| The Nairobi Hospital Radiology Department|
Modern, dynamic and professional diagnostic imaging centre - that is The Nairobi Hospital Radiology Department. With the best technology available today, the hospital has established leadership in diagnostic and interventional imaging in the medical sector.
Diagnostic Invasive Procedures
The department has a dedicated digital subtraction angiography machine which performs a wide range of diagnostic and interventional procedures:
Cerebral angiography: This is an examination of the blood vessels supplying blood to the brain. Doctors use cerebral angiography to detect abnormalities in the brain's blood vessels, such as narrowing, blockage or any other malformation.
Peripheral angiography: Periphery angiograms are used to examine the blood circulations to body structure other than the heart. Examples of periphery angiography are renal arterigraphy, subclavian arteriography, carotid arteriography, femoral arteriography and mesenteric arteriography, among others.
These are procedures for managing abnormalities through the aid of x-ray imaging. Some of such procedures include:
Digital Fluoroscopic Examinarions
- Nephrostomy drainage: This is the external drainage of urine by percutanious insertion of a catheter into the kidneys in a situation where a patient has kidney failure.
- Endoscopic retrograde cholangio-pancreatography: This is a procedure carried out by gastroentrologists to directly visualize the duodenum, ampulla of vater and the common bile ducts through a scope (a tube with special lenses and camera). A dye (contrast medium) is introduced into the biliary system under the guidance of x-rays (fluoroscopy). Doctors use this procedure to check for blocked ducts and tumours among other conditions. During this procedure, a blocked duct can be opened up and a special tube (stent) inserted to keep it open.
- Venography: This examination is also called phlebography. It is an x-ray examination of the venous circulation by introducing use of a radio-opaque dye injected intravenously. It is mainly used in checking for blood clots in the deep veins.
- Barium studies: These include barium swallow, barium meal, barium enema and barium meal and follow through.
barium meal is an examination of the stomach and duodenum after a patient ingests barium suspension and visualisation is made on a screen. barium enema is an examination of the large bowels through the introduction of liquid barium and air under X-ray guidance. barium meal and followthrough is used to follow up the progression of barium suspension through the small and large bowels after a short barium meal.
- Sialograms: This is an x-ray test to demonstrate the salivary glands through introduction of radio-opaque dye and use of x-rays to visualise and record the images. It is done on patients with suspected blockage of the salivary ducts.
- Hysterosalpingogram: This examination involves introduction of a special dye (contrast) into the female reproductive organs to demonstrate the anatomy of the uterus and fallopian tubes. It is usually carried out on women with infertility. It can demonstrate blocked tubes, fibroids and other abnormalities.
- Ductograms: This test involves introduction of a dye (contrast) through the nipple of the breast to demonstrate the anatomy of the mammary ducts. It is commonly carried out on patients presenting with nipple discharge.
- Simulation for radiotherapy: This is a procedure carried out in conjunction with Radiation Therapists to plan for radiotherapy treatment of cancers.
All routine imaging is performed digitally using the latest computed radiography systems or direct digital systems. Images are displayed on high resolution monitors and recorded on dry films, CDs or DVDs. The digital imaging is a cleaner production process that does not involve use of darkroom chemicals. High quality images are produced with minimised need for retakes.
Trauma and emergency imaging is done at the Emergency and Accident Centre x-ray room. The service is available on 24 hour basis.
- Digital Orthopan tomography (OPG): It is a technique of acquiring panoramic images of the lower and upper jaw including the left and right temporal-mandibular joints. Thin slices of images are acquired by moving the x-ray source and the receptor (detector) in opposite directions. Orthopantomography is useful in demonstrating fractures, tumours, abcesses, teeth misalignment, impaction and cavities among others.
- Migration Chest X-rays: The department undertakes all migration chest x-rays for United Kingdom (UKTBDP), Australian, Newzealand and Canada as well as United States Refugee Programme (USRP). A dedicated department has been established at the Plaza Annex for these clients referred by International Office of Migration (IOM). All the chest x-rays are captured digitally.
Contrast studies are also performed on various anatomical regions to investigate diseases. They include:
- Intravenous Urography: This is an examination to check the kidneys and the tubes that drain them (ureters). Conditions such as kidney stones, inflammation and congenital abnormalities among others can be investigated. Normal patients can undergo the test when they are screened to donate a kidney to a needy close relative.
- Micturating Urography(MCU): This is a test where the picture is taken as the patient empties the bladder. The examination is carried out on patients with incontinence, urine retention and painful passage of urine among other conditions.
CT scanning is an imaging technique that involves the acquisition of information as x-rays from a rotating source(CT tube) pass through the human body to a special detector (or detectors). This is combined with the logic of a computer to reconstruct images which are displayed on a monitor, processed and then recorded either on a film or CD.
The Hospital has a modern volumetric CT scanner that enables a wide range of CT scanning options including:
- CT angiography: This is an examination that involves visualization of blood vessels through injection of a radio-opaque dye intravenously and acquisition of data as the dye circulates in the blood. Reconstruction is done to demonstrate the vessels clearly in several dimensions.
- CT guided biopsy: A piece of tissue is removed from the body for labolatory analysis under CT guidance.
- Dental CT: This examination allows the panoramic imaging of the upper and lower jaws including both tempora-mandibular joints using a CT scanner. The image produced is very important in maxillo-facial and dental implant surgery planning.
- CT Bone mineral densitometry: This is a CT technique for checking the calcium content of the bones to detect osteoporosis.
The department has three color doppler ultrasound machines which are used for all routine abdominal, pelvic, masculo-skeletal and vascular imaging. Besides, the following other studies are also carried out:
- Ultrasound guided biopsy
- Ultrasound guided pleural tapping
- Ultrasound guided drainage of abscesses
- Follicular tracking
Magnetic Resonance Imaging (MRI)
MRI involves the interaction of a strong external magnetic field, magnetic properties of atomic nuclei and radio-frequency waves. It utilizes the principles of magnetic resonance of atomic nuclei. Images are produced with the aid of a strong uniform body-sized strong and stable magnet and associated radio-frequency waves and a fast and powerful computer.
- MRI Magnetic Resonance Cholangio-pancreatography- This examination noninvasively demonstrates the biliary system in a similar manner with endoscopic retrograde choledo-pancreatography. . Magnetic resonance cholangiopancreatography (MRCP) is a relatively new application of MRI technology using special software. The images it produces are similar to those produced during endoscopic retrograde cholangiopancreatography (ERCP), in which the doctor gets images by having the patient swallow a flexible tube--an endoscope. But in MCRP, the risks of sedation and perforation inherent in endoscopic techniques are avoided. The test is very helpful in assessing obstruction of the bile ducts, inflammation of the gallbladder, and the anatomy of the pancreatic ducts.
- MRI Whole body imaging- This is a whole body evaluation for detection of cancer. The examination helps in the assessment of metastatic bone disease, multifocal musculo-skeletal disorder and tumour staging.
MR Angiography- this is an examination that demonstrates the blood vessels without necessarily introducing a dye. Blood vessels of the brain, neck, body and the limbs can all be demonstrated.
MR periphery angiography- This is an examination that demonstrates the arterial circulation from the level of the kidneys to the toes. The data is acquired in a single examination and displayed in the same image.
Cardiac Catheterization Laboratory
The cardiac catheterization laboratory is a 24 hour centre used in the diagnosis and treatment of complex heart and blood vessel diseases without opening up the body. In this special laboratory, diagnostic and closed heat surgeries are performed under local anaesthesia. The laboratory has the capacity of eight procedures a day including emergencies which has put The Nairobi Hospital in a leadership position in performance of the following procedures:
- Diagnostic coronary angiography
- Coronary artery balloon angioplasty and stenting (percutaneous coronary intervention)
- Percutaneous Balloon Valvuloplasty
- Whole heart catheterization
- Insertion of Chemotherapy delivery device
- Temporary and permanent pace maker implantations
- Coil and chemical embolization treatment of tumors
- Placement of inferior vena cava filters
The staff consists of Radiographers, Nurses, specialized Consultant Cardiologists, Cardiac Technicians and Support Staff. This team of professional ensures that daily bookings are done as per schedule, preventive measures are carried out and the patients get the best care during treatment.
To ensure safety and infection control measures are in place, the department carries out quarterly contamination checks.
The nurses are both Basic Life Support and Advanced Cardiac Life Support certified.
Cardiac Angiography System
The new cardiac angiography system (Axiom Artis dTC) is a mixed system with a flat panel detector capable of neurological, cardiac and peripheral angiography. It operates on lowest radiation dose to patients with excellent image resolution.
It has rotational angiography, 3D vessel rendering for inline stent measurement, good ergonomics, DVD image recording among other features. It also has a Microstream for End Tidal Carbon dioxide supply
Intra Aortic Balloon Pump Machine
Supports severely compromised cardiac output patients. It also has a Microstream for End Tidal Carbon dioxide supply
HeartStart XL Defibrillator and monitor
For emergencies and it includes resuscitation equipment
Portable IntelliVue MP50 monitors
For patient monitoring during and after the procedure.
The Hemochron Response dual Well Microprocessor for Measuring Activated Clotting Time.
- The HemoCue machine for measurement of blood glucose levels.
- Perfusor Pumps for infusion of accurate medications.