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Year : 2002  |  Volume : 12  |  Issue : 3  |  Page : 319
Multi-slice CT-how abreast are we with the changed CT scenario?


Editor-in-chief, The Indian Journal of Radiology and Imaging, India

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How to cite this article:
Desai S. Multi-slice CT-how abreast are we with the changed CT scenario?. Indian J Radiol Imaging 2002;12:319

How to cite this URL:
Desai S. Multi-slice CT-how abreast are we with the changed CT scenario?. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Aug 8];12:319. Available from: http://www.ijri.org/text.asp?2002/12/3/319/28469
The medical fraternity has experienced quantum leaps every time there has been advancement in imaging; be it the discovery of X-rays or the introduction of cross-sectional imaging. As radiologists we are aware of the rapid technological advances that are occurring in the field of imaging software and hardware, but are we really tapping its potential to the fullest?

With the introduction of multi-slice CT a whole new imaging territory has opened to us, for e.g. cardiac CT, CT perfusion CT endoscopy. Research and literature on these subjects is abundant. We have to educate ourselves from the work of others as well as from our own experiences. To image the heart and coronaries has been a challenge to all radiologists practicing CT. The problems so far have been in terms of spatial and temporal resolution due to the motion of the heart and the close proximity of contrast opacified coronary arteries with contrast filled cardiac chambers. Now with multi-slice CT and ECG gating we have overcome these technical hurdles. The non-invasiveness, OPD-basis, low cost this procedure should be advocated as lucrative features that will carve a niche for CT coronary angiography in today's "heart- conscious" world. Coronary calcium scoring is an effective screening tool for significant atherosclerotic burden and must be utilized for the same.

Stroke is another major cause of morbidity and mortality today. CT brain is the first imaging done to rule out intracranial bleed and can be complimented with CT perfusion study to make it a one-stop shop for imaging in stroke. Its shorter post-processing time makes it superior to MR perfusion, as time is crucial in stroke management. Faster scanning time permits us to perform CT angiography with rapidity, less contrast and better resolution. CT angioscopy gives an endoluminal view of the vessels. With software advances we can only better resolve subtle, soft plaques. CT bronchoscopy and colonoscopy allow us to have an endoscopic view distal to a lumen-obstructing lesion that cannot be bypassed by a conventional scope. With fusion of CT and PET, we can now obtain both anatomical and physiological information simultaneously. In many diseases, the metabolic/physiological alterations precede anatomical changes. CT-PET will allow us to diagnose these conditions earlier in the course of the disease. Advances are plenty and we will have to keep pace with them.

Although electron beam CT has been around in clinical practice for some time now, the high cost, limited cardiac usage and equipment size have been deterring factors in its popularity. With the advent of multi-slice CT, cardiac CT has become a routine investigation. In such a scenario, we have to be conversant with anatomy and diseases of the heart so as to prevent cross-sectional cardiac imaging from slipping away from our hands as has happened with cardiac angiography. Ignorance at this stage will result in a vicious cycle of lack of a trained radiologist leading to referring specialists mastering the technique and making it a part of their domain. We must learn from our past mistakes. Today we face a situation where other specialists are doing procedures, which should legally and ethically be performed by a radiologist. For instance we have obstetricians doing antenatal sonography, urologists doing percutaneous nephrostomies and above all cardiologists performing interventional radiological work. This problem has arisen due to lack of competent, enthusiastic and dynamic radiologists who shy away from taking up new challenges and keeping pace with the advancing technology. If we do not wake up to the situation now, the day is not far when we will be rendered to doing the technical job and the referring physician will do the reporting.

Similarly, CT bronchoscopy, colonoscopy face hesitant acceptance by endoscopists. What is needed is to have dedicated clinical studies with full participation of the endoscopists in our own set-ups instead of relying on foreign data. Findings on a well-performed CT endoscopy with thorough evaluation are bound to be corroborated by matching results on a conventional endoscopy. This will raise the confidence level of the referring physician in the modality. Faster scanning time, use of less contrast and better post-processing software are features that should be exploited to our advantage. We have to be computer literate and be able to make full use of the newer software to provide detailed relevant diagnostic information.

It is imperative that we understand the newer applications of multi-slice CT, their current status in imaging protocols as well as their limitations so as to be able to make their judicious use. We have to act now to prevent radiological diagnostic work from slipping away from our domain.

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Correspondence Address:
Shrinivas Desai
Editor-in-chief, The Indian Journal of Radiology and Imaging
India
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Source of Support: None, Conflict of Interest: None


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