Radiologist

Radiologist is a general practitioner of medicine who specializes in the use of non-ionizing radiation and radioactive isotopes for the diagnosis and treatment of a disease. Radiologists can specialize in any of the disciplines such as computed tomography, diagnostic radiology, ultrasound, pediatric radiology etc. A radiologist should have completed graduation from a medical school followed by at least four years of residency in the chosen area of specialization. Radiologists have a special role in diagnosing diseases as they go by the results of the medical images that they have captured thus understanding the situation better.

• Capture images of body parts using gamma rays, x-rays, sound waves etc.
  
• Diagnose the disease as per the image captured.
  
• They can also treat few diseases using radiation therapy called as radiation oncology or can conduct image guided surgeries called as interventional radiology.
  

A radiologist can be a general one who interprets the images of all parts of the human body or can be a sub-specialized one who specializes in any particular area of imaging. Thus ensure

• Your radiologist has the exact brand of specialization that you and your doctor are looking for. For e.g. if you want a radiologist for MRI scanning ensure you have a person who is having a specialization in the field of MRI.
  
• Ensure that his center is equipped with the right equipment to meet your needs.
  
• Ask the radiologist to brief you on the preparation required for the imaging and the procedure of the scan.
  
• Above all ensure the radiologist has the required board certification.
  

Modern technology and radiologists

The field of radiology has seen various changes. Traditional x-rays have been replaced with gamma rays and of the late isotopes and sound waves are used to generate images and treat diseases too.

• Digital imaging has helped the radiologist in diagnosing more precisely the condition of the disease.
  
• Fluoroscopy methods are adapted where a contrasting agent is induced either orally or intravenously.
  
• CT scans are now obtained as 3D images thus giving finer details of the body parts thus making diagnosis better and accurate.
  
• Use of ultrasound in studying the various stages of development of the fetus has helped the field of ob-gyn in reducing the number of fetal abnormalities thus helping the doctors take the required measures.
  
• Cardiovascular MRI, MR image guided therapy are areas of advancement in the field of MRI imaging.
  
• Nuclear medicine has made a break through in the field of bone scanning thus helping doctor's understand cancers better.
  

Mesenchymal Chondrosarcoma is an extremely rare malignancy of bone or soft tissue, often an aggressive form of bone cancer. It is a variant type of the conventional Chondrosarcoma which is a form of bone cancer arising from cartilage cells. Cartilage is a specialized tissue and it serves as a buffer or cushion at joints.

The skeleton of an embryo consists of cartilage which slowly converts into bone. In Mesenchymal Chondrosarcoma, approximately two-thirds affect the bones, especially the spine, ribs and jaws. In other cases, it affects the areas of the body other than bone, in soft tissues such as muscle and fat. Mesenchymal Chondrosarcoma occurs with greater frequency in young adults (aged 10-30). It is present in 2% of all chondrosarcomas and it has no sexual or racial predilection, but females are slightly more affected than males.

Signs and symptoms

Symptoms could vary depending upon the exact location and progression of tumor. Mesenchymal Chondrosarcoma mostly arise in the bones of the jaw, spine or the ribs. Tumors can develop in arms and legs frequently as well and especially in the femur (thigh bone). Tumors appearing as soft tissue masses can affect the muscle or central nervous system.

Some symptoms of Mesenchymal Chondrosarcoma resemble that of many other illnesses and disorders and this can lead to a false diagnosis initially. This is seldom the sickness that doctors perceive when presented with symptoms that match this rare cancer. It can generally be diagnosed without much difficulty when pain and swelling in the specific part of the body is located though other possibilities are usually tested first.

Although specific symptoms associated with Mesenchymal Chondrosarcoma are vague and non specific; yet many develop pain and swelling in the affected area. Lumps and joint stiffness are other clinical symptoms of the tumor. Such symptoms can be present even long before a diagnosis is made. One third of patients are symptomatic for more than one year. A large tumor can compress nearby structures and cause additional symptoms, for instance, a spinal cord paralysis, or if in the eye socket, can cause pain, swelling, visual disturbances and protrusion of the eyeball. Since this is an aggressive form of cancer, it can spread to other areas of the body - lungs, liver, lymph nodes and other bones and can cause life threatening complications.

Causes

While the exact cause of Mesenchymal Chondrosarcoma is unknown and investigations are ongoing, there is no identifiable risk factor for the development of Mesenchymal Chondrosarcoma that has been discovered.

Whereas, due to abnormal changes in the structures and orientation of cells known as oncogenes or tumor suppressor genes, these malignancies can develop. Current research shows that abnormalities of DNA, carrier of the body's genetic code can cause cellular malignant transformation. These abnormal genetic changes appear to occur quite spontaneously for unknown reasons.

Diagnosis

A diagnosis of Mesenchymal Chondrosarcoma may be difficult, but some seek attention due to pain and swelling. Diagnosis may be based upon clinical examination, and detailed patient history. A variety of specialized tests include X rays studies, a procedure in which a small sample of tissue is removed and studied under a microscope. A biopsy of a tumor or mass determines what type of cancer is present by identifying the cell type that makes up the tumor. In those suspected of Mesenchymal Chondrosarcoma, an open biopsy or a needle guided biopsy is recommended.

There are specialized imaging techniques that are used to evaluate the size, placement and extension of a tumor and to serve as an aid for future surgical procedures among those with Mesenchymal Chondrosarcoma. Such imaging techniques include CT scanning and MRI. Often CT scan of the lungs is performed as there is a risk of Mesenchymal Chondrosarcoma spreading to the lungs. Bone scans, tests that can detect areas of increased or decreased bone activity may be performed to determine whether Mesenchymal Chondrosarcoma has spread to affect other bones.

Clinical presentation

Like many other tumors, Mesenchymal Chondrosarcoma may metastasize thorough the blood and attack other organs within the body. It spreads to the lungs, though it may spread to other locations as well. When it appears near the spine, it is particularly troublesome. Depending upon the size of the tumor, it may place significant pressure on the spine and cause pain and partial paralysis. Should tumor be present in the skull, it can cause similar neurological problems.

Treating Mesenchymal Chondrosarcoma

To optimize treatment, a multidisciplinary group of health professionals at the time of suspicion of a bone sarcoma is highly recommended. Coordinated effort of a team of medical professionals is necessary to treat Mesenchymal Chondrosarcoma. While physicians specialize in the diagnosis and treatment of cancer, specialists in the use of radiation can treat cancer along with surgeons, oncology nurses and other specialists.

Specific therapeutic procedures and interventions vary depending upon numerous factors such as primary tumor location, stage of primary tumor and whether the tumor has spread to distant sites, individual's general health and other elements. Radiation may or may not be employed in the treatment of Mesenchymal Chondrosarcoma. Some medical oncologists advocate chemotherapy treatment plan. Radiation therapy post surgery is also typically standard practice for large tumors.

Since chances are that Mesenchymal Chondrosarcoma may recur after optimal therapy, patients should be routinely examined after surgery for follow up care. Surgical resection is the ideal method of treating Mesenchymal Chondrosarcoma assuming that the tumor can be removed without causing much damage to other organs or tissues.

Surgery is often followed up with chemotherapy and radiation to ensure that no cancerous cells are allowed to survive, grow and spread again. In case tumor is in an inoperable location, then radiation and chemotherapy can be used to shrink the tumor enough to allow for safe operation. Local sufficiently radical treatment for prevention of recurrence is vital. Patients have to avoid spicy food, smoking and drinking to avoid recurrence of the disease. Early detection and early diagnosis and treatment are the key to prevention and treatment of this disease.

Intensity Modulated Radiation Therapy

Intensity modulated radiation therapy or IMRT is one of the most effective and precise methods of therapy administered in the treatment of cancer and tumors of various origins. This method was first employed in San Francisco at PAMF - Palo Alto Medical Foundation center in California. PAMF used this technique for the treatment of cancers of neck and prostate soft tissues.

Mechanism and clinical aspects of IMRT

Intensity modulated radiation therapy is an advanced version of the three dimensional conformal radiation therapy. The technique is administered with the integrated software and hardware to determine the amount of radiation required on a specific target. The IMRT team consists of clinicians, radiologists and physicists to evaluate the specific site and the radiation dose on the cancer cells in the specific location. The doses of radiation are determined by the clinicians after identifying the location of the target and also the normal tissues adjacent to it. These factors are further evaluated by the physicist through a specified computer software to calculate the effective dose proportion and also to reduce the side effects. IMRT technique involves the usage of dynamic multi leaf collimators (DMLC) which determine size and shape of the target site in relation to therapy that can be administered.

DMLC enables the radiation to be administered in different intensity levels through variations created in the single beam. This method helps in calculated release of radiation based on the requirement, whether high or low on the target site. The IMRT technique avoids the speculations of trial and error methods through its inverse planning technique in association with computer programmed release of the radiation. This prevents the normal surrounding tissues from getting damaged. IMRT technique has gained in importance because of its effective tumor control and cost saving factor. This method is also efficient as it not does involve different energies derived from photons or combinations associated with photons and electrons.

IMRT technique involves important requirements such as patient immobilization. This is to prevent the missing of target site during radiation therapy. IMRT for moving organ systems is considered as a sensitive and significant factor as the moving organs can affect the delivery of radiation to the target sites. Immobilization tools of invasive fixation systems (peacock talon system) and non-invasive fixation systems (reinforced mask) are used in the IMRT technique. In case of head cancer and neck cancer, oral stents and bite blocks are used to prevent the surrounding tissue damage. In conditions such as prostate cancer, patient immobilization is very difficult and hence, immobilization box is used.

Advantages of the IMRT technique

IMRT has potentially produced many advantages in the field of radiation therapy and oncology. It enables in the identification of multiple target sites in conditions such as brain metastases. The therapy affects the target sites while avoiding other normal tissues of the brain. This facilitates the prevention of CNS toxicity. The radiation thresholds of the IMRT are effective in the determination of normal tissue tolerance surrounding the target area. This helps minimizing complications such as vision loss and impairment associated with sensory organs.

Side effects of IMRT

The side effects of IMRT are predominantly associated with the equipment. These leakages often affect the intensity of the radiation related to the target site. The most common leakage are found in the multi leaf collimators. Another factor is the administration IMRT in children. Children are extremely sensitive to radiation therapies and subsequently if radiation therapies are administered in children, there may be incidences of mutated genes which may cause other complications. Studies specify the increase in the onset on secondary cancers in elderly population. This is predominantly noticed in case of prostate cancers.