In this insightful interview with Dr. Sanjiv Chawda, a consultant neuroradiologist, we delve into the fascinating realm of neuroimaging, particularly the role of MRI scans in studying the brain and spine.
Can you tell us about your journey to become a neuroradiologist?
To become a neuroradiologist, I followed a specific path. I began by earning my medical degree at Cardiff University. After that, I embarked on various medical roles, ultimately achieving Membership of the Royal College of Physicians (MRCP).
Following my general medical experience, I dedicated five years to radiology training. Subsequently, I spent an additional two years specialising in Neuroradiology through a fellowship program in London. This involved rotations at several esteemed hospitals, including the National Hospital for Neurology and Neurosurgery, Royal London, and Great Ormond Street.
Since the turn of the millennium, I’ve held the position of consultant neuroradiologist. Many might think neuroradiology is a niche field, but it involves a wide range of responsibilities. I’ve actively participated in numerous medical meetings, such as those focusing on head and neck oncology, thyroid conditions, dementia, orbital issues, neuro-oncology, spine cases, and skull base matters. Additionally, I’ve been part of a neurology multidisciplinary team (MDT). These meetings have provided invaluable experience and insight over the years.
Until recently, I was actively involved in interventional neuroradiology, a field where we treat conditions such as brain aneurysms and arteriovenous malformations. This work also included procedures like spinal biopsies, demonstrating the diverse range of responsibilities I’ve undertaken in my role.
At Living Room Health, I am the consultant neuroradiologist, where I specialise in diagnostic imaging for various aspects of the brain, spine, and head and neck. The term “head and neck” encompasses a wide range of areas, including sinuses, orbits, and the throat. At Living Room Health, our primary focus is on MRI (Magnetic Resonance Imaging), although I can also handle diagnostic imaging involving CT scans and plain films related to neurological conditions.
"Now, GPs have direct access to imaging services. When a patient presents with symptoms, GPs can recommend the necessary imaging, which can often be faster and more efficient, especially for MRI scans. Patients can self-refer for these scans and then consult their GP based on the results, potentially eliminating the need to see a specialist immediately."
What is the role of MRI (Magnetic Resonance Imaging) in neuroimaging, specifically in studying the head and spine?
In the field of neuroimaging, the most common MRI scans we perform at Living Room Health are related to the brain, cervical, thoracic, and lumbar spine. These four areas constitute the bulk of our work.
For brain imaging, we often encounter patients with various concerns. Some individuals experience persistent headaches or dizziness and want to rule out any underlying issues. We also assess whether there are signs of a stroke or the presence of brain lesions, such as tumours.
When it comes to spinal imaging, one of the frequent requests is to investigate disc herniations. Many people are familiar with this condition, as it can lead to nerve compression and pain. However, not all spinal issues involve nerve compression. Some patients may have spinal pain due to wear and tear without nerve involvement.
In cases where there’s no nerve compression, surgery is typically not necessary. Instead, we might identify arthritic changes in the spine. In such instances, we can explore non-surgical options like facet joint injections to alleviate pain. These procedures involve using a needle to administer local anaesthetics or other therapeutic measures.
At Living Room Health, we offer similar pain reduction procedures for spinal pain, which can be a valuable service for patients seeking relief.
How does it differ from other imaging modalities, and what makes it particularly valuable for neurological assessments?
When it comes to diagnosing disc bulges that might be causing nerve compression, CT scans have limitations. They are relatively effective in the lumbar spine but struggle to provide clear insights in the cervical and thoracic spine and sometimes even the lumbar region. On CT scans, disc bulges appear as soft tissue, making it challenging to differentiate them from other body tissue such as ligament and hence determine if they’re causing compression. Additionally, CT scans do not visualise the spinal cord, so you can’t identify if something is pressing on it. MRI, on the other hand, excels at this task.
MRI is particularly valuable for its ability to differentiate soft tissues. For brain assessments, while a CT scan can detect large tumours or haemorrhages, MRI is essential for evaluating conditions like dementia, multiple sclerosis, or the detailed characteristics of tumours. Moreover, MRI does not involve radiation, making it a preferred choice for many patients who can self-refer for an MRI scan, unlike CT scans, which require a medical referral.
In what clinical scenarios or neurological conditions is a head or spine MRI scan commonly requested?
In the field of neuroimaging, we commonly encounter patients with various concerns related to the head and spine.
For head imaging, the most frequent issues include headaches, dizziness, light-headedness, and unsteadiness. Some individuals have a family history of conditions like multiple sclerosis and seek brain scans to ensure there are no lesions. Additionally, some opt for comprehensive body checkups, which include brain imaging as part of the examination.
In the case of spine imaging, the primary reason is usually pain, especially if it’s causing symptoms in the arms or legs. Patients experiencing sensations like pins and needles or sensory issues in their extremities may also require brain or spine scans. Any neurological symptoms warrant further imaging to understand and address the underlying causes.
Could you explain the basic principles of how an MRI scan works to capture detailed images of the brain and head?
MRI (Magnetic Resonance Imaging) involves a patient entering a large magnet, and this magnetic field necessitates certain safety precautions. Patients are required to complete a safety questionnaire to ensure they have no implants or objects that could react adversely to the magnetic field, such as metallic foreign bodies in the eye that might pose a risk of injury.
Within the MRI machine, the magnetic field causes the protons in the patient’s body (which are a part of the body’s molecules) to align in a vertical direction. A radiofrequency current is then applied to the patient. The way these protons interact with the radiofrequency pulse generates an image. Different types of soft tissues respond differently to this pulse, allowing us to create detailed images of structures within the brain, spine, or other organs like the liver and kidneys.
MRI offers excellent soft tissue differentiation, and it’s possible to send various types of pulses to obtain different types of information. During an MRI scan, patients are typically in the machine for about half an hour for a brain scan, with each imaging sequence lasting three to four minutes or longer. Each sequence provides distinct information, which is why patients must remain still during each one. Motion during a sequence can result in artefacts that reduce image quality.
In contrast, a CT scan is much quicker, typically taking only about five seconds to scan the entire head, so there’s less need to remain perfectly still for an extended period.
Can you elaborate on the significance of contrast-enhanced MRI scans for brain and head imaging? When is contrast typically used, and how does it aid in identifying certain neurological conditions?
Contrast agents are used in MRI scans selectively. Most of the time, they are unnecessary. However, we consider using contrast when investigating conditions like cranial nerve diseases or suspected infections or brain tumours. In most cases, patients do not have any serious issues, so contrast is not required initially. But if an abnormality is detected, it’s easier to administer contrast for a follow-up scan.
The reason for using contrast is that abnormalities often involve a breakdown of the blood-brain barrier. As a result, the contrast agent leaks out at these points, making the pathology more visible during imaging. This enhances our ability to detect and diagnose certain conditions.
How has technology and software advancements in MRI imaging influenced your practice and the accuracy of brain/head assessments? Are there any recent developments that have significantly improved your ability to diagnose neurological conditions?
Technology has brought remarkable advancements to MRI. In the past, we used film packets for X-ray images and examined them on viewing boards with backlighting. Today, we can instantly report scans from anywhere in the world as soon as they are completed, thanks to digital imaging and telemedicine. This has greatly improved image transfer and reporting efficiency, especially when on call, and has led to quicker turnaround times for patients. They can now receive their results on the same day or the following day, which is a significant advancement in MRI imaging.
Recent advances in medical imaging have led to more sophisticated techniques, particularly in the realm of brain tumour diagnosis and treatment planning. By administering contrast injections, we can observe how the contrast agent interacts with the brain tumour. Additionally, we utilise specialised imaging modalities such as spectroscopy, which allows us to examine specific compounds like choline and amino acids within the tumour. Given the vast array of tumour types, these techniques help us determine the likely nature of the tumour before resorting to a biopsy.
This information is invaluable in decision-making. If a tumour appears highly malignant, we may opt for a biopsy followed by treatments like radiotherapy. Conversely, if the tumour is benign, our goal is complete removal, leaving no remnants behind. Such insights enable us to plan surgeries more effectively, tailoring our approach to the specific characteristics of the tumour.
As a consultant neuroradiologist, what advice do you have for patients and healthcare professionals when it comes to understanding the value and significance of brain/head MRI scans?
When patients are considering consulting a specialist, such as a neurosurgeon or neurologist for issues related to the brain or spine, having an MRI scan beforehand can be highly beneficial. Most clinicians request an MRI scan, and having this scan prior to the specialist visit allows for quicker treatment planning, particularly in the NHS.
Without the scan, the process can take longer, as you would need to wait for the scan after the specialist consultation. This might require an additional visit to the consultant for a follow-up discussion. Having an early diagnosis through the MRI scan can pre-empt this and help streamline the patient’s healthcare journey.
Moreover, if symptoms resolve on their own and the scan is normal, it may eliminate the need for further specialist consultations, saving time and resources.
What’s your opinion on the importance of self-referral access to MRI like at Living Room Health?
I believe that the future of medical imaging is evolving, especially with recent government initiatives. Not too long ago, GPs had to refer patients to specialists, leading to lengthy waiting times for diagnosis and treatment, sometimes spanning several years. However, advancements have occurred, particularly with the introduction of MRI imaging throughout the country, thanks to government policies like those during Tony Blair’s tenure.
Now, GPs have direct access to imaging services. When a patient presents with symptoms, GPs can recommend the necessary imaging, which can often be faster and more efficient, especially for MRI scans. Patients can self-refer for these scans and then consult their GP based on the results, potentially eliminating the need to see a specialist immediately.
This approach helps alleviate the backlog in hospitals, allowing them to focus on acute and cancer care. The younger generation is embracing this change, as they are tech-savvy and often seek medical information online. We’re seeing a shift toward a younger cohort, those under 50, utilising these technologies for self-referral, while older individuals may not be as familiar with these options. This shift towards GPs and self-referral for diagnostics appears to be the direction in which we are heading.
What aspects of your role as a consultant neuroradiologist do you find most fulfilling and rewarding?
One of the most rewarding aspects of my work is when I can identify and visualise something that a referring clinician is specifically querying. For instance, when a clinician mentions left arm symptoms or specifies a particular nerve like left C6, and I can see that exact issue on the imaging, it’s highly satisfying.
Moreover, I find it gratifying when clinicians seek my opinions on complex imaging or images reported by other professionals for second opinions. I’m particularly drawn to complex and unusual cases, as they provide valuable learning experiences. Dealing with complicated cases helps improve my skills and makes handling cases in the future seem simpler.
For those seeking diagnostic imaging services related to the brain, spine, or head and neck, Living Room Health is at the forefront of providing cutting-edge MRI scans. Dr. Chawda, as the consultant neuroradiologist at Living Room Health, ensures the highest standards of care and accuracy in these vital diagnostic procedures. To book a head or spine MRI at Living Room Health, please feel free to contact us for more information and scheduling. Your journey to a precise diagnosis and personalised healthcare begins here.
Dr Sanjiv Chawda
CONSULTANT
NEURORADIOLOGIST
