DEPARTMENT OF SURGICAL ONCOLOGY

Colon and Rectal Surgery is dedicated to the assessment, diagnosis, and treatment of disorders of the colon, rectum, and anus. The Colon and Rectal Surgery Program is the delivery of high-quality, cost-effective medical and surgical care with dignity and compassion. Colon and rectal surgeons specialize in disease management and complex pelvic floor disorders. Department performs advanced surgical techniques, including minimally invasive surgery approaches and sphincter-preserving surgeries, which maintain normal bowel function and quality of life and avoid the necessity of a colostomy. The department has extensive experience in treating patients with inflammatory bowel disease, benign and malignant colorectal neoplasm, complex anorectal diseases, and management of pelvic floor disorders, especially fecal incontinence and rectal prolapse. Specialized in the diagnoses of colorectal conditions by colonoscopy, endorectal and endoanal ultrasound, flexible sigmoidoscopy and routine proctoscopic examination. Department works closely with gastroenterology, medical oncology, diagnostic and radiation oncology, and pathology, and Tumor Board. Diagnostic studies, both before and after surgery is critical to patient care. Follow-up care for colorectal surgical patients is considered crucial for lifelong health. Department has extensive experience in treating patients with:

• Anorectal diseases and problems
• Abscesses
• Anal fissure
• Anal fistula
• Hemorrhoids
• Polyps or adenomas
• Colonic dysmotility

· Colonoscopy, especially in high-risk patients and post-colorectal surgery follow-ups

· Colorectal cancer (primary and recurrent)

• Colorectal polyps
• Constipation
• Crohn’s disease
• Diverticulitis
• Fecal incontinence
• Inflammatory bowel disease
• Pelvic floor dysfunction
• Polyposis syndromes
• Pouchitis
• Rectal cancer
• Rectal prolapse
• Ulcerative colitis

Endocrine Surgery is the treatment of benign and malignant diseases of the glands and organs of the endocrine system: the thyroid gland, parathyroid glands, adrenal glands and the pancreas. Combination of diagnostic and treatment strengths treatment, to unify state-of-the-art treatment options into personalized care.

Esophageal cancer is a rare disease in which cancer cells form in the soft tissues of the tube that carries food and liquid from the mouth to the stomach. For some esophageal cancers, surgical oncology is the preferred treatment for early-stage disease. Surgery may also be a part of treatment for late-stage cancer, combined with other treatment therapies such as radiation or chemotherapy. Successful esophageal surgery requires both expertise and experience. Department has the most skilled and pioneering physicians in this area, using state-of-the-art surgical technologies and drawing on the latest research and advances in the surgical treatment of esophageal cancer.

Minimally invasive surgery may be an option for patients determined to have a small cancerous area. For patients with larger areas of cancer, the surgical oncologist may remove partially or complete Esophagus. For either procedure, nearby lymph nodes are also often removed both to test for the spread of cancer and to try to limit the migration of cancerous cells to other parts of the body.

Surgical management for patients with cancer, inflammatory bowel disease, and diverticular problems includes extensive diagnostic testing with endo-rectal ultrasound and diagnostic colonoscopy. Rectal cancer surgery is performed to minimize the need for permanent “bags” and to ensure, if at all possible, “nerve preservation.” Colon J-pouches or “Coloplast” procedures may be used to minimize frequent bowel movements and bowel urgency. The colorectal surgical team provides diagnostic workups and treatment for patients with inflammatory bowel disease. Patients with colitis requiring surgery may undergo “restorative proctocolectomy,” avoiding permanent stomas (surgically constructed openings) most of the time. The other procedure includes colorectal and anal canal. Hepatectomies, radical pancreas and gall bladder surgeries. Radio Frequency Ablations (RFA) of hepatic tumors.

Thoracic (Esophagus), VATS, Stomach, Small Bowel, Colon, Rectum, Radical Cytectomies, Hysterectomy, Werthiems, Diagnostics.

Overview:

Head and neck oncology at Basavatarakam Indo American Cancer Hospital & Research Institute (BIACH&RI) specializes in the diagnosis, treatment, and management of cancers that affect the head and neck region. As India’s 2nd best cancer hospital, we are committed to providing world-class care to our patients, using the latest advancements in medical technology and research.

Our multidisciplinary team comprises highly skilled and experienced specialists, including head and neck surgeons, radiation oncologists, medical oncologists, reconstructive surgeons, pathologists, radiologists, and other supportive staff, who work collaboratively to create personalized treatment plans for each patient.

Conditions Treated:
Our Head and Neck Oncology department deals with a wide range of cancerous and non-cancerous tumors, including but not limited to:

Oral cavity cancer
Oropharyngeal cancer
Nasopharyngeal cancer
Laryngeal cancer
Hypopharyngeal cancer
Paranasal sinus cancer
Salivary gland tumors
Thyroid cancer
Skin cancer of the head and neck region
Skull base tumors
Diagnostic Services:
At BIACH&RI, we employ state-of-the-art diagnostic tools and techniques to accurately identify and stage head and neck cancers.

Our Head and Neck Oncology Team:

Fellows in Head & Neck Oncology

1. Dr. L. M. Chandra Sekhara Rao. S

   • MS, DNB(ENT), PDCC (Plastic Surgery)

   • MNAMS, M.Ch (Head & Neck Oncology)

   • Chief & Sr. Consultant

2. Dr. Hemant Kumar Nemade

   • MS (ENT), FHNSO (Head & Neck Oncology)

   • Consultant

3. Dr. G. T. Jonathan

   • MDS (Oral & Maxillofacial Surgery)

   • Consultant

4. Dr. Sravan Kumar Ch.

   • MS (ENT), FHNSO (Head & Neck Oncology)

   • Consultant

5. Dr. Anil Kumar

   • MS (ENT), FHNSO (Head & Neck Oncology)

   • Consultant

Our team of skilled professionals at the Head and Neck Oncology department is dedicated to providing comprehensive care and support to patients. With their expertise and experience, they work collaboratively to create personalized treatment plans, ensuring the best possible outcomes for patients.

Radical esophageal surgeries, lung, medicinal and chest wall surgeries.

Nephrectomies. adrenalectomies, cystectomies, penectomies, Inguinal Block dissections, cystoscopies.

All aspects of women cancers-cervical, ovarian, uterine, vulval are dealt comprehensively.

Medical oncology also operates the “Pain and Palliative Care Service” that is for the benefit of all patients in this hospital. This service was started in response to a resolution at the 64th World Health Assembly –that advocated palliative care as an essential part of treatment for people with cancer and other chronic illnesses.

Patients can attend the OPD for palliation of symptoms such as pain, loss of appetite, shortness of breath, anxiety and depression and get advice on issues like nutrition and activities of daily living. Palliative care focuses on the quality of life of patients and their families. This type of health care is very communicative and pays more attention to the goals of patients and their families to make them comfortable. Some issues that usually may be minor for doctors but are most important for patient’s quality of life. These may get overlooked during the course of treatment for cancer. These can be discussed and resolved during counseling.

As the course of illness changes from chemotherapy to best supportive care, family/caregivers are counseled about any special care or support that the patient may need at home.

The skype consultation facility has been provided for very sick patients who cannot attend the hospital.

Pain And Palliative Medicine

Our team comprises 3 physicians. Dr. Srinivasa Shyam Prasad Mantha M.D, CCEPC, Dr. Praneeth Suvvari M.D, D.M Onco-Anaesthesia AIIMS, CCEPC, NFPM, Dr. Praveen Kumar Kodisharapu, DNB, CCEPC, NFPM, working as full-time Consultants. We also have one dedicated social worker, 7 dedicated nurses working under the department.

Dr Praneeth and Dr Shyam have participated in the CTC-4 (Cancer Treatment Centers Palliative care provider) foundation course in January 2020. This course was jointly conducted by Lien Collaborative foundation, Singapore and AIIMS, New Delhi. As part of this training, they underwent observership in the department of palliative medicine at Kasturba Medical College, Manipal under the supervision of Dr. Naveen Salins. Dr Praneeth and Dr Praveen are currently pursuing National Fellowship in Palliative Medicine (NFPM) from the Institute of Palliative Medicine (IPM), Kozhikode, Kerala.

We run a Cancer Pain palliative Medicine clinic which runs 6 days a week and yearly for more than 1000 new outpatients. We also liaise with the lymphedema clinic, stoma clinic for continuity of care.

We are running 12 bedded dedicated palliative care ward and providing a variety of palliative services like management of acute pain crisis with patient-controlled infusion pumps, interventional pain management with various nerve blocks, management of acute breathlessness, sub-acute intestinal obstructions, end of life care, psychosocial support and other services. Also, we provide round the clock inpatient services to patients who are admitted to various other wards on-call basis followed by a daily review. We liaise with various governments and private run Palliative and Hospice centres within the area of the patient home for the continuity of palliative care and assist them with home care needs.

The department regularly conducts orientation classes to doctors of other specialties in the hospital and nurses about palliative care and its importance. We are proud to announce that the National Board of Examinations has granted us permission to start a formal degree in “DNB Palliative Medicine” from the year 2022 with 2 seats annually. We are one of the first 5 institutes in India that were given this opportunity to do this training course.

The procedure serves mainly 3 purposes

· Replacing a missing gene e.g. in Thalassemia, Sickle cell disease and many genetic disorders. These are diseases where the person is otherwise normal, except for one missing gene, and replacing that gene is curative.

· Allows the use of high doses of anticancer therapies, which may lead to loss of bone marrow. Without stem cells support, marrow will recover only after a long time, resulting in a high complication rate from infections or bleeding. Infused stem cells provide early recovery of blood cells. It considerably lowers the risk of low blood counts due to marrow suppression. Thus it is one form of “Supportive Therapy” and not a treatment of cancer by itself. This is the case in Autologous (self) transplants and in the majority of Allogeneic transplants.

· Some “Graft versus Disease activity”, more commonly known as “Graft v Leukemia effect” in Allogeneic transplant, especially evident in chronic myeloid leukemia.

· Sources of Hematopoietic Stem Cells: Bone Marrow is the tissue that is found inside our bones. It is a spongy texture and is rich in stem cells. Bone marrow is collected from the iliac crest (hip bone) in the operating room.

· Peripheral blood stem cells (PBSC): Stem cells are collected from the circulating bloodstream using a process called apheresis.

· Umbilical Cord Blood: The cord of newborn babies is a rich source of stem cells.

Blood cells grow in the same way as other human cells. They develop in the bone marrow from a parent cell known as “stem cell”. These stem cells begin to divide and mature until they are fully developed, forming all the different types of blood cells: white cells, platelets and red blood cells. Stem cells are usually found inside the bone marrow spaces of large bones, however, they can also travel from bone to bone to others by way of the blood system. A very small percentage of the white blood cells circulating through our veins are stem cells.

There is no surgery involved in Transplant, for the patient or donor. It is a very safe procedure for a donor. Nothing is lost permanently in the body e.g. as in a kidney Transplant. Stem cells regenerate in a few days. For the same reason, there are over 1 crore (10 million) volunteer donors for stem cell transplants in the USA. Stem Cells are infused into the patient through a live Blood Transfusion.

The Stem Cells can be collected from the patient’s own body or can be harvested from another person. This other person is known as a donor.

Autologous transplant

Stem cells are taken from the patient either by bone marrow harvest or apheresis (peripheral blood stem cells) and then given back to the patient after conditioning treatment.

Allogeneic transplant

The donor has the same HLA type as the patient. Stem cells are taken either by bone marrow harvest or apheresis (peripheral blood stem cells) from an HLA matched donor, usually a brother or sister. Other donors for allogeneic bone marrow transplants include the following:

· An identical twin – A syngeneic transplant is an allogeneic transplant from an identical twin. Identical twins are considered a complete genetic match for a transplant.

· Unrelated transplants (UBMT or MUD, for matched unrelated donor) – The HLA matched stem cells are from an unrelated donor, usually found through the national registries.

· Umbilical Cord Blood transplant – Stem cells are taken from an umbilical cord immediately after delivery of an infant. The stem cells are tested, typed, counted and frozen until they are ready to be transplanted.

· Stem cell transplant is an exciting area of medicine. It is a well-established treatment for several cancers and diseases of blood for the past few decades.

There are three main steps in the transplantation process.

· The first step is the collection of the bone marrow or stem cells (the harvest) from the donor. We now know that the umbilical cord blood is also a rich source of stem cells.

· The second step is to completely destroy the existing bone marrow and thereby help the patient receive the new stem cells.

· The third step is to infuse the bone marrow or the stem cells through the intravenous route, like a blood transfusion. There may be no signs of a new bone marrow growing for two to three weeks, and occasionally it may be a few months before the new bone marrow produces all the components of the blood adequately.

Having a transplant can be very demanding, physically and emotionally. It may help if patients can talk about their fears and concerns.

It is important to understand why one is having the transplant and what the actual processes will be so that the patient can make practical arrangements and also prepare himself or herself mentally. It is a good idea to discuss the entire process with the doctors and nurses involved before the patient goes into the hospital.

Here are some questions one may like to ask:

· What are the benefits of the treatment?

· What are the risks of the treatment?

· How will the transplant affect the way I live?

· Will, I will be able to have children after a transplant?

· How long will it be before I can start leading a normal life again?

· What are the other treatments available to me?

· Can one predict how the disease will progress?

• Who can visit me?

· Will my treatment make me feel too unwell to see people?

· Is there a television in the room?

· Is there a telephone link in the room?

· Can I bring in my own clothes?

· What do you suggest that I bring to the hospital to make my stay more comfortable?

· Where can the attendees stay?

· Being fully informed and prepared will help to make the transplant process easier for the patient and the family.

Matching bone marrow is done by blood tests alone. It is not necessary to test the donor’s bone marrow at this stage.

It is usual to start by testing the brothers and sisters, as they are likely to provide the best match; parents are not usually good matches.

The donor should be in good health. He or she will be given a thorough medical checkup to make sure that there will be no risk to his or her own health from the procedure.

Collecting bone marrow

About a week or two before the bone marrow harvest is done, the patient (or the donor, for an Allogeneic transplantation) may have 1 to 2 units of blood withdrawn. This will be given back during the bone marrow harvest.

The harvest itself is carried out under general anesthesia, so one will feel nothing. It involves the removal of some marrow from inside the bones at the back and front of the pelvis (the hip bones).

The patient or donor will have to stay in the hospital overnight to recover fully from the general anesthesia. Usually, it feels sore for a few days and mild painkillers may be required. These will be administered by nurses or doctors.

How are the stem cells collected?

Stem cell harvesting is done following a course of daily injections of a growth factor. This procedure takes about 3 hours. The patient will be made to lie down on a couch and a transfusion will be put into the vein of each arm. Blood will be collected from one arm, into a machine called a centrifuge, which spins it to separate out the stem cells. These are collected, and the remaining blood is returned through the IV in the other arm. The stem cells can even be frozen.

What is Umbilical Cord Blood Transplantation?

Many children and young adults with serious blood diseases such as leukaemia, need a bone marrow transplantation to give them a chance to live. Unfortunately, a marrow donor cannot always be found. Sometimes searching for a donor takes so long that the patient dies before a compatible donor is available.

However, now a new source of blood-forming stem cells has been found – Umbilical Cord Blood.

This is the blood that is left behind in the placenta and the umbilical cord after the delivery of a baby. Cord blood is rich in stem cells and can be used instead of bone marrow for transplantation.

The stem cell in the cord blood is of high quality and very potent in producing blood cells. Cord blood transplants appear to cause less serious immunological side effects. The ‘matching’ between donor and recipient appears to be less critical. This means that the chance of finding suitable cord blood for transplantation is much greater than that of bone marrow.

Stereotactic Radiosurgery is a non – invasive technique to deliver a single high dose of radiation to limited, well-defined target volumes while avoiding nearby normal tissue and critical structures. It is a potentially curative therapy in benign non –invasive tumors.

Though radiosurgery can be done using positively charged particles and gamma knife, linac based X-knife (Radiosurgery with high energy X-rays) became more popular because of many advantages as follows.

• Dose distribution is equivalent to gamma knife.
• There is great flexibility in altering the pattern of beam delivery.
• Field shaping is relatively easy to achieve.
• Fractionated treatments are also possible (SRT) if required.
• The cost is relatively low

BIACH & RI has the most advanced linac-based Radio surgery facility namely Brain lab supported Novalis Tx machine which makes the use of intensity modulation also for better conformity. With inbuilt micro MLC (High Definition MLC), it is capable of performing SRS (Stereotactic Radiosurgery) / IMRS (Intensity Modulated Radio surgery) with the help of a planned Treatment planning system from the Brain lab.

The greatest advantage of using Novalis supported radio surgery is the three-dimensional volumetric verification (3D-3D matching) of reference and localized images using CBCT at any time before and during treatment. This 3Dimentional matching is not possible with other radio surgery delivery methods. This gives the highest confidence in treatment delivery.

Radio surgeries are being successfully performed for different lesions using this ultra-modern system. SRS is also being done using a brain lab invasive frame.

Stereotactic Body radiotherapy (SBRT) can be done mainly for lung/liver cases using free breath and breath-hold techniques. Basavatarakam has Real-time Position Management (RPM) system and ABC (Active Breath Control) system for this purpose. Using 4D CT (4 Dimensional Computed Tomography) and RPM system SBRT can be executed in our Novalis linear accelerator.

Active Breathing Control (ABC) which is available with a synergy machine allows temporary and reproducible immobilization by monitoring the breath cycle and achieving a breath hold for a preset time at a pre-determined lung volume level.

It is a very important delivery technique advancing rapidly in radiotherapy. Linear accelerators that have the facility for X-ray volume imaging are capable of doing this technique. Patient setup can be verified three dimensionally before the delivery of the dose fraction. Therefore patients can be treated accurately by correcting these errors. Two ultra-modern linear accelerators capable of doing IGRT namely Elekta Synergy and Varian Novalis Tx are installed at the institute.

IMRT started in Basavatarakam in the year 2005 and more than 5000 IMRT plans have been successfully completed to date and are a record number in India. This is the only institute in south India that did this many IMRTs. 4 linear accelerators are IMRT capable.

Brachytherapy is the treatment method in which a small sealed radioactive source is kept very close to (within the natural body cavities or implanted directly) the tumor. High dose rate brachytherapy (HDR) is a promising brachy treatment modality in which the treatment time is a few minutes instead of a few hours.

Varisource ix HDR Brachytherapy is a most advanced unit with a step size of less than 2 mm. Treatment planning conformity advantage is more with less step size. Around 10 brachytherapy cases per day are treated.

Treatment of cancer using gamma rays & x-rays from radioactive material placed at some distance away from the patient is called Teletherapy. Though Radioactive cobalt is the most popular and ideal source for this type of treatment, it is gradually replaced by technologically advanced linear accelerators.

A linear accelerator is modern equipment that produces X-rays and electrons of different energies. The introduction of linacs changed the scenario of cancer therapy. We have six modern linear accelerators with Stereotactic Radiation Surgery -SRS, Stereotactic Radio Therapy – SRT, Intensity Modulated Radiation Therapy -IMRT, Image Guided Radiation Therapy -IGRT, Intensity Modulated Radiation Surgery -IMRS, with Rapid Arc facilities.

At BIACH&RI, treatment simulation with orthogonal fluoroscopy using a conventional simulator is the standard practice, for a long time for treatment verification. It has the advantage to detect some movements of the patient during the process which helps to perform possible corrections to the planned beams. The department has a modern simulator facility namely Varian acuity digital simulator.

It is basically a CT unit with a flat couch used for radiotherapy planning purposes and moving lasers. We have Philips big bore CT which is the first of the kind in India with 16 slices and 85 cm bore size.

In the virtual simulation, the patient is required only at the time of CT scanning. Simulation can be done using CT slices and planning software without the requirement of the patient. The department has three virtual simulation stations (Focal –sim) for this purpose.

SRS is a non-invasive technique to deliver a single high dose of radiation to a limited, well-defined target volume while avoiding normal tissues and critical structures near to it. Modified high energy linear accelerators with micro multi-leaf collimator facility (MLC) are the most versatile radiation producing machines for radiosurgery. It is a linear accelerator-based sophisticated method of delivering a high dose of radiation very precisely to a small volume of tissue. BIACH&RI has two different MLC-based SRS facilities namely the DIREX system and BRAIN LAB. For this iPlan and accsoft planning, systems were used.

Three-dimensional conformal radiation therapy (3D CRT) developed as a method of allowing higher doses to tumors, limiting doses to normal tissue, and improving local control and patient outcomes. Linear accelerators with multileaf collimator arrangements are capable of doing this technique (Four linacs have this facility).

Intensity-modulated radiotherapy (IMRT) is the most sophisticated, advanced technique for radiotherapy planning. In this method, the intensity of each beam will be modulated in an optimal way to get the required distribution according to the prescription. Intensity-modulated beams will be directed from different directions. It is an advanced 3D conformal radiotherapy. MLC based linear accelerators are required to deliver IMRT treatment. Four linear accelerators are, IMRT capable

It is a most important delivery technique advancing rapidly in radiotherapy. Linear accelerators that have the facility for X-ray volume imaging are capable of doing this technique. Patient setup can be verified three dimensionally before the delivery of the dose fraction. Therefore patients can be treated accurately by correcting these errors. Two ultra-modern linear accelerators are capable of doing IGRT Control. namely Elekta Synergy and Varian Novalis Tx. with Rapid Arc ( with Active Breath)

Active Breathing Control (ABC) based IGRT is mainly for lung/liver cancers. ABC allows temporary and reproducible immobilization by monitoring the breath cycle and achieving a breath hold for a preset time at a predetermined volume level.

Small sealed radioactive sources are kept very close to, within the natural body cavities or implanted directly into the tumor in this method. A small single stepping source will generate the required dose distribution by moving to different pre-planned positions. HDR brachytherapy solves the potential disadvantages of the Low Dose Rate (LDR) brachytherapy method. Treatment time is only a few minutes. Therefore no hospitalization is required. BIACH&RI has a high-end HDR brachytherapy unit Varisouce IX with 20 channels that use an Ir-192 source. With this machine, implants, Templates and all kinds of intracavitary radiotherapy procedures are performed. It is the only center with image-guided brachytherapy with CT compatible applicators for the treatment of cancer cervix.

Rapid arc technology is a new and advanced form of intensity-modulated radiotherapy which delivers precise treatment in a shorter time. It is many times (5 to 8 times) faster than conventional and helical IMRT techniques. Intrafractional patient setup errors can be effectively minimized when compared with other techniques that improve the quality and comfort. With Inbuilt micro MLC, it is capable of performing IMRS also with the help of

Intrabeam, an Intraoperative radiotherapy system was installed at our center in 2009 which is the first of its kind in India. With 50kev and 40microamps it is capable to treat all intraoperative tumors. Especially it is useful in intact breast cases. Other cases like the brain, soft tissue, vagina, rectum, etc. Can also be performed The main advantage of this instrument is that it is capable of delivering dose immediately after surgery. Instead of taking more than 25 fractions on a linear accelerator, the single fraction is sufficient and the patient can be treated along with the surgery.

All patients coming for surgical procedures are given anesthesia after the pre-anesthesia check-up. Seven major operation theatres and two minor operation theatres function every day in the Operation theatre complex. These theatres cater to the inpatient and outpatients undergoing procedures under local or general anesthesia. All care is taken to ensure the safety of the patient. The department has anesthesia workstations and high-end monitoring to cater to high-risk surgical patients.

All patients undergoing surgery under anesthesia would postoperatively stay in SICU (Surgical Intensive Care Unit) or HDU (High Dependency Unit) under close monitoring till they are safe to be sent to their wards/rooms. Critically ill patients are managed in the SICU by our team of Anesthesiologists with appropriate inputs from the respective surgical units.

Anesthesia services are also provided for patients, particularly kids who are uncooperative for procedures like MRI, CT scan, Biopsy, Lumbar puncture, Radiation therapy, Endoscopy, etc.

Pain and Palliative Medicine Department started off as a pain clinic in Basavatarakam Indo American Cancer Hospital & Research Institute. We are currently managing cancer patients with pain and palliative needs in an outpatient setting, in-hospital consultation, palliative ward services and patients requiring home care.Our team comprises 2 physicians. Dr. Praneeth Suvvari M.D, D.M Onco-Anaesthesia AIIMS, CCEPC, NFPM & Dr. Praveen Kumar Kodisharapu, DNB, CCEPC, NFPM, working as full-time Consultants. We also have one dedicated social worker, 7 dedicated nurses working under the department.

Dr Praneeth and Dr Shyam have participated in the CTC-4 (Cancer Treatment Centers Palliative care provider) foundation course in January 2020. This course was jointly conducted by Lien Collaborative foundation, Singapore and AIIMS, New Delhi. As part of this training, they underwent observership in the department of palliative medicine at Kasturba Medical College, Manipal under the supervision of Dr. Naveen Salins. Dr Praneeth and Dr Praveen are currently pursuing National Fellowship in Palliative Medicine (NFPM) from the Institute of Palliative Medicine (IPM), Kozhikode, Kerala.

We run a Cancer Pain palliative Medicine clinic which runs 6 days a week and yearly for more than 1000 new outpatients. We also liaise with the lymphedema clinic, stoma clinic for continuity of care.

We are running 12 bedded dedicated palliative care ward and providing a variety of palliative services like management of acute pain crisis with patient-controlled infusion pumps, interventional pain management with various nerve blocks, management of acute breathlessness, sub-acute intestinal obstructions, end of life care, psychosocial support and other services. Also, we provide round the clock inpatient services to patients who are admitted to various other wards on-call basis followed by a daily review. We liaise with various governments and private run Palliative and Hospice centres within the area of the patient home for the continuity of palliative care and assist them with home care needs.

The department regularly conducts orientation classes to doctors of other specialties in the hospital and nurses about palliative care and its importance. We are proud to announce that the National Board of Examinations has granted us permission to start a formal degree in “DNB Palliative Medicine” from the year 2022 with 2 seats annually. We are one of the first 5 institutes in India that were given this opportunity to do this training course.

Most cancer treatments run over months or years. Patients who have limited venous access, may face difficulties in getting venous access for every treatment cycle. We provide services for long-term vascular access, which helps patients take their treatments without the trouble of repeated difficult cannulations.

There are various types of long-term vascular access devices. The commonly used are –chemoport, PICC line and Hickman catheter. Your oncologist would suggest an appropriate vascular access for you. Some procedures can be done under local anaesthesia but some may need general anaesthetic during insertion. If a general anaesthetic is required, they are done as day-care procedures. You would require to visit us one week after the procedure for wound assessment and dressing change as required.

CHEMOPORT:

INFORMATION FOR THE PATIENT AND FAMILY

CHEMOPORT – YOUR RESCUER DURING CHEMOTHERAPY
Chemoport is an advanced vascular device used to ease your chemotherapy experience. It protects your veins, is less painful than routine methods and aesthetically better option for delivering chemotherapy medicines.

What is Chemoport?
Chemoport is an implantable device placed under the patient’s skin to allow easy access to your central veins. It allows healthcare professionals to draw blood as well as deliver chemotherapy drugs directly into veins via your chemoport.

What are the advantages of Chemoport?
You need not be pricked in your hand every time to search for veins. The insertion of chemoport helps protect your body from unnecessary damage to peripheral veins in the arms and legs.

Are there any restrictions of mobility?
No. You can perform all routine activities like bathing, swimming with your port. There are no special restrictions for Chemoport.

How long Chemoport can be kept in the body?
Chemoport can be left in place for months and even years without any problem.

How is Chemoport placed?
The device is surgically inserted under the skin in the upper chest and appears as a bump/ button under the skin. The surgery itself is considered minor, and is typically performed under both local anaesthesia and general anaesthesia.

How long do I need to be in hospital for Chemoport insertion procedure?
It is done as a day care procedure and patient can go home on the same day.

Will I have pain after Chemoport insertion?
Patients sometimes have a little discomfort after the procedure, and can be managed with a pain killer for 24–48 hours. Rarely, there could be severe pain at Chemoport placement site.

How is Chemoport used?
Once the chemoport is placed, it is ready to be used. Whenever a medical treatment is needed, a special needle (Huber needle) is placed in the port. For most patients there is only a mild pricking sensation felt during needle insertion.

Can I receive blood through my Chemoport?
Yes. You can receive blood transfusion through your Chemoport.

What special care needs to be taken for Chemoport?
Till the Chemoport wound heals, cleanliness and care as suggested by the doctor needs to be followed. After the wound heals, no special precautions are required and you can resume your daily activities. If the chemoport is used infrequently, it needs to be flushed with heparin locks at least once in a month.

Are there any risks associated with Chemoport?
Like any procedure, this procedure too is associated with a very small risk of bleeding and infection. Other less common complications are vessel injury, nerve injury, port occlusion, thrombosis and catheter breakage. Very rarely (1:100) the infection may be severe enough to require the removal of the port. There is also a risk of blockage of the catheter if heparin flushes are not done as advised by the doctor.

When will my Chemoport be removed?
Chemoport can be kept in the body for as long as it is needed to provide a regular venous access. Once the chemotherapy cycles are over, your doctor, would advice you the removal of Chemoport which can be planned. Chemoport removal procedure is a minor procedure done in Operation Theater.

What is the cost of Chemoport?
Ask your doctor the cost for placement of Chemoport. Some insurance companies cover the cost, while others don’t. You need to check it with your insurance company.

1. Nair AS, Rayani BK. Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy. Korean J Pain. 2017 Apr;30(2):93-97.

2. Nair AS, Rayani BK. New anticoagulants and antiplatelet agents in perioperative period: Recommendations and controversies! Indian J Anaesth. 2017 May;61(5):448-449.

3. Nair A, Asiel C, Naik V. Transection of flexometallic endotracheal tube during Le Fort’s osteotomy. J Anesth Periopr Med 2017; 4(6): 291-292.

4. Nair AS, Naik VM, Rayani BK. FAST HUGS BID: Modified mnemonic for surgical patient. Indian J Crit Care Med 2017; 21:713-4.

5. Radha Rani D, Sridevi Chaitanya B, Senthil Rajappa J, Basanth Kumar R, Krishna Prabhakar K, Krishna Mohan MVT, Vibhavari Naik, et al. Retrospective Analysis of Blood Stream Infections and Antibiotic Susceptibility Pattern of Gram Negative Bacteria in a Tertiary Care Cancer Hospital. Int J Med Res Health Sci. 2017; 6(12): 19-26.

6. Nair A, Bharuka A, Rayani BK. The Reliability of Surgical Apgar Score in Predicting Immediate and Late Postoperative Morbidity and Mortality: A Narrative Review. Rambam Maimonides Med J. 2018 Jan 29;9(1):e0004.

7. Nair AS, Naik V, Saifuddin MS, Anne P, Kumar KP, Rayani BK. An observational study for knowing the compliance of patients scheduled for major abdominal and thoracic cancer surgeries in a single specialty center. Anesth Essays Res 2018; 12:552-4.

8. Nair AS, Naik V, Rayani BK. Intra-operative fluid management during mastectomy: How we do it! Indian Anaesth Forum 2018;19(2):90-91.

9. Nair AS, Poornachand A, Kodisharapu PK. Ziconotide: Indications, Adverse Effects, and Limitations in Managing Refractory Chronic Pain. Indian J Palliat Care. 2018 Jan-Mar;24(1):118-119.

10. Nair AS, Kodisharapu PK, Anne P, Saifuddin MS, Asiel C, Rayani BK. Efficacy of bilateral greater occipital nerve block in postdural puncture headache: a narrative review. Korean J Pain. 2018 Apr;31(2):80-86.

11. Nair AS, Naik VM, Seelam S, Rayani BK. Acute gastric conduit dilatation after oesophagectomy as a cause of respiratory distress. Indian J Anaesth 2018; 62(7):559-560.

12. Nair AS, Seelam S, Naik V, Rayani BK. Opioid-free mastectomy in combination with ultrasound-guided erector spinae block: A series of five cases. Indian J Anaesth 2018; 62(8):632-634.

13. Nair AS, Vanzar P, Rayani BK. Implications of accessory pectoral muscles for ultrasound-guided thoracic wall blocks. Indian J Anaesth. 2018 Oct;62(10):824-825.

14. Nair A, Amula VE, Naik V, Kodisharapu PK, Poornachand A, Shyam Prasad MS, Saifuddin MS, Rayani BK. Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block: A Randomized Controlled Trial. Rambam Maimonides Med J. 2019; 10 (1).

15. Naik VM, Rao KS, Rayani BK, Subrahmanyam M, Subramanyam R. Long-term venous access devices and anesthesiologists. Update in Anaesthesia 2019; 33:62-69.

16. Mantha SSP, Kaushik S, Nair AS, Rayani BK. Unusual path taken by peripherally inserted central catheter guidewire. Saudi J Anaesth. 2019 Jul-Sep;13(3):259-260.

17. Naik VM, Saifuddin MS, Nair AS, Rayani BK. Acute onset quadriparesis following oesophagectomy due to isolated hypophosphataemia. Indian J Anaesth 2019;63:498-9.

18. Nair AS, Upputuri O, Mantha SSP, Rayani BK. Levorphanol: Rewinding an Old, Bygone Multimodal Opioid Analgesic! Indian J Palliat Care. 2019 Jul-Sep;25(3):483-484.

19. Naik VM, Mantha SS, Rayani BK. Vascular access in children. Indian J Anaesth 2019;63:737-45.

20. Nair AS, Naik VM, Upputuri O, Rayani BK. How to avoid malpositioning of central venous catheter using ultrasound? Ann Card Anaesth 2019; 22:455-6.

21. Nair AS, Naik VM, Busa N, Rayani BK. Triton sponge and canister app for estimating surgical blood loss. Saudi J Anaesth 2019; 13:390.

22. Nair AS, Mantha SSP, Azharuddin M, Rayani BK. Lidocaine 5% Patch in Localized Neuropathic Pain. Indian J Palliat Care. 2019 Oct-Dec;25(4):594-595.

23. Nair AS, Mantha SSP, Kumar KP, Rayani BK. Sublingual Buprenorphine: A Feasible Alternative for Treating Breakthrough Chronic Pain. Indian J Palliat Care. 2019 Oct-Dec;25(4):595-596.

24. Sumanth DK, Nair AS, Mantha SSP, Rayani BK. Feasibility and efficacy of sublingual buprenorphine tablets in managing acute postoperative pain after elective breast cancer surgeries: A series of 10 cases. Indian J Anaesth. 2019 Dec;63(12):1036-1038.

25. Seelam S, Nair AS, Christopher A, Upputuri O, Naik V, Rayani BK. Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: A randomized controlled study. Saudi J Anaesth. 2020 Jan-Mar;14(1):22-27.

26. Nair AS, Mantha SP, Pulipaka SK, Rayani BK. Cebranopadol: A First-in-Class Nociceptin Receptor Agonist for Managing Chronic Pain. Indian J Palliat Care. 2020 Jan-Mar;26(1):147-148.

27. Nair A, Mantha SS, Suvvari P, Anne P. HTX‐011: Another game changer multimodal analgesic or an ephemeral, experimental drug! Saudi J Anaesth 2020;14:419‐20.

28. Thammineedi Subramanyeshwar Rao, Patnaik SC, Saksena AR, Rayani BK, Naik VM, Saifuddin S, Nusrath S. A Perplexing Case of Pneumothorax After Transhiatal Esophagectomy Managed By a Simple Remedy. Indian J Surg Oncol. 2020 Sep;11(2):269-271.

29. Suvvari P, Nair A, Anne P, Rayani BK. Innovative method to deal with pericatheter leak in home-based management of malignant ascites. Indian J Palliat Care 2020;26:394.

30. Nair AS, Saifuddin MS, Naik V, Rayani BK. Dexmedetomidine in cancer surgeries: Present status and consequences with its use. Indian J Cancer. 2020 Jul-Sep;57(3):234-238.

31. Nusrath S, Nair A, Dasu S, Subramanyeshwar Rao T, Raju KVVN, Rayani BK, Naik VM, Patnaik SC, Rajagopalan Iyer R, Saksena AR, Ramanuja Rao M, Saifuddin S, Narayanan H, Dandamudi RR, Gupta N. Single-Dose Prophylactic Antibiotic Versus Extended Usage for Four Days in Clean-Contaminated Oncological Surgeries: A Randomized Clinical Trial. Indian J Surg Oncol. 2020 Sep;11(3):378-386.

32. Nair A, Suvvari P, Mantha SSP, Rayani BK. Bayesian Adaptive Design Scope of Utilizing it for Research in Palliative Care. Indian J Palliat Care. 2021 Jan-Mar;27(1):186-187.

33. Nair AS, Pulipaka SK, Anne P, Rayani BK. Role of almitrine bismesylate in managing refractory hypoxemia in COVID19 acute respiratory distress syndrome. Saudi J Anaesth 2021;15:76-7.

34. Naik VM, Rayani BK, Bharuka A. Failure of hinged tip laryngoscope due to design variation. J Anaesthesiol Clin Pharmacol 2021;37:135-6.

35. Subramanyeshwar RT, Raju KVVN, Patnaik SC, Saksena AR, Pratap RR, Rayani BK, Naik VM, Nusrath S. Minimally Invasive Esophagectomy the Standard of Care: Experience from a Tertiary Care Cancer Center from India. Indian J Surg Oncol. 2021 Jun;12(2):335-349.

36. Nair AS, Naik V, Saifuddin MS, Narayanan H, Rayani BK. Regional anesthesia prevents cancer recurrence after oncosurgery! What is wrong with the hypothesis? Indian J Cancer. 2021;58:447-54.

37. Suvvari P, Nair A, Mantha SSP, Saifuddin MS, Naik V, Rayani BK. Management of Malignant Ascites by Indwelling Tunnelled Catheters in Indian Setup: A Case Series. Indian J Palliat Care. 2021 Apr-Jun;27(2):349-353.

38. Naik V M, Nusrath S, Rayani B K, et al. (October 13, 2021) Pneumomediastinum: A Rare Complication of Epidural Analgesia. Cureus 13(10): e18747. DOI 10.7759/cureus.18747

39. Vibhavari Naik, Sai Kaushik P. H., Abhijit Nair, Priya Nayak, Basanth Rayani. Clinical audit of code blue calls in a tertiary oncology hospital in India. Anesthesia & Analgesia | September 2021 • Volume 133 • Issue 3 • Supplement 2; Page 892. (Abstract at the 17th WCA 2021)

40. Aanchal Bharuka, Vibhavari Naik, Basanth Rayani. Covid-19 positivity rate and outcomes of elective surgeries in tertiary oncological setup in India – a retrospective observational study. Anesthesia & Analgesia | September 2021 • Volume 133 • Issue 3 • Supplement 2; Page 1907. (Best 200 Abstract at the 17th WCA 2021)

41. Naik Vibhavari M, Cheruku Deepika Reddy, Mantha Shyam Prasad S, Rayani Basanth Kumar. Unusual presentation of early postoperative trans-hiatal colonic herniation after esophagectomy, Journal of Anaesthesiology Clinical Pharmacology: online ahead of print October 13, 2021. doi:10.4103/joacp.JOACP_287_20

42. Prasad Mantha S, Nair A, Kodisharapu P, et al. (October 29, 2021) Ultrasound-Guided Continuous Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Patients Undergoing Radical Nephrectomy: A Randomized Controlled Trial. Cureus 13(10): e19120. doi:10.7759/cureus.19120

43. Postoperative Short Course Content Study group. Priorities for content for a short-course on postoperative care relevant for low- and middle-income countries: an e-Delphi process with training facilitators. Anaesthesia. 2022 Mar 23. doi: 10.1111/anae.15675. Epub ahead of print. PMID: 35319098.

44. Naik Vibhavari M, Cheruku Deepika Reddy, Swathi Uppalapati, Rayani Basanth Kumar. Femoral peripherally inserted central catheter in superior vena cava syndrome – Challenges of tunnelling. Indian Journal of Anaesthesia 2022; 66 (5): 388-389. doi: 10.4103/ija.ija_476_21

45. Naik V, Rayani BK, Bharuka A, Nair A. Steps involved and trouble‐shooting during chemoport placement: How we do it? J Anaesthesiol Clin Pharmacol 2022 (ahead of print)

46. Nair A, Anne P, Kumar KP, Mantha SS. Nanotechnology in pain medicine: What is new? J Anaesthesiol Clin Pharmacol (ahead of publication)

• What are the risks of anesthesia?

All operations and all types of anesthesia do have some element of risk, depending upon many factors including the type of surgery and the pre-existing medical problems of the patient like hypertension, diabetics, etc., Fortunately, adverse events are very rare. Your anaesthesiologist takes precautions to prevent an accident from occurring just as you do when driving a car or crossing the street. The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your anesthesia.

• What about eating or drinking before my anesthesia

As a general rule, you should not eat or drink anything after midnight before your surgery. Under some circumstances, you may be given permission by your anesthesiologist to drink clear liquids up to a few hours before your anesthesia.

• Should I take my usual medicines?

It is important to discuss this with your anaesthesiologists. Do not interrupt medications unless your anesthesiologist or surgeon recommends it.

• Would I have pain after surgery?

All surgical procedures are associated with a certain degree of pain and discomfort depending on the nature of the procedures. Also, patients have varying thresholds to pain. All measures are taken by us to alleviate pain using a multimodal approach.

• What else should I know about anesthesia?

Many people are apprehensive about surgery or anesthesia. If you are well informed and know what to expect, you will be better prepared and more relaxed. Talk with your anaesthesiologist. Ask questions. Discuss any concerns you might have about your planned anesthetic care. Your anesthesiologist is not only your advocate but also the physician uniquely qualified and experienced to make your surgery and recovery as safe and comfortable as possible.

The main aim of the department is to provide high-quality service in the shortest possible time. The department pro- actively traces all positive reports and shares the findings with the treating consultants for better understanding which helps to reduce any possible nosocomial infections.

Services Offered

Culture and susceptibility testing

• Automation in blood culture (BacT/Alert-3D).
• Conventional Routine cultures of various samples
• Fully Automated BD Phoenix for bacterial identification and antimicrobial sensitivity (with MIC values) along with Kirby Bauer disc diffusion testing (CLSI) to obtain accurate results of antibiotic sensitivity complementary to BD Phoenix.
• Automated ID and MIC susceptibility testing for yeast fungi.
• Conventional methods for Mycobacterial culture.

Serology

• Automated ECI system with Enhanced Chemiluminescence Immuno Assay principle for viral hepatitis ( B & C ).
• Diagnostic tests for all major infectious diseases like HIV (all HIV positives are confirmed with 3 different tests as per WHO recommendations).
• Rapid diagnostic tests for typhoid fever, rheumatoid arthritis, streptococcal infections.
• Rapid diagnosis of sepsis by markers like Serum Procalcitonin ( Roche Cobas E411 ) & CRP.

Quality control

The laboratory meticulously follows internationally recommended techniques, adheres to inbuilt control protocols and guidelines and this reflects in the accurate test results. Our laboratory has been accredited by NABL

Following are the highlights of our quality control practices.

• Quality Control protocols are followed, as per international standards.
• Antibiotic sensitivity is done as per the Clinical and Laboratory Standards Institute (CLSI) with the American Type Culture Collection (ATCC) controls.
• Enzyme Immuno Assay (EIA) controls evaluated in every run.
• Computerized data.
• A standard operating procedures (SOP) manual was prepared as a reference document for all technical staff to follow. This was upgraded as per NABL standards.
• The department regularly takes part in the EQAS ( External quality assurance program) and in ILPT ( Inter laboratory proficiency testing )

Hospital Infection Control

The department of Clinical Microbiology is an active member of the hospital infection control committee (HICC).

The department carries out surveillance of hospital-acquired infections (HAI) with the help of Infection control nurses & Link nurses.

Laboratory records are analyzed to determine the rate of infection in various areas of the hospital.

Presently the surveillance is passive and is based on the laboratory records of culture-positive cases.

Based on this, infection rates (CIR) are calculated for important HAI.

This helps in identifying outbreaks and monitoring susceptibility patterns.

Apart from surveillance of HAI, environmental surveillance activities are also carried out which includes air sampling in critical and semi-critical areas.

In addition to this, the infection control practices are also routinely monitored by the following activities

• Efficacy of the new disinfectants to be purchased is done when desired by the concerned authority.
• In use test of the disinfectants used in the hospital.
• Monitoring of CSSD
• Surveillance of pathogens.
• Infection control policies being practiced are: disinfection, surveillance, isolation, antibiotic and chemoprophylaxis.
• Active participation in Induction training programs and In house training of nurses & other paramedical and Medical staff.
• Antibiogrammes are being circulated to all the staff concerned every 4 months
• Continuing medical education (CME) program held regularly.

Mammography is performed on the new GE Sonograph DS Full Field Digital Mammography unit, which provides unsurpassed image quality at minimized radiation dose.

Our Breast Imaging division is enriched with Digital mammography, Sonomammography, Elastography and 1.5T MRI with breast coil equipment which can detect breast cancer at the earliest stage. Ours is one of the very few centers in the country where breast screening is done with Digital mammography and Elastography which has the highest sensitivity of detecting benign or malignant breast lesions. Ultrasound-guided and stereotactic core biopsies are also performed.

Soft copy reporting of the digital images is done on the attached Reporting Workstation. The workstation is also equipped with Computer-Aided Detection (CAD) software which assists the radiologists in detecting small masses and microcalcifications in the breasts.

Multi-slice CT is one of the most potent tools for the early detection, diagnosis and treatment planning of cancer.

CT scanning of the whole body is carried out on the Siemens Emotion 6 slice CT scanner, which is capable of obtaining 6 slices per rotation of the x-ray tube, a slim, wide-open, high-speed patient gantry that allows high-quality images in a very short period and low radiation exposure.

Dual / Triple phase contrast-enhanced scans, Dynamic scans, CT Angiography, and 3D reformations are carried out wherever applicable. Multiplanar reformatted images are routinely obtained on the diagnostic workstations to aid in the diagnostic interpretation of the CT scans.

The department is equipped with 4 Ultrasound machines with Color Doppler which contribute to the high level of confidence of the Radiologist for evaluation of the lesions and serve as an excellent guiding tool for the various Diagnostic and Therapeutic procedures.

Three machines are used for the diagnostic purpose to carry out various ultrasound examinations of the abdomen, pelvis and small parts, as well as intracavitary (transrectal and transvaginal) examinations. One machine is used for guided FNAC, Biopsy and therapeutic drainage procedures.

The Color Doppler scanners are extensively used to assess the vascularity of the tumors. The arterial and venous Doppler examinations are carried out for the evaluation of patients with associated peripheral Vascular Diseases and screening as well as diagnosis of Deep Venous Thrombosis.

The portable Ultrasound unit enables –

• Emergency Scanning of the patients in the ICU.
• Bedside Drainage procedures like – Pleural & Peritoneal Tapping,
• Abscess Aspiration
• Indwelling Pigtail Drainage

An intra-operative Ultrasound Scanning facility is provided to facilitate

• Resection of the tumors by localization of small lesions.
• To assess vascular involvement intra-operatively.
• To assess complete removal of the lesion.
• To perform Intra-operative Tumor Ablation (Radiofrequency Ablation).

This is one of the few centers in the country to have ACUSON S2000 Siemens elastography machine which can detect benign and malignant lesions non-invasively. We use this technology predominantly for breast, prostate and liver lesions. It also increases the accuracy of guided FNAC and biopsy procedures.

Replacing conventional radiography for reducing patient radiation dose and for giving excellent diagnostic quality images, the department has a 500ma Image Intensifier, 400ma HF and 300 ma X-Ray Unit. The department is also equipped with 60ma mobile X-ray units for emergency bedside radiography.

Our Breast Imaging division is enriched with Digital mammography, Sonomammography, Elastography and 1.5T MRI with breast coil equipment which can detect breast cancer at the earliest stage. Ours is one of the very few centers in the country where breast screening is done with Digital mammography and Elastography which has the highest sensitivity of detecting benign or malignant breast lesions. Ultrasound-guided and stereotactic core biopsies are also performed.

Images from the digital imaging modalities i.e. CT, MRI, Ultrasound, Computerized Radiography, DSA and Digital Mammography, are stored in the PACS (GE Centricity) and also transmitted across the hospital network so that as soon as the images are acquired by each of these modalities, they can be viewed by the referring clinicians without any delay on the PC in their office, OPD, or any other site in the hospital. Reporting of all Computerized Radiography, CT, MRI, Ultrasound and Mammography examinations is carried out at the Diagnostic workstations.

Basavatarakam Indo-American Cancer Hospital has added the latest GE Discovery GE Discovery MI Gen 2 Digital PET-CT is the latest PET-CT equipment with a brand new technology that belongs to the next platform unlike the other common PET Scanners which are of analogue types.

It is SiPM based technology.

It is the 6th Digital PET-CT installed in the entire country and the first in South India.

Being a premier teaching cancer institute, it is commited to purchasing the latest technology. It has got AI based capabilities for CT and PET which is exclusive for Digital PET. It is also capable of doing parametric imaging and whole body dynamic PET scans. Having an onsite cyclotron, this PET scanner is capable of imaging short lived tracers with low yield and hence can do various new research projects. This scanner has a very high resolution and sensitivity. It is capable of doing 2 times faster scans and with half of the activity. Having in-built 4D technology, free breathing lung scans with respiratory gating can be performed.

The overall radiation exposure to the patient is also much lesser. Having a 128 slice CT scanner, we can perform CT angiography and superior 3 phase and 4 phase liver scans. It is equipped with thicker LSO crystal with TOF and Q Clear technology for better resolution. Having worked with conventional PET-CT scanner for more than 14 years, it was time for us to be geared up for the future with the latest technology. Besides CT scan, it can also be fused with the MRI scan with precision. It has got the auto-in technology for automatic positioning of the patient.

BIACH & RI has also a medical cyclotron facility. Medical cyclotron provides a high-quality isotope production facility that produces a variety of PET-Tracers also called radioactive molecules which are used for the diagnosis of various illnesses. These molecules are injected intravenously and images are acquired using a PET-CT scanner.

The facility currently houses a General Electric PET trace Cyclotron. The GE PET trace is an automated compact self-shielded medical cyclotron capable of producing 16.5 MeV protons. The high-energy cyclotron provides for a high yield [18F-]-fluorodeoxyglucose (FDG) production which can cater to the need of FDG to PET-CT centers in entire south India.

A whole-body DOTONAC PET SCAN uses a radioactive tracer to obtain images of a specific type of tissue, or disease state of the tissue. It is the freely dissolved gallium-ion Ga3+ that is active. For the applications, the radioactive isotope gallium-67 (67Ga), which has a decay half-life of 3.26 days, is used.

Gallium-67 is imaged with a gamma camera, with a SPECT camera, or with SPECT/CT hybrid machines.

It is taken up by tumors, inflammation, and both acute and chronic infection, allowing these pathological processes to be imaged by nuclear scan techniques. It is particularly useful in imaging osteomyelitis that involves the spine, and in imaging older and chronic infections that may be the cause of a fever of unknown origin.

Whole-body survey to localize the source of fever in patients with Fever of Unknown Origin (FUO).

Detection of pulmonary and mediastinal inflammation/infection, especially in the immunocompromised patient.

Evaluation and follow-up of active lymphocytic or granulomatous inflammatory processes such as sarcoidosis or tuberculosis.

Diagnosing vertebral osteomyelitis and/or disk space infection where Ga-67 is preferred over labeled leukocytes.

Diagnosis and follow-up of medical treatment of retroperitoneal fibrosis.

Evaluation and follow-up of drug-induced pulmonary toxicity (e.g. Bleomycin, Amiodarone)

Evaluation of patients who are not candidates for WBC scans (WBC count less than 6,000 and/or poor IV access).

A radioiodine therapy ward has also been integrated within the department of nuclear medicine that is used for the treatment of thyroid cancer patients with radioactive iodine. The ward is consisting of three isolation rooms. So, three patients can be treated at the same time in this facility.

Over 500 thyroid cancer patients are already treated with radioiodine at the Dept of nuclear medicine, BIACH & RI. Not only patients from Andhra Pradesh, but also from other states like Karnataka, Maharashtra and Orissa are benefited due to this facility.

MIBG therapy for neuroendocrine tumors is also available here.

The department is headed by highly qualified Nuclear Medicine Physicians and well experienced nuclear medicine technologists, certified and experienced CT technologists, Radio chemists and Nursing staff.

Go To Doctors

Diabetic evaluation and fitness are necessary for cancer patients undergoing surgical and other treatments.

• Cervical Cancer
• Endometrial/Uterine Cancer
• Ovarian/Fallopian Tube Cancer
• Vaginal Cancer
• Trophoblastic Disease / Molar pregnancies
• Pre-invasive Conditions / Dysplasia of Cervix or Vulva / Colposcopy/ LEEP/ CRYO

Chemotherapy, Radiotherapy can have their own adverse consequences like nausea, vomiting, poor appetite, decreased energy levels, and pain. As does extensive surgery-body disfigurement, physical handicap. The good news is that nobody needs to suffer; the pain and discomfort (physical or emotional) can be mitigated with appropriate medication, therapy and relaxation. At BIACH & RI we believe in holistic care and understand that our patients, in addition to needs specific to their illness, also need care and psychological support during this difficult period in their lives. The Department of Psychiatric Oncology has been started with these initiatives in mind. Dr. Aftab Ali Khan who has extensive experience in this particular field of Medicine/Psychiatry heads the department.

The following services currently fall in the purview of the department:

• Assessment and treatment of clients with cancer and mental health issues identified either by their caregivers or primary doctors. Management is with medication and or counseling as needed.
• Support and psychoeducation to caregivers of patients. (as they too go through a lot of stress and are usually the unsung heroes in this.)
• For patients who might have adverse effects from Chemo, Radio and Other interventions we provide support in addition to pharmacological interventions. This is to ensure your adherence to treatment and facilitate recovery. This would be in liaison with the treating doctor(s) and might all also include allied departments like Social Work and Physiotherapy

The nephrologists along with oncologists and intensive care doctors deal with nephrotoxic effects of commonly used chemotherapeutic agents, acute kidney injury syndromes in cancer patients, and kidney-related issues in recipients of bone marrow transplantation.

Cardiac

• TMT
• 2d echo
• Stress thallium TMT
• ECG

GI Cancer/ENT

• Endoscopy
• Colonoscopy
• Ultrasound Endoscopy

Renal support

• Dialysis Machine

Pulmonology

• Pulmonary Function Test (PFT) equipment