Diagnostic Ultrasound and Color Doppler

What is ultrasound?

Using high frequency sound waves, which are not audible, images are the internal organs and body parts are generated.

Where it is used?

Ultrasound scan as many applications in almost all body parts. Mainly it is used to evaluate the internal organs of the abdomen like :
Liver – Liver abscess, Jaundice, Liver injury etc.
Gall Bladder – Calculi, Cholecystitis, tumour etc.
Pancreas – Pancreatitis, Pancreatic injury etc.
Kidneys – Calculi, Flank pain, blood in the urine( hematuria) etc.
Uterus and adnexa – Fibroid, pelvic pain, excessive bleeding, irregular periods, suspected pelvic mass/ cyst etc.

It is also used to look for fluid in the abdomen, thorax etc.
Ultrasound scan has major applications in evaluating thyroid, breast, scrotum and in many musculoskelatal condition.

Color Doppler :

This is the special type of ultrasound scan where in blood flow in the body is detected and evaluated. Its major applications include limb swelling with suspicion of blood clots, limb pain with suspicion of reduced blood flow, dilated veins (varicose veins) , giddiness with suspicion of block in the neck vessels.

Is repeated use of Ultrasound harmful?

No. ultrasound scan can be done as many times as required, provided proper guidelines are followed. The sound energy used for diagnostic purposes is safe and is non – ionizing.

Any preparation required?

3-6 hours of fasting is ideal for abdominal scan. Patients with gyenecological conditions need to drink about 2-3 glasses of water to fill the urinary bladder.

Pregnant patients and childern do not require any preparation.

Center for Pain management under Ultrasound guidance

Pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage’.”

Put more simply, pain is what the person feeling it says it is.

The onus on the physician is to understand it and respond in the manner appropriate to the person (rather than the pain).

Today’s doctors have understood to listen to the patient’s description of their pain and act upon that. Just because they cannot see the pain’s source does not mean it doesn’t exist.

We are pleased to offer comprehensive and compassionate Pain Management care.

Who should consult a pain clinic?
Anybody with long standing pain or intermittent pain for a long duration especially people with :
Back Pain / Sciatica
Neck Pain
Headaches
Facial Pain
Joint Pain
Frozen Shoulder
Cancer Pain
Neuropathic Pain
Pelvic Pain
Fibromyalgia
Chronic regional Pain Syndrome
Persistent pain after back / spine surgeries
Persistent pain following routine surgeries

The various treatment options available are:

Medications:
Simple pain killers act on the chemicals produced by damaged cells and nerves reducing inflammation and pain.  There are multiple other pain killers which are similar to antiepileptic and antidepressant drugs and they work on the chemicals released by the brain and nervous system to reduce pain. These drugs are delivered through various means including but not limited to tablets, liquids, injections and patches.

Nerve Blocks / Interventions :
Pain signals are carried to the brain by nerves from the site of pain via the spinal cord. Quite often it is possible to block these signals by giving injection around the nerves or next to the spine so as to give pain relief. These may be temporary or permanent with drugs, cryotherapy or radiofrequency ablations. These OPD or day care procedures are carried out utilizing ultrasound scans to provide very accurate targeting of these nerves and provide lasting relief with very few side effects.

Minimally invasive interventional procedures are also offered instead of major surgical procedures where risks outweigh the benefits of major surgeries.

Interventional oncology with High resolution Ultrasound Guidance

What is interventional oncology?

Interventional oncology is a type of cancer care performed by specially trained radiologists called interventional radiologists. They use advanced imaged-guided techniques such as CT, fluoroscopy or ultrasound to deliver treatment through a small skin puncture.

Interventional oncology targets cancer and/or the pain it causes. These procedures are often used with standard cancer treatments — such as surgery, chemotherapy and radiation — and may reduce pain and/or extend life. For certain types of tumors, interventional oncology procedures can be curative. Recovery is quick. Most interventional oncology procedures are outpatient procedures

Our interventional radiologists are nationally known specialists in cancer care and pain relief.

Who is a candidate?

Generally, interventional oncology is meant for patients who have not responded to chemotherapy or radiation, cannot receive more radiation, are unable to undergo surgery and/or need relief from their cancer pain. It is also used as a “bridge” for certain cancer patients who are waiting for an organ transplant.

Cancer type

The following cancers can be treated with these interventional procedures:

  • Bone cancer
    • Radiofrequency ablation (RFA)
    • Vertebral augmentation (cementoplasty)
  • Kidney cancer
    • Cryoablation (CA)
    • Microwave ablation
  • Liver cancer
    • Chemoembolization
    • Cryoablation (CA)
    • Radioembolization [TARE]
    • Radiofrequency ablation (RFA)
    • Microwave ablation
    • Irreversible Electroporation (IRE)
  • Lung
    • Radiofrequency ablation (RFA)
    • Microwave ablation
    • Irreversible Electroporation (IRE)

Radiofrequency Ablation

What is radiofrequency ablation (RFA)?

RFA is a procedure used to destroy the tumor and the small blood vessels that ‘feed’ it.
It uses image guidance to insert a thin probe through the skin and into a tumor.
Once in position, the tip of the probe heats up to kill nearby cancer cells.
RFA is used to treat bone, liver and lung cancer and is performed by an interventional radiologist.

If you have bone cancer

Advantages of (RFA)

  • Decreases pain and pain medication use
  • Increases mobility
  • Treatment can be repeated
  • Can be used with other cancer therapies

If you have liver cancer

Advantages of RFA

  • Treatment can be repeated
  • Can be used with other cancer therapies
  • Is considered curative in some types of liver cancer

If you have lung cancer

Advantages of RFA

  • Can be used on patients who are not candidates for lung cancer surgery
  • Preserves lung function better than surgery, especially for those with a breathing impairment
  • Can be repeated or used with radiation therapy for persistent tumors
  • Helps shrink tumor, and increases effectiveness of chemotherapy or radiation therapy
  • Provides pain relief if tumor invades the chest wall

Cryoablation

What is cryoablation?

Cryoablation is an image-guided procedure that uses extreme cold to destroy or damage cancerous tissue. It is performed when surgery to remove a tumor may be difficult or impossible. An interventional radiologist performs cryoablation using a “cryoprobe.” This is a thin probe that delivers extreme cold that forms an ice ball at its tip, freezing nearby cancer cells. Sometimes more than one probe is used.

If you have bone and/or soft tissue cancer

Advantages of cryoablation

  • Decreases pain and pain medication use
  • Increases mobility
  • Treatment may be repeated

If you have kidney cancer

Advantages of cryoablation

  • Most patients resume normal activities within 24 hours
  • Less painful with fewer side effect than other treatments
  • Preserves more kidney tissue than surgery
  • Does not impact blood pressure
  • May be repeated if necessary
  • Is considered curative

If you have liver cancer

Advantages of cryoablation

  • Less painful than open surgery
  • Saves more healthy tissue than surgery
  • Can be repeated as often as necessary
  • Needs day care monitoring- no recovery period after discharge

Microwave Ablation

What is microwave ablation?

Microwave ablation is a cancer treatment that uses heat to destroy a tumor. It is performed by an interventional radiologist who uses image-guidance to insert a small probe into a tumor. Once the probe is in position, microwave energy is discharged, releasing a controlled amount of heat that destroys abnormal tissues. Microwave ablation is often used on small, inoperable liver and lung tumors.  It’s also used in patients waiting for a liver transplant.

Advantages of microwave ablation 

  • Takes less time radiofrequency ablation – the standard treatment for liver cancer
  • Can be repeated as necessary
  • Can be used on larger tumors
  • Several small tumors can be treated at the same time

Irreversible Electroporation (IRE)

What is irreversible electroporation (IRE)?

Irreversible electroporation (IRE) uses short bursts of electricity to destroy small tumors in difficult-to-treat areas. Often these tumors lie close to blood vessels and nerves in the liver and lung. IRE selectively damages the tumor’s cells causing them to die. It does not damage nearby healthy tissue. IRE is performed by an interventional radiologist who uses image guidance assistance.

Advantages of irreversible electroporation (IRE)?

  • Is easy to tolerate
  • Can be used with surgery
  • Can be curative in some cases
  • Leaves healthy tissue intact
  • Minimal if any side effects

Vertebral augmentation/cementoplasty

What is vertebral augmentation?

Some cancers and/or their treatments cause painful fractures (breaks) in the spine or pelvis. Vertebral augmentation is an image-guided procedure to treat broken vertebrae (the interlocking bony segments of the spinal column) and fractures in the pelvis. It uses a special cement to stabilize the bone and provide pain relief. Vertebral augmentation is also known as a “cementoplasty.”

Advantages of vertebral augmentation / cementoplasty

  • Decreases pain and use of pain medications
  • Improves quality of life
  • Reduces disability
  • Can be used with other cancer therapies

Chemoembolization

What is chemoembolization?

Chemoembolization is an image-guided procedure that delivers a high dose of chemotherapy (anti-cancer drugs) to a tumor while also blocking its blood supply. Although not a cure, chemoembolization is very effective in treating primary liver cancers and other types of cancer that have spread. Chemoembolization is performed by an interventional radiologist.

Advantages of chemoembolization

  • Most patients resume normal activities within one week
  • While not a cure, most patients show improvement
  • In most cases, the tumor stops growing and may even shrink
  • Treatment may be repeated multiple times and/or combined with other cancer therapies
  • Improves quality of life
  • May extend life from months-to-years for patients with inoperable tumors
  • Allows for more curative options, such as surgery or a liver transplant, in some patients

Radioembolization

What is radioembolization?

Radioembolization is an image-guided procedure that uses tiny radioactive beads to treat cancer. The particles lodge in the tumor and emit radiation that kills cancer cells. Radioembolization is considered a “palliative” (pain-relieving) treatment that also slows cancer growth. It is performed by an interventional radiologist.

Advantages of radioembolization

  • Most patients resume normal activities within one week
  • Reduces pain
  • Slows growth of the tumor
  • Improves quality of life
  • May extend life from months-to-years for patients with inoperable tumors
  • Allows for more curative options, such as surgery or a liver transplant, in some patients

Dr. Madhukar. B. K
MBBS, MD(Radiodiagnosis, PGIMER Chandigarh) Senior Residency in Interventional Radiology(AIIMS, New Delhi)
Consultant Interventional Radiologist