Blog

Dr. Varsha Joshi

World Cancer Day was celebrated on 4 th February. Just like every year - the day was about talking, educating and spreading awareness about cancer - to stand strong and stand together against cancer. I was reminded of my son’s music teacher who was operated about 4 years ago for early stage buccal cancer - a simple man with no predisposing risk factors who was completely shaken by the diagnosis and the surgery that followed. But fortunately, he is doing good today and leading a normal life. Cancers of the and Neck (HNC) are fairly common - comprising about 30% of cancers in India. They often cause long lasting and sometimes permanent changes that can significantly affect functionality and appearance of an individual, in turn impacting body image and self-esteem. Not everyone who is diagnosed with HNC has a known risk factor - sometimes there may be no reason why the cancer has developed - just like the case of my son’s music teacher. Having said that - there are a number of risk factors that can increase the risk for HNC. Tobacco and alcohol are major risk factors for HNC - infact TOBACCO is the single most important risk factor for oral cancer. All tobacco products - cigarettes, cigars, pipes, smokeless tobacco like gutkha, khaini, betel quid are linked to head and neck cancer. Don’t we all read the disclaimer below the cigarette packets - “Cigarette smoking is injurious to health” - oral cancer is certainly one of the serious health hazards that we are linked to tobacco. So what can you do to lower your risk for HNC ?? Quit smoking today - you will not only reduce your risk for HNC but also the risk to your near and dear ones around you. DO NOT use tobacco products. Avoid or limit your alcohol intake. Talk to your doctor about HPV vaccination. Maintain good oral health. If you feel a lump or swelling in the nose, neck or throat or have a sore throat that is persistent and won't go away or have noticed a change in your voice - you might want to consider visiting a doctor soon ! As Head and Neck radiologists, we come across oral cancers so often - almost every day. Contrast MDCT serves as a one-stop shop for gingivobuccal and retromolar cancers at most centers, providing all necessary information to the treating surgeon. Likewise - contrast MRI is the go to investigation for patients with tongue, palatal and floor of mouth cancers. It is so important to have a structured reporting format and check list - accurately report the soft tissue extent, bone erosion, perineural spread and associated metastatic adenopathy - this is exactly how we are going to make a difference in the patient’s life - impact the prognosis and treatment option available to the patient ! Dr. Varsha Joshi ISHNR President

Dr. Varsha Joshi

It is the month of January 2023. As I was driving to work on this unusually cold winter morning, I turned on the car radio and was audience to this short talk show on National Thyroid Awareness Month on FM radio. Though I could only get the last 30 seconds of the physician’s interview, it did give me enough material to think about, for the rest of my drive. Isn’t it amazing how a small butterfly shaped gland that sits in the neck controls so many body systems, so much so that if it does not function properly it can actually result in serious problems! Too little or too much of thyroid hormones, underactive or hyperactive, cancerous or benign nodules - each has its own set of symptoms and problems! Thyroid disorders are much more common in women and generally life long! Weight issues generally bring the patient to the doctor apart from other symptoms like anxiety, sleep disturbances and neck swellings to name a few. Lab tests and USG are primary investigations in evaluating thyroid diseases. As Head and Neck Radiologists, we come across HRUS of the thyroid and ultrasound assisted fine needle aspiration biopsy of a thyroid nodule fairly commonly. CT and MRI have a limited role in the initial investigation of a patient presenting with a thyroid nodule and are reserved for cases with locally advanced disease or cancers. Dr. Varsha Joshi ISHNR President

Dr. Sarthak Swarup, Dr. Diva Shah

Honouring Technologists and Radiologists on International Day of Radiology (IDOR) 2024: Bringing Expertise and Precision to Imaging - Dedicated to Supporting Patients On November 8, 2024, the Indian Society of Head and Neck Radiology (ISHNR) joins the global radiology community to celebrate the International Day of Radiology (IDOR). This day is dedicated to acknowledging the invaluable contributions of radiologists, technologists, and radiographers, especially those working in the complex field of head and neck imaging. The theme, "Radiologists and Radiographers Supporting Patients," sheds light on their essential role in providing patient-centred care, from the earliest stages of diagnosis to treatment and beyond. Technologists and radiologists work closely, ensuring precision in imaging while prioritizing the safety and comfort of each patient. Their collaboration supports accurate diagnoses and efficient workflows, ultimately benefiting patient outcomes. This year's IDOR theme highlights the compassionate side of radiology - emphasizing the human connection fostered by these professionals. Head and neck radiologists and technologists are often the bridge between advanced imaging technology and patients' well-being. By establishing trust and reassurance, they create a supportive environment where patients feel cared for throughout their medical journey. The evolution of imaging approach from anatomical to functional, and later hybrid, and molecular imaging (refer image) - reflects a commitment to more precise, patient-centred approaches in head and neck cancer care, allowing radiologists to contribute significantly to personalized treatment strategies and improved patient outcomes. On this IDOR, the ISHNR proudly honours these professionals who make a difference daily, dedicating themselves to both the art and science of imaging. We celebrate their exceptional skill, commitment to accuracy, and dedication to patient care, recognizing that their work embodies the true spirit of radiology: a blend of technical expertise, compassion, and unwavering support. Happy International Day of Radiology 2024! Blogger - Dr Sarthak Swarup , Dr. Diva Shah

Dr. Jyoti Kumar

World Hearing Day, observed on March 3rd each year, serves as a reminder of the profound importance of hearing health and the incredible gift of sound. It's truly awe-inspiring how the ability to hear is intricately designed, with critical anatomy packed within the tight space of the temporal bone. Without the precise volume and composition of the endolymph and perilymph within the inner ear, hearing would be impossible. These minuscule fluids help transmit sound vibrations, allowing us to experience and interpret the world around us—whether it's the rustling of leaves in the wind or the chirping of birds at dawn. It beautifully showcases the marvel of creation and how every part of our ear is perfectly designed to work together. Hearing is not just a physical sense; it connects us to the beauty of the world. It enables us to appreciate the symphony of nature, the melodies of life, and the delicate whispers of the environment that we often take for granted. Sounds can uplift our spirits, stir memories, and even guide us through our daily interactions. The role of imaging in evaluating and treating hearing loss is indispensable. It allows for a more precise understanding of the underlying causes of both conductive and sensorineural hearing loss, leading to more effective and tailored treatment options. On World Hearing Day, let’s acknowledge the importance of this precious sense, raise awareness about hearing loss prevention, and celebrate the technologies that help those with hearing impairments experience the world in a way that everyone deserves to. Dr. Jyoti Kumar Vice President ISHNR

Dr. Nivedita Chakrabarty

April is designated as “Oral Cancer Awareness Month” to promote awareness about the prevention and early detection of oral cavity cancers (cancers of the lip, oral tongue, floor of mouth, buccal mucosa, hard palate, alveolus, and retromolar trigone) and oropharyngeal cancers (cancers of the base of tongue, tonsil, oropharyngeal wall, and soft palate). Statistics: Based on the Globocan 2022 estimates, oral cavity is 16th most common cancer globally, ranking 15 th in mortality. Asia has the highest incidence and mortality of oral cavity and oropharyngeal cancers contributing to 75.1% and 53.5% mortality worldwide respectively. Oral cancer is the top-most cancer in Indian males, 4 th common cancer in Indian females, and 2 nd most common cancer overall, ranking 2 nd in mortality. Risk factors: Tobacco (in any form), alcohol, poor oral hygiene, low-nutritional diet, human papilloma virus (HPV) infection, are the risk factors.Oral potentially malignant disorders include proliferative verrucous leukoplakia, oral submucous fibrosis, erythroplakia, and HPV-associated dysplasia. Prevention and early detection: It is crucial to focus on prevention as 46% of oral cancers are preventable if risk factors (mainly tobacco) are avoided, and with early detection of precancerous lesions. In addition, HPV vaccination can help prevent oropharyngeal cancer. Early detection and treatment of cancer can save life, as 5-year survival of localised oral cavity cancer is > 80%, which drops to 30-40 % with distant metastasis. 5-year survival of localised and regional oropharyngeal cancer is 59% and 62% respectively, which drops to approximately 29% with distant metastasis. Role of imaging: Surgery is the mainstay of treatment for oral cavity cancers provided there are no contraindications on imaging. Mucosal lesions are directly visualised by the surgeons, however, the role of imaging lies in delineating the submucosal and the entire extent of the lesion, providing information on perineural spread, extent of bone involvement, degree of vessel encasement, status of cervical lymph node, and possible infiltration of prevertebral fascia. Oropharyngeal cancers, on the other hand, are usually treated with chemoradiotherapy, for which, delinating the entire extent of lesion on imaging along with staging, are crucial. However, T1/T2 non-midline cancers are amenable to transoral robotic surgery (TORS), provided there is no infiltration of superior pharyngeal constrictor muscle or parapharyngeal space, and there is no medialization of internal carotid artery. Let us all pledge to educate all those who consume tobacco around us—be it cab-drivers, household help, friends, or relatives, about the detrimental effects of tobacco. Together, we must urge the government to ban all endorsements related to tobacco products, such as gutkha and pan masala. Let us use social media as a platform to emphasize that smoking, alcohol consumption, and chewing tobacco are not “cool.” It is crucial to disseminate this knowledge beyond hospitals and screening camps, with the aim of reaching every corner of the society, to reduce the incidence of this preventable cancer. Blogger: Dr. Nivedita Chakrabarty, Joint Secretary, ISHNR

Dr. Diva Shah

A Tribute to Teamwork - The Spirit Behind Every Image Each year, November 8 marks the International Day of Radiology (IDOR), a day to celebrate the science that sees beyond the visible, and the people who make it possible. It commemorates Wilhelm Conrad Roentgen's discovery of X-rays in 1895, a moment that changed the course of medicine forever. But beyond the technology, beyond the machines and scans, lies the true heart of radiology: teamwork. Head and Neck Radiology: Where Collaboration Defines Clarity In the intricate landscape of head and neck imaging, teamwork is not just desirable - it is indispensable. Every scan tells a story of collaboration: The radiologist, interpreting with precision. The technologist, ensuring every parameter captures the subtle detail. The surgeon, seeking a roadmap for complex surgical navigation. The pathologist and oncologist, piecing together the puzzle of diagnosis and therapy. Together, they form a symphony of science and empathy - ensuring that no patient is just an image, but a person whose story is seen in full dimension. Teamwork: The Core of Progress The growth of Head and Neck Radiology as a subspecialty has been a journey powered by collective effort: from the pioneers who laid the foundation, to the new generation that continues to innovate with cross-sectional imaging, functional MRI, and PET-MR techniques and advances in interventions. The spirit of teamwork extends beyond departments and hospitals. It thrives through societies and platforms that unite us. The Indian Society of Head and Neck Radiology (ISHNR) stands as a beacon of this unity, where shared learning, mentorship, and mutual respect define our academic culture. Learning, Leading, and Looking Ahead As radiologists, we often work behind the scenes, yet our work illuminates the path for surgeons, oncologists, and clinicians alike. On this International Day of Radiology, let us acknowledge the invisible bonds that make visible differences: the teamwork that transforms scans into strategies and images into impact. "Alone we can scan an image, but together we can see the whole story." Blogger @ Dr Diva Shah Happy International Day of Radiology! On behalf of the Indian Society of Head and Neck Radiology (ISHNR) Family