X-rays and scans that can give you the best images from Spectrum

X rays and scans have become the order of the day in determining the problems with bones and internal organs. Spectrum radiology provides low radiation services which result in accurate diagnosis.

The medical technology these days have moved forward in leaps and bounds as the world improvises with the latest trend and technology. There are more accurate diagnosis and fewer mistakes. Expert advice is always accompanied with reports regarding blood tests and detailed examination of internal organs. A simple headache may be further investigated into with scans of the brain and related examinations. Latest technology is made available wherever you go as the hospitals compete to update their technology and equipment. Continue reading

NEW GP MRI INDICATIONS…WHAT DOES IT ALL MEAN (Part 1)

As of 1 November 2013, the GP MRI requesting rights have been extended to include indications for patients aged 16 years and over. These indications include Brain, Cervical spine and Knee.

This 3 part series will include case studies to help identify and highlight some appropriate senarios that MRI would be most useful. For more information please call our Randwick or Liverpool sites on 9399 5357 or 9600 9552.

Part 1 – MRI brain:


GPs can refer for a Medicare funded MRI head scan for unexplained chronic headache with suspected intracranial pathology and unexplained seizure(s), for adults 16 years and over.

CHRONIC HEADACHE

Case History 1

A 50 year old man presents with chronic headaches that have become progressively worse over the last 2 months.

He mentions that the headache wakes him from sleep, and is worse in the mornings but improves over the day. They have increased in frequency and have been associated with blurred vision and dizziness. He also mentions morning vomiting that is not associated with nausea.

Case History 2

A 26 year old female presents with chronic headaches that have persisted over the last two years.

Her weekly headaches are described as band like and are not associated with an aura. The headaches are not associated with vomiting, changes in vision, they do not wake her from sleep and they are not triggered by exercise or coughing. She has no history of trauma and the headaches have not changed in severity since two years ago. Her neurological examination showed no focal findings and the rest of the physical examination was normal. She takes paracetamol for headache relief. She is worried about intra cranial pathology.


unexplained seizure(s)

Case History 1

A 43 year old man presents with a friend after having a first time seizure at home.

The friend describes that the man’s right hand suddenly contracted, and the right arm then started jerking and his head turned to the other side. Soon after he lost consciousness, fell and his whole body started “shaking”. The episode was brief and regaining of consciousness was associated with confusion. The man had been incontinence during the event, and fortunately did not sustain any visible injuries. He has no previous history of seizures or a family history of epilepsy.

Case History 2

A 24 year old male with type 1 diabetes mellitus presents for follow up at the GP after hospitalisation 1 week ago for hypoglycaemia.

The man was at a music festival when his friends started to notice that he was becoming dizzy and dull. His friends mentioned that he lost consciousness and his body started ‘convulsing’. He was taken to the emergency department for treatment. On examination he has a normal neurological examination. He admits to having ‘hypos’ in the past but has never had convulsions before. He is worried about epilepsy and intra cranial pathology, and wants your opinion on an MRI scan.


discussion – chronic headache

Headaches are a common complaint presenting to primary care. Imaging can aid clinical decision making depending on the clinical picture and the pre-test probability. Intra cranial pathology is a rare but important cause to exclude, especially if the headache is associated with focal neurological findings, signs of increased ICP and progressive severity. When considering an imaging modality often CT is generally recommended in emergency situations. However MRI offers an imaging modality with no ionising radiation that is more sensitive in detecting white matter lesions than CT [1, 2].

MRI with its increased sensitivity may also increase detection of ‘incidentalomas’ which are often alarmingly anxiety provoking for the patient, regardless of its level of clinical significance. Imaging solely for patient reassurance has short term benefit- a study of 150 patients treated for chronic headache at a specialist clinic had returned to the same level of anxiety one year after an MRI excluded intracranial pathology[1]

1.National Guideline, C. Diagnosis and management of headache in adults. A national clinical guideline. 12/1/2013]; Available from: http://www.guideline.gov/content.aspx?id=13446.

2. Carville, S., et al., Diagnosis and management of headaches in young people and adults: summary of NICE guidance. BMJ, 2012. 345.



discussion – unexplained seizure(s)

A detailed clinical history, eyewitness account and examination is critical to recognise the need for imaging after a new onset seizure. If the history does not reveal any precipitating cause, determining the seizure type-particularly partial (focal) seizures- can help weigh the decision in favour of imaging to investigate aetiology.

MRI is the imaging modality of choice in the diagnostic workup of new onset, unexplained seizure. However, non-contrast CT is generally recommended for emergency situations or where MRI is contraindicated (e.g. prostheses, metallic foreign body). MRI imaging is indicated in new onset, unprovoked seizure particularly in patients with adult onset epilepsy, patients >25 years old and focal onset in history or examination.1

1 Clinical Guidance for MRI referral. East Melbourne: Royal Australian College of General Practitioners, 2013.

new gp mri indications…what does it all mean (part 2)

As of 1 November 2013, the GP MRI requesting rights have been extended to include indications for patients aged 16 years and over. These indications include Brain, Cervical spine and Knee.

This 3 part series will include case studies to help identify and highlight some appropriate senarios that MRI would be most useful. For more information please call our Randwick or Liverpool sites on 9399 5357 or 9600 9552.

part 2 – MRI Cervical spine

GPs can refer for a Medicare funded MRI cervical spine for trauma or radiculopathy.

cervical spine trauma

Case History 1

A 30 year old male dives into a shallow pool and is evaluated in the emergency department.

The head and neck were completely immobilised. The neurological examination was abnormal and cervical spine CT demonstrated a cervical fracture with dislocation of C6/7.

Case History 2

A 24 year old male driver was rear ended outside the GP practice.

He walks into the practice, sits down and asks for an evaluation. He complains of some delayed onset neck pain. He is alert on examination, without midline cervical tenderness and no other serious or painful injuries. There is no evidence of focal neurological deficits, with full range of neck motion and no signs of intoxication. He wants to know if he needs to get some imaging for his neck.

Discussion

The major concern of cervical spine trauma is cervical fracture which may be difficult to distinguish clinically. CT scan remains the recommended imaging of choice if cervical spine fracture is suspected, particularly in an acute emergency presentation. In the acute trauma setting, due to the devastating consequences of missed cervical fracture, immobilisation of the head and neck is key.

In primary care, tools such as the NEXUS criteria can be used to determine the need for neuroimaging 1. MRI is not indicated for fracture detection but is indicated if there is a contraindication to other imaging or there is indication of ligamentous, spinal cord or arterial injury. There is poor evidence that MRI is useful in whiplash injury evaluation as it is not useful for prognostic value or treatment guidance 2. Clinical judgement should be used to evaluate the need for MRI, since there is little evidence to show increased benefit of obtaining MRI in addition to CT cervical spine.

1 Clinical Guidance for MRI referral. East Melbourne: Royal Australian College of General Practitioners, 2013.

2 Kongsted, A., et al., Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up. European Spine Journal, 2008. 17(8): p. 996-1005.

NEW GP MRI INDICATIONS…WHAT DOES IT ALL MEAN (PART 3)

As of 1 November 2013, the GP MRI requesting rights have been extended to include indications for patients aged 16 years and over. These indications include Brain, Cervical spine and Knee.

This 3 part series will include case studies to help identify and highlight some appropriate senarios that MRI would be most useful. For more information please call our Randwick or Liverpool sites on 9399 5357 or 9600 9552.

PART 3 – MRI KNEE

GPs can refer for a Medicare funded MRI Knee for suspected acute ACL tear following acute trauma or the inability to extend the knee suggesting possible acute meniscal tear following acute trauma.

acute knee trauma

Case History 1

A 40 year old woman presents with a swollen left knee which keeps ‘locking’.

This began after twisting while gardening a couple of days ago. Her knee is mildly swollen and she unable to fully extend the knee but can ambulate. There was joint line tenderness, but no tenderness at the head of the fibula or over the patella. However Thessaly and Apley tests were negative.

Case History 2

A 26 year old women complains of a ‘popping’ sensation in her right knee during a game of netball.

She needed to be helped off the netball court but was able to walk unassisted into the GP. Her right knee is acutely swollen, without tenderness at the head of the fibula or over the patella. The anterior drawer test positive but Lachman test negative.

Discussion

MRI is the imaging of choice for the diagnosis of acute meniscal tears and acute ACL tears. X Ray and ultrasound are not useful in the evaluation of soft tissue knee injury. It decreases the need for invasive diagnostic arthroscopy. MRI is a useful diagnostic tool when diagnosis is uncertain, and can help clinical decision making particularly when determining surgical or conservative management

1. Clinical Guidance for MRI referral. East Melbourne: Royal Australian College of General Practitioners, 2013.

A Family Jewel- Dual Energy CT with Gemstone

What is it? How does it work?


Dual energy CT scanning is a non-invasive imaging technique utilising dual energy at the same site, thereby distinguishing distinct materials based on their differing attenuation properties. This allows for material based or ‘spectral imaging’ instead of the conventional attenuation based imaging.

There are a number of dual energy CT units on the market, with the GE Discovery 750HD CT unit available at Spectrum Medical Imaging Liverpool. This unit uses a single X-ray tube with fast kV switching between 80 and 140 kVp with 0.4 ms interval[1] focused at the tissues of interest. Then the gemstone detector, with a slice thickness of 0.625mm, utilises gemstone scintillator materials allowing for fast sampling, low afterglow, and high light output. Following acquisition, the data is calibrated with ability to adjust contrast enhancement and create iodine map images.

What are the benefits over conventional CT?

  • Decreased ionising radiation dose
  • Faster scan times
  • Reduced beam hardening effects
    • Useful for metal prosthesis
  • Improved images
    • Multiple imaging planes
    • 3D reconstruction
    • Material differentiation & quantification
  • Multisystem applications




What are the clinical applications?


Dual Energy CT has widespread applications including:

  • Cardiovascular imaging
  • Oncological detection and monitoring[4]
  • Renal stones[1]
  • Pulmonary embolism[5]
  • Abdominal imaging[6]
  • Musculoskeletal imaging[7]


1. Krasnicki, T., et al., Novel clinical applications of dual energy computed tomography. Adv Clin Exp Med, 2012. 21(6): p. 831-41.

2. Halliburton, S., et al., State-of-the-art in CT hardware and scan modes for cardiovascular CT. J Cardiovasc Comput Tomogr, 2012. 6(3): p. 154-63.

3. Vliegenthart, R., et al., Dual-energy CT of the heart. AJR Am J Roentgenol, 2012. 199(5 Suppl): p. S54-63.

4. De Cecco, C.N., et al., Dual-energy CT: oncologic applications. AJR Am J Roentgenol, 2012. 199(5 Suppl): p. S98-S105.

5. Zhang, L.J., et al., Dual-energy CT lung ventilation/perfusion imaging for diagnosing pulmonary embolism. Eur Radiol, 2013. 23(10): p. 2666-75.

6. Morgan, D.E., Dual-energy CT of the abdomen. Abdom Imaging, 2013.

7. Nicolaou, S., et al., Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. AJR Am J Roentgenol, 2012. 199(5 Suppl): p. S78-86.

A spectrum of caring

Spectrum Medical Imaging is committed to helping our community. Spectrum actively promotes and encourages staff, patients, referring doctors and the general public to be aware and participate in a variety of charity and community events.

What campaigns has Spectrum been involved in?

Pink Ribbon Breakfast for National Breast Cancer Foundation
The NBCF raises funds for medical research into the prevention and cure of breast cancer. Spectrum also actively promotes the importance of breast screening in our practices and on our website.

www.nbcf.org.au/


Jeans for Genes Day for the Children’s Medical Research Institute
Raising funds for medical research, the CMRI aims to improve and extend the lives of children by targeting childhood diseases.

www.cmri.org.au//




Movember for the Movember Foundation
This campaign, held every November, aims to improve men’s health by supporting programs and research into prostate cancer, testicular cancer and mental health.

au.movember.com/

City2Surf
City2Surf is a 14km fun run held in Sydney held annually. This event aims to raise much needed funds for more than 800 charities.

www.city2surf.com.au/




Spectrum is now a proud sponsor of the Volunteer Fire Fighters Association and the Australasian Institute of Policing.

To find out more or to support these great organisations please visit:
www.aipol.org or volunteerfirefighters.org.au

General Practitioner Education Nights
Spectrum hosts a number of GP education nights throughout the year within the local community.



These nights offer a special opportunity to present new developments in medicine and radiology, discuss clinical scenarios and importantly to connect with our referring doctors.

Double the Strength – 3T MRI

Double the Strength – 3T MRI

Spectrum Medical Imaging now offers 3 T MRI scanning at our Silver Street Randwick location.

What is 3T MRI scanning?

Magnetic resonance imaging (MRI) is a medical imaging technique that utilises magnetic fields to give detailed anatomic images without ionising radiation. MRI scanning has broad uses including musculoskeletal, prostate, cardiac, breast and paediatric applications.


Tesla (T) is the unit of measurement quantifying the strength of a magnetic field. To date, 1.5 T MRI scanners have been the industry standard. The new 3T MRI produces double the magnetic field strength of the standard 1.5T MRI scanners, resulting in high image quality and anatomical detail.

What are the benefits of a 3T MRI scanner?

Twice the strength means

  • Higher spatial resolution with reduced image noise
    • Particularly useful for high quality vascular imaging & neuroimaging
    • Increased sensitivity to detect pathology
  • Shorter scan time and wider bore
    • Maximising patient comfort



Our Liverpool and High Street Randwick practices also offer 1.5T MRI scanning.

Something to Smile About-Dental Imaging

Something to Smile About-Dental Imaging

Spectrum Medical Imaging offers a range of dental imaging services across all practice locations. Our team includes oral and maxillofacial radiologists who can offer specialised and expert dental imaging interpretation.

Who can refer for diagnostic imaging services?


  • Medical practitioners
  • Dental practitioners
  • Oral and maxillofacial surgeons
  • Prosthodontists
  • Dental specialists-periodontists, endodontists, pedeodontists, orthodontists
  • Specialists in oral medicine/oral pathology Dental prosthetists are not currently about to order imaging under Medicare

What dental imaging services are available at Spectrum? How are they useful? Who can refer?

2D Dental Diagnostic Imaging

Orthopantomogram/OPG

  • A panoramic radiograph illustrating upper and lower jaw anatomy, with all teeth, frontal and maxillary sinuses, the nasal cavity and the temporomandibular joint. Images are taken at a number of planes to create the composite image. Such imaging has a broad range of applications with particular usefulness in diagnosis and orthodontic assessment.

Frontal and Lateral Cephalogram

  • An X-ray taken of the front and side of the skull. It is particularly useful for assessment of relationships between major anatomical structures, which is needed for treatment planning

Bone Age Study

  • An X-ray is taken of a child’s fingers, hand and wrist with an assessment of the epiphyses (growth plates). The skeletal maturity can be derived to detect advanced or delayed growth which has a relationship with dental maturation. This is a useful test for treatment planning for paediatric dental practitioners.

2D dental imaging is available at our Liverpool, Maroubra, Randwick and Alexandria locations.

3D Dental Diagnostic Imaging

CS 9000 3D Cone Beam CT

  • This high resolution, low radiation technology is commonly used for wisdom tooth extraction planning and tooth implantation treatment. Medicare rebate is available for referrals from a dental specialist or medical practitioner.

CT Dentascan

  • This specialised CT scan uses special software to give detailed 3D anatomy of the jaw and soft tissues. This modality has broad use but is particularly useful in assessing impacted teeth and tooth implantation planning. Medicare rebate is available with referral from a dental specialists and medical practitioners.

MRI

  • MRI scans are useful for assessing soft tissue structures. Medicare rebate is available with referral from a dental specialists or medical specialist (not a GP).

3D Cone Beam Imaging is available at Randwick.

Introducing Silent Scan

Silent Scan is a completely new way of acquiring clinical images that nearly eliminates the noise in MR imaging.

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The acoustic noise during MR scanning is one of the largest complaints from patients, technologists, and MR staff. The noise often adds significant stress to an already stressful clinical situation and has been a long standing issue with MR. With Silent Scan, GE has taken a major step towards Humanizing MR.

We did not dampen the noise from an MR scanner; we invented a way to avoid even making the noise

Noise is measured in decibels (dBA), a non-linear scale that is normalized to the human ear. Silent Scan adds less than 3dB of noise above the ambient levels in the room. Typically MR imaging adds about 30dB of noise above the ambient levels in the room … Silent Scan is a factor of about 1,000 times lower.

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For reference, the magnet cold-head noise in the scan room is louder than a Silent Scan acquisition. The noise level from Silent Scan has been likened to an inkjet printer working in the room next door.

Silent Scan helps reduce anxiety and can give more peace of mind to patients, especially elderly, paediatric & claustrophobic patients.

During traditional MR image acquisition, the gradient coils within the magnet are continually switched on and off to generate image information. The faster the gradients are switched, the faster the image acquisition, and traditionally the better the image quality. Unfortunately, fast gradient switching leads to higher acoustic noise.

Silent Scan acquires image data with static gradients. The gradients do not switch (change amplitude within the TR) and thus do not generate noise.

Instead of switching the gradients on and off, Silent Scan uses ultra-fast RF switching technology to help generate images.2061284

Information provided by GE Healthcare Technologies