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RADIOLOGY SERVICES

Bristlecone Hospitals provides state-of-the-art, high-quality diagnostic imaging services and patient-centered care. It is our goal to act as an imaging resource that serves as an extension of area medical practices. We strive to exceed your expectations by providing a comfortable environment that brings together the technology, imaging skills, expertise, responsiveness, and excellent care physicians require and patients deserve

Bristlecone Hospitals offers following Radiology services:

Digital X-ray vs Normal X-Ray

X – rays: X-rays are a form of radiation, like light or radio waves that can be focused into a beam, much like a flashlight beam. Unlike a beam of light, however, X –rays can pass through most objects, including the human body. When X-rays strike a piece of photographic film, they can produce a picture. Dense tissues in the body, such as bones, block (absorb) many of the X-rays and appear white on an X-ray picture. Less dense tissues, such as muscles and organs, block fewer of the X-rays (more of the X-rays pass through) and appear in shades of grey. X-rays that pass through air appear black.

X –ray is one of the fastest and easiest ways for a physician to view the internal organs and structures of the body. X-Ray is an excellent tool for assessing skeletal trauma (eg. Broken bones), for diagnosing the gastro-intestinal system (digestive tract) and for comprehensive imaging of the thoracic cavity including the lungs and heart.

Digital radiology may represent the greatest technological advancement in medical imaging over the last decade. The use of radiographic films in x ray imaging might become obsolete in a few years. An appropriate analogy that is easy to understand is the replacement of typical film cameras with digital cameras. Images can be immediately acquired, deleted, modified, and subsequently sent to a network of computers.

The benefits from digital radiology are enormous. It can make a radiological facility or department filmless. The referring physician can view the requested image on a desktop or a personal computer and often report in just a few minutes after the examination was performed. The images are no longer held in a single location; but can be seen simultaneously by physicians who are kilometres apart. In addition, the patient can have the x ray images on a compact disk to take to another physician or hospital.

MOBILE X-RAY MACHINES

 A rise in obesity rates and an increasing  demand for patient-centric medical care, there are times when healthcare professionals simply need a “radiology room on wheels.”

Mobile x-ray is designed to be just such a solution – specifically for use when it is not safe or practical to move a patient from his or her bed to the radiology department. And as mobile x-ray technology has evolved over time, users have continued to demand improved accessibility, reliability and flexibility to help address the increasingly specialized radiographic needs of patients.

ULTRASOUND

Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses high-frequency sound waves to produce images of structures within your body. The images can provide valuable information for diagnosing and treating a variety of diseases and conditions.

Most ultrasound examinations are done using a sonar device outside your body, though some ultrasound examinations involve placing a device inside your body.

Ultrasound scan is a painless test that uses sound waves to create images of organs and structures inside your body. It is a very commonly used test. As it uses sound waves and not radiation, it is thought to be harmless. Doppler and duplex scans are used to visualise blood or fluids flowing through the body.

Ultrasounds are sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from 'normal' (audible) sound in its physical properties, only in that humans cannot hear it. This limit varies from person to person and is approximately 20 kilohertz (20,000 hertz) in healthy, young adults. Ultrasound devices operate with frequencies from 20 kHz up to several gigahertz.

Ultrasound is used in many different fields. Ultrasonic devices are used to detect objects and measure distances. Ultrasound imaging or sonography is often in medicine. In the non-destructive testing of products and structures, ultrasound is used to detect invisible flaws. Industrially, ultrasound is used for cleaning, mixing, and to accelerate chemical processes. Animals such as bats and porpoises use ultrasound for locating prey and obstacles. Scientist are also studying ultrasound using grapheme diaphragms as a method of communication.

Ultrasonography is an ultrasound-based diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, to capture their size, structure and any pathological lesions with real time tomographic images. Ultrasound has been used by radiologists and sonographers to image the human body for at least 50 years and has become a widely used diagnostic tool. The technology is relatively inexpensive and portable, especially when compared with other techniques, such asmagnetic resonance imaging (MRI) and computed tomography (CT). Ultrasound is also used to visualize foetuses during routine and emergency prenatal care. Such diagnostic applications used during pregnancy are referred to as obstetric sonography. As currently applied in the medical field, properly performed ultrasound poses no known risks to the patient. Sonography does not use ionizing radiation, and the power levels used for imaging are too low to cause adverse heating or pressure effects in tissue. Although the long-term effects due to ultrasound exposure at diagnostic intensity are still unknown, currently most doctors feel that the benefits to patients outweigh the risks. The ALARA (As Low As Reasonably Achievable) principle has been advocated for an ultrasound examination – that is, keeping the scanning time and power settings as low as possible but consistent with diagnostic imaging – and that by that principle non-medical uses, which by definition are not necessary, are actively discouraged.

Ultrasound is also increasingly being used in trauma and first aid cases, with emergency ultrasound becoming a staple of most EMT response teams. Furthermore, ultrasound is used in remote diagnosis cases where tele-consultation is required, such as scientific experiments in space or mobile sports team diagnosis.

According to RadiologyInfo, ultrasounds are useful in the detection of pelvic abnormalities and can involve techniques known as abdominal (transabdominal) ultrasound,vaginal (transvaginal or endovaginal) ultrasound in women, and also rectal (transrectal) ultrasound in men

CARDIAC ECHOCARDIOGRAM

An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture is more detailed than a standard x-ray image. An echocardiogram does not expose you to radiation

  • An echocardiogram can also be used to detect congenital heart defects in unborn babies.
  • Look for the cause of abnormal heart sounds (murmurs or clicks), anenlarged heart, unexplained chest pain or pressure, shortness of breath, or irregular heartbeats.
  • Check the thickness and movement of the heart wall.
  • Look at the heart valves and check how well they work.
  • See how well an artificial heart valve is working.
  • Measure the size and shape of the heart's chambers.
  • Check the ability of your heart chambers to pump blood (cardiac performance). During an echocardiogram, your doctor can calculate how much blood your heart is pumping during each heartbeat (ejection fraction). You might have a low ejection fraction if you haveheart failure.
  • Detect a disease that affects the heart muscle and the way it pumps, such as cardiomyopathy.
  • Look for blood clots and tumours inside the heart

We have different types of echocardiograms are:

  • Transthoracic  Echo Cardiogram(TTE). This is the most common type. Views of the heart are obtained by moving the transducer to different locations on your chest or abdominal wall.
  • Stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having youexercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart (coronary artery disease).
  • Doppler echocardiogram. This test is used to look at how bloodflows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.
  • Transesophageal echocardiogram (TEE). For this test, the probe is passed down the esophagus instead of being moved over the outside of the chest wall. TEE shows clearer pictures of your heart, because the probe is located closer to the heart and because thelungs and bones of the chest wall do not block the sound waves produced by the probe. A sedative and an anaesthetic applied to the throat are used to make
  • Echocardiography

FETAL DOPPLER

Doppler fetal monitor or Doppler fetal heart rate monitor is a hand-held ultrasound transducer used to detect the fetal heartbeat for prenatal care. It uses the Doppler effect to provide an audible simulation of the heart beat. Some models also display the heart rate in beats per minute. Use of this monitor is sometimes known as Doppler auscultation. Doppler fetal monitors are commonly referred to simply as "Dopplers".

Doppler fetal monitors provide information about the fetus similar to that provided by a fetal stethoscope. One advantage of the Doppler fetal monitor over a (purely acoustic) fetal stethoscope is the electronic audio output, which allows people other than the user to hear the heartbeat. One disadvantage is the greater complexity and cost and the lower reliability of an electronic device]

Originally intended for use by health care professionals, this device is becoming popular for personal use. However, the FDA recommends against their home use, citing possible harm to a developing fetus and that these should only be used under the supervision of a healthcare professional when medically indicated for the benefit of the health of mother and child

Ultrasound image of a fetus in the womb, viewed at 12 weeks of pregnancy (bidimensional-scan)

TRANS ESOPHAGEAL ECHOCARDIOGRAM

Transesophageal echocardiography (TEE) is a test that produces pictures of your heart. TEE uses high-frequency sound waves (ultrasound) to make detailed pictures of your heart and the arteries that lead to and from it. Unlike a standard echocardiogram, the echo transducer that produces the sound waves for TEE is attached to a thin tube that passes through your mouth, down your throat and into your esophagus. Because the esophagus is so close to the upper chambers of the heart, very clear images of those heart structures and valves can be obtained.

  • TEE is a test that uses sound waves to make pictures of your heart’s muscle and chambers, valves and outer lining (pericardium), as well as the blood vessels that connect to your heart.
  • Doctors often use TEE when they need more detail than a standard echocardiogram can give them.
  • The sound waves sent to your heart by the probe in your esophagus are translated into pictures on a video screen.
  • After this test, you may have a mild sore throat for a day or two
  • TEE can give clearer pictures of the upper chambers of the heart, and the valves between the upper and lower chambers of the heart, than standard echocardiograms.
  • TEE is often used to provide information during surgery to repair heart valves, a tear in the aorta or congenital heart lesions. It’s also used during surgical treatment for endocarditis, a bacterial infection of the inner lining of the heart and valves.
  • Look for the cause of abnormal heart sounds (murmurs or clicks), anenlarged heart, unexplained chest pain or pressure, shortness of breath, or irregular heartbeats.
  • Check the thickness and movement of the heart wall.
  • Look at the heart valves and check how well they work.
  • See how well an artificial heart valve is working.
  • Measure the size and shape of the heart's chambers.
  • Check the ability of your heart chambers to pump blood (cardiac performance). During an echocardiogram, your doctor can calculate how much blood your heart is pumping during each heartbeat (ejection fraction). You might have a low ejection fraction if you have heart failure.
  • Detect a disease that affects the heart muscle and the way it pumps, such as cardiomyopathy.
  • Look for blood clots and tumours inside the heart

B K ULTRASOUND

  • Ultra High Resolution Ultrasound System
  • Based on TriCore Technology developed by BK Ultrasound Scientists, the new bk is a powerful system that delivers exceptional speed and performance.

BK systems feature advanced transducers for general imaging, urology and emergency medicine, including the world’s only Triplane transducer. Every transducer has a unique Smart™ button that enables you to activate it, freeze, store and print images with a simple touch. Twin Cam Zero Insertion Force (ZIF) connectors reduce noise and are designed to be connected and removed with one hand. Up to four transducers can be connected to the bk3000 at once. Our advanced transducer technology offers superior access across a wide range of patient body types.

The bk3000 uses Multichannel Synthesis to deliver Ultra High Resolution Imaging and 2D Doppler. The technology fuses channel information to dramatically reduce noise and artifacts, while increasing detail and contrast resolution. With the bk3000, you’ll routinely see anatomy and micro-visualization not seen with conventional ultrasound. Visualize subtle tissue contrast, see real information at depth, and notice exceptional detail in moving structures with increased frame rates

Unparalleled performance in a sleek system that is designed for easy mobility in tight spaces, the bk3000 has a small footprint and five wheels for superb stability.

The system is completely adjustable to suit the preferences of clinicians, whether standing or sitting. Its monitor swivels and allows multiple adjustments for individual preferences. The bk3000’s intuitive user interface is designed for easy control with all major mode controls easily accessible. The keyboard is sealed, making it very easy to clean

ECG

Electrocardiography (ECG ) is the process of recording the electrical activity of the heart over a period of time usingelectrodes placed on a patient's body. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle depolarizing during each heartbeat.

In a conventional 12 lead ECG, ten electrodes are placed on the patient's limbs and on the surface of the chest. The overall magnitude of the heart's electrical potential is then measured from twelve different angles ("leads") and is recorded over a period of time (usually 10 seconds). In this way, the overall magnitude and direction of the heart's electrical depolarization is captured at each moment throughout the cardiac cycle. The graph of voltage versus time produced by this non-invasive medical procedure is referred to as an electrocardiogram (abbreviated ECG).

During each heartbeat, a healthy heart will have an orderly progression of depolarization that starts with pacemaker cells in thesinoatrial node, spreads out through the atrium, passes through the atrioventricular node down into the bundle of His and into thePurkinje fibers spreading down and to the left throughout the ventricles. This orderly pattern of depolarization gives rise to the characteristic ECG tracing. To the trained clinician, an ECG conveys a large amount of information about the structure of the heart and the function of its electrical conduction system. Among other things, an ECG can be used to measure the rate and rhythm of heartbeats, the size and position of the heart chambers, the presence of any damage to the heart's muscle cells or conduction system, the effects of cardiac drugs, and the function of implanted pacemakers.

  • Electrocardiography
  • Intervention
  • ECG of a heart in normal sinus rhythm.

Reasons for performing electrocardiography include:

  • Suspected heart attack
  • Suspected pulmonary embolism
  • A third heart sound, fourth heart sound, a cardiac murmur[5] or other findings to suggest structural heart disease
  • Perceived cardiac dysrhythmias
  • Fainting or collapse
  • Seizures
  • Monitoring the effects of a heart medication
  • Assessing severity of electrolyte abnormalities

A typical ECG tracing is a repeating cycle of three electrical entities: a P wave (atrial depolarization), a QRS complex (ventricular depolarization) and a T wave (ventricular repolarization).

ECG Waves and Intervals:

What do they mean?

  • P wave: the sequential activation (depolarization) of the right and left atria
  • QRS complex: right and left ventricular depolarization (normally the ventricles are activated simultaneously)
  • ST-T wave: ventricular repolarization
  • U wave: origin for this wave is not clear - but probably represents "afterdepolarizations" in the ventricles
  • PR interval: time interval from onset of atrial depolarization (P wave) to onset of ventricular depolarization (QRS complex)
  • QRS duration: duration of ventricular muscle depolarization
  • QT interval: duration of ventricular depolarization and repolarization
  • RR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate)
  • PP interval: duration of atrial cycle (an indicator of atrial rate)
  • 12 LEAD MOBILE ECG
  • The portable device can be used to administer emergency care to cardiac patients , people can now monitor their condition at home if they do not have time to visit their doctor. "Just as people use the glucometer to monitor their blood sugar levels, soon they will be able to use the tele-ECG to monitor their heart
  • The ECG graph can be transferred to the mobile phone using bluetooth and then sent as an MMS to an expert. This will help in administering emergency care at the patient’s bedside rather than move him to a hospital.
  • The standard 12-lead mobile electrocardiogram is a representation of the heart's electrical activity recorded from electrodes on the body surface. This section describes the basic components of the ECG and the lead system used to record the ECG tracings.

Orientation of the 12 Lead ECG

It is important to remember that the 12-lead ECG provides spatial information about the heart's electrical activity in 3 approximately orthogonal directions:

  • Right ⇔ Left
  • Superior ⇔ Inferior
  • Anterior ⇔ Posterior
  • Each of the 12 leads represents a particular orientation in space, as indicated below (RA = right arm; LA = left arm, LL = left foot):
  • Bipolar limb leads (frontal plane):
  • Lead I: RA (-) to LA (+) (Right Left, or lateral)
  • Lead II: RA (-) to LL (+) (Superior Inferior)
  • Lead III: LA (-) to LL (+) (Superior Inferior)
  • Augmented unipolar limb leads (frontal plane):
  • Lead aVR: RA (+) to [LA & LL] (-) (Rightward)
  • Lead aVL: LA (+) to [RA & LL] (-) (Leftward)
  • Lead aVF: LL (+) to [RA & LA] (-) (Inferior)
  • Unipolar (+) chest leads (horizontal plane):
  • Leads V1, V2, V3: (Posterior Anterior)
  • Leads V4, V5, V6:(Right Left, or lateral)
  • Lead Placement Diagrams.

TREAD MILL TEST (CARDIAC STRESS TEST)

The cardiac stress test is done with heart stimulation, either by exercise on a treadmill, pedalling a stationary exercise bicycle ergometer, or with intravenous pharmacological stimulation, with the patient connected to an electrocardiogram (ECG).

The patient is brought to the exercise laboratory where the heart rate and blood pressure are recorded at rest. Sticky electrodes are attached to the chest, shoulders and hips and connected to the ECG portion of the Stress test machine. A 12-lead EKG is recorded on paper. Each lead of the ECG represents a different portion of the heart, with adjacent leads representing a single wall. For example:

  • Leads 2, 3, and aVF = bottom or inferior portion of the heart.
  • Leads V1 and V2 = septum or partition of the heart.
  • Leads V3, V4, V5 and V6 = anterior or front portion of the heart.
  • Leads 1 and aVL = superior or top and outer left portion of the heart.
  • Lead aVR looks at the cavity of the heart and has almost no clinical value in identifying coronary disease.

 Three of the EKG leads are also constantly displayed on the treadmill monitor. Each lead representing a different wall. The physician has the option of selecting different combinations of three.

The treadmill is then started at a relatively slow "warm-up" speed. The treadmill speed and it's slope or inclination are increased every three minutes according to protocols are perfectly acceptable). The protocol dictates the precise speed and slope. Each three minute interval is known as a Stage (Stage 1, Stage 2, Stage 3, etc. Thus a patient completing Stage 3 has exercised for 3 x 3 = 9 minutes). The patient's blood pressure is usually recorded during the second minute of each Stage. However, it may be recorded more frequently if the readings are too high or too low.

As noted earlier, the ECG is constantly displayed on the monitor. It is also recorded on paper at one minute intervals. The physician pays particular attention to the heart rate, blood pressure, changes in the ECG pattern, irregular heart rhythm, and the patient's appearance and symptoms. The treadmill is stopped when the patient achieves a target heart rate (this is 85% of the maximal heart rate predicted for the patient's age). However, if the patient is doing extremely well at peak exercise, the treadmill test may be continued further. The test may be stopped prior to achievement of the target heart rate if the patient develops significant chest discomfort, shortness of breath, dizziness, unsteady gait, etc., or if the ECG shows alarming changes or serious irregular heartbeats. It may also be stopped if the blood pressure (BP) rises or falls beyond acceptable limits. Please note that the systolic BP (upper number) may normally rise to 200 at peak exercise. At the same time, the diastolic BP (lower number) remains unchanged or falls to a slight degree. In contrast, the BP of patients with hypertension or high BP will show a rise of both systolic and diastolic readings. The latter may rise above 90 – 100

C-ARM

Experience the difference of using a C-arm designed for the specific needs in Orthopedics. The power to penetrate  dense anatomy in lumbar and hip regions in small or large patients. The precision to   accentuate boney anatomy for clear spine and ortho images. The performance to get the image you need in less time and with fewer exposures.

  • Move it easily into place, set it up fast and get exceptional images. With easy steering, customized one-button pre-sets and clear dynamic imaging
  • 37 % more information per image may be crucial for an optimal workflow. You can see all the surrounding structures at a glance and can accurately plan and perform your intervention.
  • Save valuable OR time. The larger field of view minimizes the number of required images
  • Minimize dose. Less exposures result in an even more gentle intervention for both you and the patient
  • Modern imaging systems will use the image intensifier as the source of images supplied to a storage system.
  • It will be used either as a fixed piece of equipment in a dedicated screening room or as mobile equipment for use in an operating theatre.
  • C-arm (encompasses the actual X-ray source and image intensifier)
  • Table
  • Fluoroscopic exposure and program controls
  • Post processing software
  • Viewing monitors
  • The C-arm systems are commonly used for studies requiring the maximum positional flexibility such as:
  • Angiography studies (peripheral, central and cerebral)
  • Therapeutic studies (Line placements i.e. Permacath/Hickman, transjugular biopsies, TIPS stent, embolisations)
  • Cardiac studies (PTCA)
  • Orthopedic procedures (ORIF, DHS, MUA, spinal work) - again generally using a portable C-arm maximum flexibility in positional use. There are very few permanently installed C-arms in an O.R. setting.The workflow seldom justifies this sort of dedication of one O.R. or Permanent C-arm
  • The Imaging system must be compact and lightweight to allow easy positioning with adequate space to work around and a wide range of motion while remaining inflexible enough so as to avoid misalignment due to flexion caused by the mass of the X-ray tube or Image system assemblies.
  • The images can be manipulated in many ways on the computer screen. Examples of this are:
  • Cine loop replay- Allows review of a dynamic scene without extra dose
  • Cine Loop editing- Shorter loops can be made over review of a dynamic scene
  • 16 Picture overview- For quick overview.
  • Zoom- Fast magnification.
  • Relative stenosis measurement- Can measure the distance of two vessels for vasuclar procedures.
  • Test Annotation- To label all images
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            Bristlecone Hospitals, A unit of Virinchi, Banjara Hills is now accredited with NABH.             Now Accredited with             Bristlecone Hospitals, A unit of Virinchi, Banjara Hills is now accredited with NABH.             Now Accredited with