computer to create detailed images of the inside of the body.

They are carried out in the hospital by specially trained radiographers and can be done while you're staying in hospital or as an outpatient during your consultation with your Doctor.

CT scans can produce detailed images of many structures inside the body, including the internal organs, blood vessels and bones.They can be used to:

• diagnose conditions – including damage to liver, lungs, brain, bones, injuries to internal organs, problems with blood flow, stroke, and cancer
• guide further tests or treatments – for example, CT scans can allow a doctor to take a needle biopsy (where a small tissue sample is removed using a needle) or drain an abscess
• monitor conditions – including checking the response to treatment given, follow-up the condition of patients, size of tumours during and after cancer treatment

What are the CT studies performed in MMM Hospital?

128CT scan examinations including

o CT brain
o CT Neck
o CT Thorax
o High resolution CT scan for lungs (HRCT)
o CT abdomen
o CT KUB
o CT joints/ extremities / spine

Preparing for a CT scan

You may be advised to avoid eating anything for several hours before your appointment to help make sure clear images are taken.

If you have any allergies or kidney problems, or if you're taking medication for diabetes, special arrangements may need to be made.

You should also let the hospital know if you are pregnant. CT scans arenot usually recommended for pregnant women unless it is an emergency, as there is a small chance the X-rays could harm your baby.

It is a good idea to wear loose, comfortable clothes as you may be able to wear these during the scan.

Before having a CT scan

Before having the scan, you may be given a special dye called a contrast to help improve the quality of the images.

This may be swallowed in the form of a drink, passed into your bottom (enema), or injected into a blood vessel.

Tell the radiographer if you feel anxious or claustrophobic about having the scan.

They can give you advice to help you feel calm and can arrange for you to have a sedative (medication to help you relax) if necessary.

Before the scan starts, depending on the area of your body being examined, the hospital may ask you to remove some clothing and wear a hospital gown.

Try to avoid wearing jewellery and clothes containing metal (such as zips) because these will have to be removed as metal causes artefacts.

What happens during a CT scan?

During the scan, you will usually lie on your back on a flat bed that passes into the CT scanner.

The scanner consists of a ring that rotates around a small section of your body as you pass through it.

Unlike an MRI scan, the scanner doesnot surround your whole body at once, so you shouldnot feel claustrophobic.

The radiographer will operate the scanner from the next room. While the scan is taking place, you will be able to hear and speak to them through an intercom.

While each scan is taken, you will need to lie very still and breathe normally. This ensures that the scan images arenot blurred.

You may be asked to breathe in, breathe out, or hold your breath at certain points.

The scan will usually take around 10 to 20 minutes.

What happens afterwards?

You shouldnot experience any aftereffects from a CT scan and can usually go home soon afterwards. You can eat and drink, go to work and drive as normal.

If a contrast was used, you may be advised to wait in the hospital for up to an hour to make sure you don't have a reaction to it.

The contrast is normally completely harmless and will pass out of your body in your urine.

Your scan results will usually not be available immediately. A computer will need to process the information from your scan, which will then be analysed by the Radiologist.

After analysing the images, the Radiologist will write a report and send it to the doctor who referred you for the scan so that your doctor can take it forward with you.

Safety of CT scans

CT scans are quick, painless and generally safe. But there is a small risk you could have an allergic reaction to the contrast dye used and you will be exposed to X-ray radiation.

The amount of radiation you are exposed to during a CT scan varies, depending on how much of your body is scanned.

CT scanners are designed to make sure you are not exposed to unnecessarily high levels.

Generally, the amount of radiation you are exposed to during each scan is equivalent to between a few months and a few years of exposure to natural radiation from the environment.

It is thought that exposure to radiation during CT scans could slightly increase your chances of developing cancer many years later, although this risk is considered to be very small (less than 1 in 2,000).

The benefits and risks of having a CT scan will always be weighed up before it is recommended.

Talk to your doctor or radiographer about the potential risks beforehand if you have any concerns.

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Computed tomography angiography (CTA) uses an injection of contrast material into your blood vessels and CT scanning to help diagnose and evaluate blood vessel disease or related conditions, such as aneurysms or blockages. CTA is performed in the Radiology department.

Uses of CTA

Physicians use CTA to check blood vessels before/following surgery, such as:

• Identify abnormalities, such as aneurysms, in the aorta, both in the chest and abdomen, or in other arteries.
• Detect atherosclerotic (plaque) disease in the carotid artery of the neck, which may limit blood flow to the brain and cause a stroke.
• Identify an arteriovenous malformation inside the brain or elsewhere.
• Detect plaque disease that has narrowed the arteries to the legs and help prepare for angioplasty/stent placement or surgery.
• Detect disease in the arteries to the kidneys or visualize blood flow to help prepare for a kidney transplant or stent placement.
• Guide interventional radiologists and surgeons making repairs to diseased blood vessels, such as implanting stents or evaluating a stent after implantation.
• Detect injury to one or more arteries in the neck, chest, abdomen, pelvis or limbs following trauma.
• Evaluate arteries feeding a tumor prior to surgery or other procedures such as chemoembolization or selective internal radiation therapy.
• Identify dissection or splitting in the aorta in the chest or abdomen or its major branches.
• Show the extent and severity of coronary artery disease and its effects and plan for an intervention, such as a coronary bypass and stenting.
• Examine pulmonary arteries in the lungs to detect pulmonary embolism (blood clots, such as those traveling from leg veins) or pulmonary arteriovenous malformations.
• Look at congenital abnormalities in blood vessels, especially arteries in children (e.g. malformations in the heart or other blood vessels due to congenital heart disease).
• Evaluate stenosis and obstructions of vessels.

What are the CT angiogram procedures performed in MMM Hospital?

o CTA
- Cerebral Angiogram
- Carotid Angiogram
- Pulmonary Angiogram
- Thoracic Aortogram
- Abdominal Aortogram
- Whole Aortogram
- Renal Angiogram
- Peripheral Angiogram
o Cardiac CT
- Cardiac Anatomy
- Coronary Angiogram
- Calcium Scoring
- TAVR/MAVR/ TTVR

How do I prepare for a CTA?

PREGNANT: If you are pregnant or think you may be pregnant, please check with your doctor before scheduling the procedure. Other options will be discussed with you and your doctor.

BREAST FEEDING: If you are breastfeeding at the time of the procedure, ask your doctor how to proceed. It may help to pump breast milk ahead of time. Keep it on hand for use until all contrast material has cleared from your body (about 24 hours after the test). However, the most recent American College of Radiology (ACR) Manual on Contrast Media reports that studies show the amount of contrast absorbed by the infant during breastfeeding is extremely low.

CLOTHING: You may be asked to change into a patient gown. If so, a gown will be provided for you. A lock will be provided to secure all personal belongings. Please remove all piercings and leave all jewellery and valuables at home.

CONTRAST MEDIA: CTA scans are done with a contrast media. The contrast media improves the radiologist's ability to find structures that are abnormal.

• Some patients should not have an iodine-based contrast media. If you have problems with your kidney function, please inform us in advance. We may be able to perform the scan with an alternate non-ionic contrast media
• You will be asked to sign a consent form that will detail the risks and side-effects associated with contrast media injected through an intravenous (IV) line (small tube placed in a vein).

ALLERGY: Please inform the access center representative when you schedule your scan if you have had an allergic reaction to any contrast media. IV contrast will not be administered if you have had a severe or anaphylactic reaction to any contrast media in the past. Mild to moderate reactions warrant a plan that includes taking medication prior to the CT examination. These plans will be discussed with you in detail when you schedule your procedure. Any known reactions to a contrast media should be discussed with your personal physician.

EAT/DRINK: If your study was ordered without contrast, you can eat, drink and take your prescribed medications prior to your procedure. If your doctor orders a CT scan with contrast, do not eat anything three hours before your CT scan. You are encouraged to drink clear liquids. You may also take your prescribed medications prior to your procedure.
• If you are undergoing a chest CTA, do not consume any caffeine or exercise three hours prior to your appointment.
DIABETICS: Diabetics should eat a light breakfast or lunch three hours prior to the scan time. Depending on your oral medication for diabetes, you may be asked to discontinue use of the medication for 48 hours after the CT examination. Detailed instructions will be given following your examination.

MEDICATION: All patients can take their prescribed medications as usual.

How is the procedure performed?

You may be asked to complete a questionnaire to ensure your safety during this procedure.

A nurse will insert an intravenous (IV) catheter into a vein, usually in your arm or hand.

The technologist begins by positioning you on the CT exam table, usually lying flat on your back. They may use straps and pillows to help you maintain the correct position and remain still during the procedure.

An automatic injection pump connected to the IV will inject contrast material at a specified rate.During scanning, the table is positioned at the start point of imaging and will then move through the opening of the machine as the actual CT scanning is performed. A single scan takes approximately one to two minutes, but multiple scans may be required.

During CTA of the heart, electrocardiogram (ECG) leads (sticky patches) will be placed on your chest to synchronize CT scanning with your heartbeats. If your heart beats too fast, it may be temporarily slowed down with medication to obtain clear images of the heart. If you receive heart rate control medication, you will be closely monitored during and after the procedure.

The technologist may ask you to hold your breath during the scanning. Any motion, including breathing and body movements, can lead to artefacts on the images. This loss of image quality can resemble the blurring seen on a photograph taken of a moving object.

When the procedure is complete, the technologist will ask you to wait until they verify that the images are of high enough quality for accurate interpretation by the radiologist.

Following the procedure, the nurse will remove the intravenous catheter and place a bandage over the needle puncture site.

How long will the scan take?

The entire CTAprocedure may be over within a few seconds. However, the actual time in the scanner room may be longer, as the technologist will have to appropriately position you on the table, verify placement of the IV line, do preliminary imaging, and set up the scanner and contrast injection pump settings based on the part of the body being imaged.

Children: CTA is rarely performed in children as they are more sensitive to radiation than adults. For children, radiologists administer low radiation dose . In some cases, especially in children with small veins, the contrast may be hand-injected using a syringe. Occasionally, sedation is required for children to keep them still during scanning. Your doctor will help determine if sedation is needed and, if so, will arrange it. Preparation for sedation may include no eating and drinking for several hours before the procedure to prevent complications. Also, an extended close observation following the scan may be required until the medication used for sedation wears off.

What are the benefits vs. risks of having CT Angiogram?

Benefits

• Angiography may eliminate the need for surgery. If surgery remains necessary, it can be performed more accurately.
• CTA is fast, non-invasive and may have fewer complications compared to conventional angiography.
• CTA may provide more precise anatomical details than other angiography procedures such as conventional catheter angiography and magnetic resonance imaging (MRI).
• For CTA, there is no need for sedation or general anesthesia.
• CTA of the heart is a useful way of detecting blocked coronary arteries.
• CTA may also cost less than catheter angiography.
• No radiation remains in a patient's body after a CT examination.
• The X-rays used for CT scanning should have no immediate side effects.

Risks

Most patients complete CT angiography with no adverse events.

• There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk involved with CT scanning.
• If you have a history of allergy to X-ray contrast material, your doctor may advise you to take special precautionary medication, such as a steroid, for a few hours or the day before CTA to lessen the chances of an allergic reaction.
• In patients who are at risk for kidney failure and who already have borderline kidney function, administering iodinated contrast material could potentially further damage kidney function. Check with your referring doctor and radiologist to obtain more information regarding this risk.
• If a large amount of X-ray contrast material leaks out from the vein being injected and spreads under the skin where the IV is placed, it may damage the skin, blood vessels, and nerves. If you feel any pain or tingling sensation in this area during or immediately after the contrast material injection, you should immediately inform the nurse/technologist.
• Women should always tell their doctor and X-ray or CT technologist if there is any chance they are pregnant.
• IV contrast manufacturers indicate mothers should not breastfeed their babies for 24-48 hours after contrast material is given. However, the most recent American College of Radiology (ACR) Manual on Contrast Media reports that studies show the amount of contrast absorbed by the infant during breastfeeding is extremely low.
• The risk of severe allergic reaction to contrast materials that contain iodine is rare, and hospitals are well-equipped to deal with them.

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This procedure is done to visualize the female reproductive system, i.e. uterus &fallopian tubes. The indication is usually infertility. The procedure is performed by the doctors from the Institute of Reproductive Medicine (IRM).

The procedure is usually done on the 9th or 10th day after the onset of menses (when the chances that the patient may have conceived are the least). The procedure is done without anesthesia; some patients may need some pain killers during the procedure as some may experience moderate pain. Patients are asked to bring one of their relatives along with them at the time of investigation.

The procedure involves cannulation of the cervix under direct vision with a cervical cannula & injection of radio-opaque contrast media into the uterus. Then multiple X-rays are taken to record the flow of contrast into the uterus and the tubes.

The procedure lasts about 30 minutes; patients may have some pain for a few hours after the procedure, but usually resume normal activities immediately thereafter. Patients may be asked to take a course of oral antibiotics after the procedure

The department functions from 8 a.m. to 7 p.m. on all days except Sundays and official holidays.

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X-ray Mammography and Sonomammographyare screening tools, searching for cancer when there are no symptoms of anything being wrong. A mammogram detects lumps, changes in breast tissue, or calcification when they are too small to be found in a physical examination.

We have specially trained female technologists who perform the mammogram by positioning the breast tissue in the screening equipment.

The results of your mammogram are given to you before you leave the hospital to reduce any anxiety you may have about the screening. We give you a letter outlining the results and any recommendations, if needed. A copy of the report is also provided to your primary care physician or the doctor who ordered the test.

(Mammography investigation is a part of the Institute of Reproductive Medicine (IRM) in The Madras Medical Mission Hospital, which is an outsourced investigation within the hospital. Consultation and Reporting is handled by IRM with NO involvement of the Radiology Department of MMM hospital)

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Dr. Shajeev JaikumarD.M.R.D; D.N.B
General Radiology

Dr. Zeeshan Lakhani D.N.B
Cardiac Radiologist

Imaging Modalities NOT available in MMM Hospital: We DO NOT have MRI , PET CT & Nuclear Medicine facilities in the hospital.