Neuroradiology as a subspeciality of radiology has grown several folds in the last 3 decades. Few days back I was reading an article by our institute’s former radiology professors Prof. Rao and Prof. Mandalam on the birth and growth of neuroimaging and vascular intervention in our department. The article detailed procedures like direct puncture carotid angiogram, ventriculogram, pneumoencephalography, all being done as diagnostic procedures and the starting of Neurointervention for arteriovenous malformations. This was in 1970s and 80s. The article was really inspiring. There is no doubt that neuroradiology as practiced today in our country is because of the passion and commitment of our seniors.
With the advent of CT, MRI and neuro-interventional procedures in the disease management of neurological diseases, the growth of neuroradiology has been phenomenal. Today we have better procedures, safer contrast media and interventional radiological devices & technically superior imaging equipment. The neuroradiologist works closely with the neurologists, neurosurgeons, neuro-anaesthesiologist, neuropathologist, oncologist and other specialities in such a way that his / her expertise can be maximally used for disease diagnoses and management. By such collaborative work, the radiologist has become an important and useful member in the patient management team.
I am sure that many young radiologists today would like to take neuroradiology as their field of subspecialisation. As the President of ISNR, I wish to mention few points that could be useful for the young radiologists interested to take up neuroradiology as a specialisation
- The young radiologist should understand the need for subspecialisation in radiology. We have to look from the patient’s perspective. Every patient wants himself or herself to be manged by a person with the best expertise and skill. The three-year MD/ DNB training may not be enough for a radiologist to be an expert in all fields of radiology.
- There should be neuroradiology training centres in the country. By now, more than 150 DM neuroradiologists have passed out from various prestigious institutions in the country. Many more have received fellowships from institutions in India and abroad. However, this is too less a number for a huge country like India & for a speciality which is growing every day. It is high time that more Medical colleges start recognised post-doctoral programs (DM / fellowship) in neuroradiology. Short term courses in Paediatric Neuroimaging, Head & Neck Imaging & Functional Neuroimaging should be conducted by institutions with expertise in these areas. ISNR will be always willing to support such programs.
- There is a need to understand the new possibilities in Neuroradiology. Functional neuroimaging, Radiomics and Imaging genomics are promising advancements in diagnostic neuroradiology. These newer techniques can improve our understanding of neurological diseases & may aid in the diagnosis and management of neurological and psychiatric diseases. Neuroradiologist can expand his/ her knowledge and skill in Neurofeedback, Neuro-rehabilitation, functional near infrared spectroscopy, and machine learning. The neuroradiologist needs to embrace Artificial Intelligence just like any other field of science and technology. Rather than taking over any field of imaging, it will improve our diagnostic capabilities and work flow in the radiology department. We should work on AI techniques, which can improve the quality of images and aid us in giving the correct diagnoses. It is essential that neuroradiologists collaborate with specialists of allied medical specialities & Biomedical engineers towards these technologies.
- In interventional neuroradiology, newer gadgets and improved armamentarium are being developed, which have made neuro-interventional procedures safer and more effective. New effective interventional methods are also being developed for example, Mechanical thrombectomy in acute stroke treatment. Skill development in these techniques is essential so that the radiologist does not lose out in turf war with other specialities.
- Finally, there is a need to think globally. We need to collaborate in the field of education & research with not only institutions within the country but also with institutions and societies abroad.
Dr. C. Kesavadas
Indian Society of Neuroradiology (ISNR)