In 1911 the Department of Physical therapy (precursor of nowaday's Department of Radiology) was established in the SotokufuHospital (the predecessor of the current National Taiwan University Hospital) when Taiwan was still under Japanese occupation. Later in 1937, it was renamed as the Department of Radiology as the mother hospital also renamed to Empire University Hospital (Taipei). After the Second World War, the sovereignty of Taiwan returned to Republic of China, the name of the department was changed to Department of Physical Therapy and the mother hospital adopted its current name. In 1954, the Division of Radiation Therapy and Isotope room were integrated into the Department of Radiology in National Taiwan University Hospital.
In 1990, the Department of Radiology was functionally divided into 3 divisions, namely Diagnostic Radiology, Nuclear Medicine and Therapeutic Radiology. As new imaging modalities such as ultrasonography and magnetic resonance imaging, which do not possess the property of radiation, added to the basic arsenals of X-ray machines, the Division of Diagnostic Radiology was renamed as Department of Medical Imaging in 1993.
Functionally, there are 5 subspecialties in the Department of Medical Imaging including the neural, chest, body, musculoskeletal, and pediatrics groups and each has a chief who is responsible to the Chairman of the department. According to daily practice, the Department of Medical Imaging has 5 categories of work: plain film (those examinations not requiring special technique nor preparation, e.g. routine chest, abdomen, and skeleton x-rays, etc).; special examinations (those requiring special technique, contrast medium, as well as preparation, and are performed by radiologist, e.g. barium meal and enema studies, intravenous urograms, etc.); Computed Tomography (CT), a sophisticated X-ray whole body scanning technique capable of producing high resolution cross sectional images of the body; Magnetic Resonance Imaging (MRI), another sophisticated whole body scanning technique capable of producing high resolution sectional (not limited to axial) images of the body and does not require ionization radiation; Vascular and Interventional Radiology which deals with examinations of the vascular system of the body and a wide spectrum of therapeutic works that helps in treating patients, e.g. embolization therapy of cancer of the liver or aneurysm of the brain, dilatation of a narrowed artery or vein, drainage of obstructed bile ducts or urinary tract, biopsy of various body parts or drainage of abscesses, etc. Ultrasonography is a powerful tool that has been known as the doctors' second stethoscope. It does not produce ionization and is a very convenient tool to examine the solid organs of the body, e.g., the liver, kidneys, the female genital organs, thyroid glands, etc. Owing to its versatility, the machine can be brought into the Intensive Care Unit to facilitate bed-side examinations. In our hospital, the administration of this modality is under Integrated Departments, but radiologists do take part in the daily service as well as using this modality to guide us in certain therapeutic procedures, for example, biliary drainage in obstructive jaundice.
In summary, nowadays the Department of Medical Imaging not only deals with diagnostic work, but also with tremendous applications in the treatment side, so that some in-operable cancers can be embolized, aneurysm in the brain or aorta that formerly should require open surgery can now be treated with coil embolization or stenting, so on and so forth, resulting in dramatically shortened hospital-stay (meaning less economical burden) and remarkably reduced discomfort of patients.
Currently the Department of Medical Imaging has six MRI machines, three of them are 1.5T, and three are 3T which is included one MR-PET; seven CT scanners of which one is 640-slice DECT, one is 256-slice MDCT, two are 128-slice MDCT, two are 64-slice MDCT, and one 16-slice CT; an angiographic suite housing 3 machines, all are digital biplane models; 3 fluoroscopic machines including 1 pediatric fluoroscopic machine; Three mammogaphic machines; 3 machines for none marrow density; 16 X-ray machines and 9 portable x-ray machines scattered in the wards and ICUs for bed-side examinations. Our MRI facilities provide clinical services for around 4000 patients per month. We also provide service for research, including functional MRI of brain, tractography, perfusion study of breast cancer and spinal cord, MDDW (Multidirectional Diffusion Weighting), ASL (Arterial Spin Labeling), SWI (susceptibility-Weighted Imaging) and MRS of different sections. Our department introduced the first integrated MR-PET system in Taiwan in 2014. It provides hybrid imaging by combing state-of-art structure imaging from 3T and functional molecular imaging from PET at one examine. Our fleet of 7 CT scanners serves the hospital's routine and emergency scanning as well as in CT guided therapeutic procedures, e.g. biopsies, drainage, etc. In addition to the traditional sectional images, we also provide post-processed images of the body like 3D CT angiography, volume-rendering of extremities, CT virtual colonoscopy, etc. The seven CT scanners totally serve about 8800 patients per month. There are many researches using these CT, such as virtual colonoscopy, 3D CTA of coronary artery and calcium score calculation, 3D reconstruction of heart in pediatric congenital heart disease, and CTA and perfusion CT in brain vascular disease. The new 640-slice multidetector CT, on service since March 2016, allows obtaining high quality imaging for CT coronary angiography within a single heartbeat.Our angiographic suite encompasses works in diagnostic and therapeutic angiographies of the neural and body groups. Basically we provide angiographic service to various body parts, e.g. in cerebral vascular accidents or in gastrointestinal bleeding. As CT & MRI have taken up most of the preliminary diagnostic work, most of the angiographic examinations have been more or less converting to therapeutic purposes, for example, angiographies for hepatic cancer & cerebral aneurysms as road maps for transcatheter embolization therapy or in aortic aneurysms for subsequent stent-graft deployment. We serve about 650 patients per month, and of these 60% are therapeutic works. We also renewed one of angiography equipments in November, 2011, which is capable of CT angiography and imaging-guided procedure. It provides more accurate intravascular diagnosis and treatment.
We also cooperate with the Medical Information System Office to support a PACS system. In this system our radiologists scrutinize the images and generate respective reports. The system incorporates all the images with the reports and deliver them to wherever required, e.g. medical filing, OPDs, clinical wards, ICUs, etc. In each viewing station, medical personnel can easily review every radiological examination (with the reports) a patient has undertaken. An attending radiologist can monitor several examinations in different locations (e.g. CT & MRI) which have been on-going under a resident's duty. Furthermore, radiologists can use this system to alert the ordering clinical doctors (without having to dial the telephone) once an emergency situation has been detected in certain examination, for example, an un-suspected pneumoperitoneum in a chest x-ray. Radiologist can also consult other fellow radiologist or clinician for a second opinion, through this system, concerning certain examination.
Tiffany T.F. Shih
Musculoskeletal radiology, CT, MR, breast imaging
Steven Shinn-Forng Peng
Assistant Professor & Vice Chairman
Clinical Assistant Professor
Chest, cardiac, and breast radiology
Gastrointestinal, hepatobiliary, genitourinary, and interventional radiology
The National Taiwan University Hospital is a recognized leader In medical education nationally, the hospital provides medical care for patients as well as training for medical students and residents:
1. Medical Students Lectures are held for 4th, 5th, and 6th-year medical students about the latest imaging techniques, radiotherapy, current trends in clinical and basic medicine for diagnosing and treating common clinical disease. The department participates in small class tutorials, and in conjunction with the Anatomy Department, provides clinical radiology diagnostic training. In conjunction with the Social Medicine Department, it has established a class in 「Technology and Patients.」 The class aims to educate medical students about the adaptation of various examinations and assesses the mental and physical effects of the technology on patients before and after the examinations.
2. Residents Specialists in the Department of Imaging sub-specialize in their respective field depending on their knowledge of clinical radiology and specialized techniques. The areas of sub-specialization include the nervous system, chest and cardiovascular system, bone and muscle system, and visceral and pediatric diagnostics. Specialists are responsible for daily morning and afternoon assemblies that aim to provide guidance and enhance the medical knowledge of residents. Visiting staff specialists or guest speakers are often invited to make presentations. The residents are encouraged to participate in inter-departmental colloquiums. Specialists are responsible for specialized examinations, and through the process, educate and enhance the skills of residents. Under the specialists' guidance, the residents take turns and are responsible for attending national monthly and yearly colloquiums on radiology, participating in case discussions, and for essay publication. After the four-year training program, residents may enter other colleges for specialized training depending on their personal interest.
The hospital provides opportunities for our young attending doctors to train abroad. Five specialists have been sent for training to overseas medical centers within the last 3 years. The hospital as well participates in academic staff training, short term medical education training overseas, and overseas academic conferences. The hospital encourages colleagues to pursue further studies. At the moment, 5 doctors are working on their PhD degree, and 3 technicians are working in their respective research areas toward a masters or PhD degree.
4. The department maintains a collection of radiological magazines and academic journals (such as Radiology, AJR, JCAT, MRI, Ultrasound, and the Magazine of the Radiology Society of ROC) and has audiovisual educational systems such as tape players, TVs, digital projection systems, and large X-ray projectors, for viewing X-ray files and electronic academic files for educational purposes.
5. The department provides radiology theory courses for majors in other departments such as physiotherapy and medical technology.
6. It fosters inter-institutional academic cooperation in the area of radiology technician training between departments of medical technology at the Yang Ming University, Tsu Chi College, and Private Yuan Pei University.
Research and accomplishments
1 Examination and 3D image reconstruction in cases of pediatric congenital heart disease using 3-dimensional electron beam computed tomography angiography (3D-EBCTA). Its diagnostic rate is almost 100% for congenital heart disease, and therefore serves as an important aid to cardiac surgery.
2 In cooperation with the Division of Neurology, Department of Internal Medicine, and Surgery, performed the first MRI-guided 3D fixed position D.B.S (deep brain stimulation) and MRI-guided subthalamotomy to successfully cure severe Parkinson's disease.
3 Performed the first GDC embolization for treating cerebral artery aneurysm in 1996. The department became the only medical service to provide aneurysm embolization training. GDC training courses are held annually.
4 Study of spinal cord perfusion with MRI and MRS.
5 Reveal the orientation of white matter fiber tracts using D.T.S. (Diffusion Tensor Spectrum) and further analyze the complex structure of cerebral white matter.
6 Study of post-coronary artery bypass graft obstruction and cardiac fiber destruction and reconstruction using D.T.S (Diffusion Tensor Spectrum) imaging. Cardiac muscle strain of the left ventricle during diastole is also evaluated using MRI.
7 Performed the first and second infra-renal aneurysm stent-graft operation in the nation, in cooperatation with the Cardiac Surgery Department.
8 Performed the first biliary stent-graft surgery in the nation.