Diagnostic Imaging - Jerudong Park Medical Centre

Diagnostic ImagingJerudong Park Medical Centre Emergency: (673) 2 612612 / (673) 7 172172

The Diagnostic Imaging Department (Radiology)at Jerudong Park Medical Centre, is one of the mostmodern imaging departments in Southeast Asia.Table of ContentsDigital Dental Imaging SystemMRI (1.5 & 3Tesla)Cardiac MRIBreast MRIMulti-Slice (64-slice) CTPeripheral QCTMammogram (Breast X-ray)Ultrasound1371216242933Services are supported by a versatile generalradiographic suite with Digital CR and a64-slice CT scanner. The CT scanner with cardial& angiography CT capabilities provides state - of -provides state-of-the-art imaging in this modality.For sophisticated neuro- radiological and musculoskeletalexaminations, there is a 1.5 & 3 Tesla superconductingMRI system with cardiac MRI, Breast MRI& MR Angiography (fMRI & DTI capability).Digital Dental Imaging SystemDigital Panoramic, and Cephalometric systems andCone Beam CT (put the Dental xray pic somewhere)Picasso-Trio full digital dental imaging systemprovides you with the most efficient Cone Beam CT(dental CT-including 3D software), DigitalPanoramic, and Cephalometric systems whileensuring effective and reliable implant surgery.Picasso- Trio is the first to have 3 functions in 1 unit.An authentic ‘3 in 1’ system. The equipment used toobtain panoramic radiographs has continued toimprove with recent advances including automaticexposure and multiple image programs.Benefits of Digital Dental Imaging System:The Images from this system helps your dentists tosee overall health of the teeth and mouth, as well asspecific ailments in the troubling tooth and itsneighboring teeth. It also gives a objectivemeasurement of the teeth, health of the bone andcondition of caries (infection) in the tooth. This helpstremendously in deciding an exact treatment to adentist and reduces element of "trial and error" fromthe treatment. Digital Dental Imaging System allowsvarious investigations, like sinus, TMJ and partialOPG. In case of Orthodontists and Implantologiests,Oral Maxillo Facial Surgeons (OMF), Cone Beam CTproves to be an essential tool to plan the surgery andmeasure postoperative progress.Radiology Diagnostic Imaging Services • 1

The Ultrasound section of the DiagnosticImaging Department boasts of the latest high-endUltrasound machines with intracavitory probesand Color Doppler features. This allows the use ofSonography in a wide spectrum of conditions.A sophisticated film-screen mammography systemand high-resolution Ultrasound system providemodern breast imaging and advanced precisionbiopsy capabilities.Conventional gastro-intestinal studies and otherprocedures which require fluoroscopic control arecarried out in a digital fluoroscopy suite withsophisticated image storage and post processingfacilities.MRIAn additional general radiography suite is availablefor routine investigations including conventionalTomographic studies.This modern and well-equipped departmentconsists of an experienced team of a SpecialistRadiologist and 5 Technologist. The Radiologist andhis team perform a broad spectrum of proceduresand are multi-skilled with individualised areas ofspecialisation.In our continuos efforts to provide excellence inhealthcare to our esteemed patients and corporatehealthcare institutions, we have collaborated andworked closely with with Nordwest Hospital,Germany in the field of Tele-Radiology . While ourin-house radiologist provides optimum clinicalenvironment for patients and referring physicians,providing daily interaction, input and consultationfor non neuroradiology and head & Neck; NordwestNeuroradiologist’ will provide interpretation ofNeuroradiology, Head & Neck Radiology andcomplex cases. This will enable more timely andefficient interpretation of radiological data, givegreater access to secondary consultation and improvepatient care.2 • Radiology Diagnostic Imaging Services

is MRI?What is MRI?MRI, otherwise also called Magnetic ResonanceImaging,MRI, otherwiseallows usalsotocalledsee veryMagneticclearlyResonanceinside theImaging, allows us to see very clearly insidehuman body without the use of X-rays. MRI imagesthe human body without the use of X-rays.help us to make the best possible diagnosis.MRI images help us to make the best possibleHow diagnosis. does it work?MRI produces clear internal body images by usingaHow particular does it work? radio frequency to create momentarymagnetic MRI produces changes. clear Ainternal computer body then images analyses by using thesignals a particular returned radio by frequency various tissues. to create momentarymagnetic changes. A computer then analyses theIs signals there any returned risk? by various tissues.There is no risk to the average patient who followsappropriate guidelines regarding metallic itemsIs there any risk?within the body. Before a MRI examination, pleaseinformThere isyourno riskphysicianto the averageor the MRIpatientSupervisorwho followsif youappropriate guidelines regarding metallic itemshave:within the body. Before a MRI examination, pleaseinform your physician or the MRI Supervisor if• a pacemakeryou have:• a metal plate, pin or other metallic implant• ever been wounded during military service• a pacemaker• an artificial heart valve• a metal plate, pin or other metallic implant••everanbeenIUDwounded during military service•• an aneurysm artificial heart clip valve•• an ever IUDbeen a metal worker• aneurysm clipMetallic • ever items been within a metal the worker body may cause discomfortor injury to you when please in the magnetic field, andmay Metallic exclude items you from within the examination. the body Also, may becausesureto discomfort inform us if or you injury are pregnant. to you when please in themagnetic field, and may exclude you from theHow examination. long does an Also, examination be sure take? to inform us if you areThe pregnant. average MRI scan takes 15 to 30 minutes witha complete examination running 30 to 45 minutes.During this time, several images may be obtained.How long does an examination take?What The can average I expect MRI during scan the examination? takes 15 to 30 minutesMRI with isa comfortable complete examination and easy forrunning the patient. 30 to First, 45the minutes. technologist During this will time, help several you lieimages downmay on be acushioned obtained. table. When you are comfortably4 • Radiology MRIWhat can I expect during the examination?MRI is comfortable and easy for the patient.First, the technologist will help you lie down ona cushioned table. When you are comfortablypositioned for the examination, the table will bemoved into the magnet. The technologist willstep to the control area and remain in contactwith you.As the MRI scan proceeds, you will hear a muffledthumping sound. Just relax - you may even takea nap – but try to lie as still as possible. Anymovement during this time will blur the images.When positioned scanning for the is complete, examination, the the technologist table will will bereturn moved into assist the magnet. you off The the table. technologist will step tothe control area and remain in contact with you.What can I do for best results?As the MRI scan proceeds, you will hear a muffledAny metallic substance on your body part canthumping sound. Just relax - you may even take acause a bright or blank spot on the picture. Tonap – but try to lie as still as possible. Any movementhelp your doctor make the best diagnosis, pleaseduring this time will blur the images. When scanningdois complete,not wear:the technologist will return to assist youoff the table.• HairsprayWhat • Mascara can I do for best results?Any • Hearing metallic aid substance on your body part can causea • bright Any removable or blank spot dental on the work picture. To help yourdoctor • Jewellery make the best diagnosis, please do not wear:• Spectacles• Hairspray• MascaraIn addition, you may find it easier to lie calm for• Hearing aidseveral minutes at a time if you avoid drinking• Any removable dental workcoffee or other caffeinated beverages before your• Jewelleryscan.• SpectaclesIn addition, you may find it easier to lie calm for severalminutes at a time if you avoid drinking coffee or othercaffeinated beverages before your scan.Radiology MRI • 5

ApplicationClinical ApplicationHead and and Neck NeckMRI gives very detailed pictures of the brain andMRI gives very detailed pictures of the brain andspine. Air and hard bone do not give an MRI signal, sospine. Air and hard bone do not give an MRIsignal,these areasso theseappearareasblack.appearBoneblack.marrow,Bonespinalmarrow,fluid,spinal blood and fluid, soft blood tissue, and likesoft the brain, tissue, vary like inthe intensity brain,vary from black in intensity to white from depending black to onwhite the amount depending of faton andthe water amount present of in fat each and tissue, water and present the machineeachtissue, setting and usedthe formachine scan. Thesetting Radiologist used for compares scan. The theRadiologist size and distribution compares of these size bright and and distribution dark areas of tothese determine bright whether and dark the tissue areas is to healthy. determine whetherthe tissue is healthy.BodyBody Nearly every part of the body may be studied withNearly MRI. Organs every within part the of the chest body and abdomen, may be studied such aswith the heart, MRI. liver, Organs bladder, within abdomen the chest and kidneys abdomen, cansuch easily as be seen. the heart, liver, bladder, abdomen andkidneys can easily be seen.Bone and JointsBone MRI isand veryJointssensitive to changes in cartilage and boneMRI structures is very resulting sensitive from to changes injury, disease in cartilage or aging. andbone Clear pictures structures suchresulting as these often from provide injury, information disease aging. not available Clear pictures throughsuch otheras medical these often investigation provideinformation and may actually not available eliminate the through need for other exploratory medicalinvestigation surgery. and may actually eliminate the needfor exploratory surgery.The new Horizon in MRI imaging“wide Bore 3T MRI”Our recent valuable addition for advancedtechnology imaging is the MAGNETOM Verio,a 3 Tesla (3T) MRI system with a 70 cm openbore and total imaging matrix (Tim) technology,the system designed to deliver high-field MRimaging to patients who are claustrophobic, inpain or discomfort3T MRI, can be used for many applications,including neurology and functional neuroevaluation, oncology imaging, orthopedicand cartilage assessment, breast, vascular andcardiac imaging. The 3T system reportedlyoptimizes parallel imaging, accelerates scan timeand improves visualization as well as patientthroughput.The larger space (wide bore) will also helpwhen imaging claustrophobic patients becausefewer patients will need sedation or refuse MRimaging services. Patient access is enhanced forboth intensive care patients and MRI-guidedinterventional procedures3T MRI with the power of Tim has up to 102seamlessly integrated matrix coil elements andup to 32 independent radiofrequency channels,enabling advanced clinical applications. Timallows combinations of up to four different coilsthat reduce the examination time.Cardiac MRIMagnetic Resonance Imaging (MRI) usesradiofrequency waves and a strong magneticfield rather than x-rays to provide remarkably6 • Radiology MRIDiagnostic Imaging Services MRI • 7

Cardiac MRIclear and detailed pictures of internal organs andMagnetic Resonance Imaging (MRI) usestissues. The procedure is valuable in diagnosing aradiofrequency waves and a strong magnetic fieldbroad range of conditions in all parts of the body,rather than x-rays to provide remarkably clear andsuch as heart and vascular disease, stroke, cancerdetailed pictures of internal organs and tissues. Theand joint and musculoskeletal disorders.procedure is valuable in diagnosing a broad rangeof conditions in all parts of the body, such as heartMRI is unique in that it can also create detailedand vascular disease, stroke, cancer and joint andimages of blood vessels without the use of contrastmusculoskeletal disorders.material (although there is a trend toward the use ofspecial non-iodinated MRI contrast material—forMRI is unique in that it can also create detailed imagesexample, gadolinium). MRI requires specialisedof blood vessels without the use of contrast materialequipment and expertise and allows evaluation(although there is a trend toward the use of specialof some body structures that may not be as visiblenon-iodinated MRI contrast material—for example,with other imaging methods.gadolinium). MRI requires specialised equipmentand expertise and allows evaluation of some bodyWhat structures are some that may common not be uses asof visible Cardiac with MRI? otherMRI imaging is methods. becoming very important in the initialdiagnosis and subsequent management ofcoronary What are some heart common disease. uses MRI of Cardiac can help MRI? physiciansto MRI look isclosely becoming at the very structures important and function in the initial of theheart diagnosis and major and vessels subsequent quickly management and thoroughly, ofwithout coronarythe heart risks disease. associated MRI can with help traditional, physicians more toinvasive look closely procedures. at the structures Using and MRI, function physicians of the heart canexamine and majorthe vessels size and quickly thickness and thoroughly, of the chambers withoutof the the risks heart, associated and determine with traditional, the extent more of damage invasivecaused procedures. by Using a heart MRI, attack physicians or progressive can examine heart thedisease. size and thickness of the chambers of the heart, anddetermine the extent of damage caused by a heartattack or progressive heart disease.After a heart attack, for example, an MRIexamination can help the cardiologist understandAfter a heart attack, for example, an MRIhow well the heart is pumping, whether the flowexamination can help the cardiologist understand howof blood is blocked in any chamber or majorwell the heart is pumping, whether the flow of bloodvessel, whether the heart muscles are damagedis blocked in any chamber or major vessel, whether theor whether the lining of the heart is swelling.heart muscles are damaged or whether the lining ofThis critical knowledge is needed to administerthe heart is swelling. This critical knowledge is neededprompt and effective treatment.to administer prompt and effective treatment.An MRI specialist can demonstrate its potentialAn MRI specialist can demonstrate its potentialfor showing not only the structure, but also thefor showing not only the structure, but also thefunction of the heart muscles, valves and vessels.function of the heart muscles, valves and vessels.Using MRI, the technologist can create movie-likeUsing MRI, the technologist can create movie-likeimages of the beating heart that doctors can useimages of the beating heart that doctors can use toto diagnose a variety of cardiovascular problems.diagnose a variety of cardiovascular problems. MRI isMRI is now being used as part of the traditionalnow being used as part of the traditional cardiac stresscardiac stress test to help physicians with earliertest to help physicians with earlier diagnosis anddiagnosis and treatment of heart disease and totreatment of heart disease and to assess the patient’sassess the patient’s recovery after treatment.recovery after treatment.How How should should I prepare I prepare for forthe procedure?Due to strong magneticfield used for for MRI MRI thatwill that will pull pull on any on any iron-iron-containing object object in in thebody, the body, MR MR technologistwill ask whether you youhave a heartpacemaker or orimplanted defibrillator, implanted port, infusioncatheter (often referred to by brand names such asPort-o-cath, Infusaport or Lifeport), intrauterinedevice (IUD), or any metal plates, pins, screwsor surgical staples in your body. In most cases,surgical staples, plates, pins pins and and screws screws pose pose no risk norisk during during MRI. Red MRI. dyes Red used dyes in tattoos used in andtattoos permanent andpermanent eyeliner mayeyeliner contain metallic may contain iron oxide metallic and could ironoxide heat up and during could MRI; heat however, up during this is rare. MRI; however,this is rare.You will be asked if you have shrapnel in your bodyYou or ever will be worked asked with if you metal. have shrapnel If there in is your anybody question or ever of metal worked fragments, with metal. you may If there be is asked anyquestion to have of anmetal x-rayfragments, that will you detect may any be asked metalto objects. have an Thex-ray radiologist that will or detect MR any technologist metal objects. mayThe ask radiologist about drugor allergies MR technologist and whether may ask youabouthavedrug undergone allergies anyand surgery whether in the you past. have If undergoneyou are orany might surgery be pregnant, in the mention past. If it to you the are MR or technologist. might bepregnant, mention it to the MR technologist.8 • Radiology Cardiac MRIRadiology Cardiac MRI • 9

How is the procedure performed?The patient is placed on a sliding table andpositioned comfortably for the MRI examination.Then the radiologist and technologist will leavethe room, and the individual MRI sequencesare performed. The patient will be able tocommunicate with the technologist at any timeby using an intercom.Depending on how many images are needed, theThe examination new patient-friendly will generally MRI System take of 15 JPMC to 45 minutes,although a very detailed study may take longer.How You is will the procedure be asked performed? not to move during the actualThe imaging patient process. is placed on a sliding table andpositioned comfortably for the MRI examination. Thenthe For radiologist examination andof technologist the heart, will contrast leave the material room,and may the be individual used to enhance MRI sequences the visibility are performed. of theThe heart’s patient chambers will and able to major communicate vessels. A withsmallthetechnologist needle connected at any time to an by intravenous using an intercom. line is placedin an arm or hand vein. A saline solution will dripDepending through the onintravenous how many line images to prevent are needed, clotting theexamination until the contrast will generally material take is injected, 15 to 45 about minutes, twothirdsof athe very way detailed through study the may exam. take longer. Youalthoughwill be asked not to move during the actual imagingprocess. When the examination is over, the patient will beasked to wait until the images are examined toFor determine examination if more of images the heart, are needed. contrast materialmay be used to enhance the visibility of the heart’schambers and major vessels. A small needleWho interprets the results and how do I getconnected to an intravenous line is placed in an armthem?or hand vein. A saline solution will drip throughthe A radiologist, intravenous who line to is a prevent physician clotting experienced until thecontrast in MRI material and other is injected, radiology about examinations, two-thirds ofwilltheway analyse through the images the exam. and prepare the report togetherwith a trained CardiologistWhen the examination is over, the patient will be askedto wait until the images are examined to determine ifmore images are needed.Who interprets the results and how do I get them?What A radiologist, are the who benefits? is a physician experienced in MRIand• other Images radiology of soft-tissue examinations, structures will such analyse as theimagesheart and prepare and major the vessels report together are clearer withand a trained moreCardiologist detailed than from other imaging methods.What • are The the findings benefits? on MRI makes it an invaluable• tool Images in of early soft-tissue detection structures and such evaluation as the heart ofmany and major diseases. vessels are clearer and more detailedthan from other imaging methods.• Even without the use of contrast material,• MRI The findings often shows on MRI makes sufficient it an details invaluable of tool theheart in early which detection are invaluable and evaluation in diagnosis of many andtreatmentdiseases.planning.•• When Even without is used, the use MRI of contrast material, material MRI islessoftenlikelyshowstosufficientproducedetailsanofallergicthe heartreactionwhichare invaluable in diagnosis and treatmentthan the iodine-based materials used forplanning.conventional x-rays and CT scanning and• does Whennot it iscontain used, MRI the contrast radioisotopes material used is less innuclear likely tomedicine produce an examinations.allergic reaction than theiodine-based materials used for conventional• MRI x-raysenables and CTthe scanning detection and of does abnormalitiesnot containthat the radioisotopes might be obscured used in by nuclear bone tissue medicine withother examinations. imaging methods.•• MRI enables can help the detection physicians of abnormalities evaluate that thefunction might be obscured and the by structure bone tissue of with the heart otherimaging methods.muscles and valves.••MRI candoeshelpnotphysiciansrequire exposureevaluatetotheradiationfunctionand the structure of the heart muscles andor the introduction of radioisotopes to thevalves.body.• MRI does not require exposure to radiation orWhat are the introduction the limitations of radioisotopes of a Cardiac to MRI? the body.WhatIn mostare thecases,limitationsthe examof a Cardiacis safeMRI?for patients withInmetalmostimplants,cases, thewithexamtheis safeexceptionfor patientsof awithfewmetaltypesimplants,of implants,withsothepatientsexceptionshouldof a fewinformtypestheofimplants,technologistso patientsof anshouldimplantinformpriorthetotechnologistthe test. Theofanexaminationimplant priormustto thebetest.usedThecautiouslyexaminationinmustearlybeusedpregnancy.cautiously in early pregnancy.10 • Radiology Cardiac MRIRadiology Cardiac MRI • 11

MRI OF THE BREAST is not a substitute formammography or ultrasound imaging but rather isa supplementary tool for detecting and stagingbreast cancer and other breast abnormalities.BREAST MRIMR MAMMOGRAPHYMR imaging does not involve radiation, theprocedure can be used to screen women below 40years old and to increase the number of screeningsper year for women at high risk for breast cancer.MRI is used to:• Evaluate any abnormalities detected bymammography.• Identify early breast cancer not detectedthrough other means, especially in womenwith dense breast tissue and those at highrisk for the disease.• Screen for cancer in women who haveimplants or scar tissue that might jeopardisean accurate result from a mammogram.• Determine the integrity of breast implants.• Distinguish between scar tissue and recurrenttumors.• Assess multiple tumour locations.• Check the progress of chemotherapy.• Look for multiple tumours prior to breastconservation surgery.• Determine whether the cancer detected bymammography or ultrasound has spreadfurther in the breast or into the chest wall.• Determine how much the cancer has spreadbeyond the surgical site after a breast biopsyor lumpectomy.• Provide additional information on a diseasedbreast to make treatment decisions.Radiology Breast MRI • 13

What is CT ScanningCT (Computerised Tomography or ComputedTomography) scanning, which is also known as CATscanning, is an advanced scan of cross-sectionalimages of the whole body such as head, chest,abdomen and spine as well other small body parts.MULTI-SLICE(64-SLICE)CT SCANNINGOffering New Levels of Excellence in CTThe SOMATOM Sensation 64-Slice CT Scannertakes scanning to new levels, employing the latestand fastest technology to create clear, detailedimages of your body that will help your doctormake the best diagnosis and treatment for you.Other capabilities include the ability to performpQCT (osteoporosis evaluation) and dental CT (dentalimplants).The 64-slice CT scanner obtains 64 slices perrotation with unmatched sharpness, detail, clarityand speed. With this scanner, patients will be able toexperience a more comfortable and shorterexamination. Patients will also benefit from thesuperior diagnostic imaging quality that can helpdetect many diseases and conditions earlier (includingheart disease), leading to a faster and more effectivetreatment.While the traditional method of identifyingheart disease has been cardiac catheterisation,the 64-slice CT scanning enables physicians tovisualise a patient’s arteries without the potentialcomplications associated with more invasiveRadiology Multi-Slice (64-slice) CT Scanning • 17

diagnostic examinations.With a 64-slice CT scan,radiologists can clearlysee if there is soft plaque,arterial stenosis (narrowing)or blockages in a patient’sheart arteries, and other early warning signs ofcardiovascular disease.A New Level of Speed• Engineered for speed and accuracy, anexamination can take as little as 10 minutes,from scan to diagnosis. * Previously, patientssuspected of heart attack might undergo astress test, EKG study, and blood testing,which could take much longer.• Allows doctors to evaluate the most commoncauses of acute chest pain with a single scan.• Permits some patients to avoid surgicalprocedures such as cardiac catheterisation.A New Level of Comfort• 64-slice technology requires that you holdyour breath for shorter periods than the older16-slice technology—for example, a scan ofthe blood vessels in your heart now requiresthat you hold your breath for 9 seconds,compared to 17 seconds with the 16-sliceequipment.A New Level of Clarity• Provides excellent image quality, regardless ofyour size and weight.• Images the beating heart in real time,permitting evaluation of its valves and themotion of its walls in greater detail.18 • Radiology Multi-Slice (64-slice) CT ScanningA New Level of Versatility• The SOMATOM Sensation 64 can also be usedwhen studying:̌ Cardiovascular conditions, includingstroke and blood clots.̌ Other conditions involving the brain,colon, or lungs.What You Don’t Know Can Hurt YouKnowing what’s happening in your body can saveyour life. The advanced diagnostic imaging of thenew SOMATOM Sensation 64 CT Scanner atJPMC reveals clear, sharp pictures of your organs,tissue and blood vessels down to the smallestdetail – all in as little as 10 seconds.The SOMATOM Sensation 64 CT Scanner offerspatients:• Completely non-invasive, painless diagnosticexamination of the heart.• A level of clarity and detail of the heartpreviously only possible with an invasiveprocedure.• Routine CT scans which are able to detect softplaques.Radiology Multi-Slice (64-slice) CT Scanning • 19

Preparation for the procedureThe patient is usually asked to fast 3-4 hours beforethe CT examination in case intravenous contrastneeds to be injected to facilitate a clearer view ofthe organs being studied. The contrast is acolourless, non-ionic agent fluid, which is injectedvia a vein (arm or leg). This may cause a warm orflushed sensation. Oral contrast agent may also beadministered, especially for abdomen and pelvicscans.If contrast agents are required, the patient willbe briefed and any allergies to food or medicinewill be ascertained. Prescribed medication may beadministered but insulin treatment for diabeticsshould be delayed until the patient resumes foodconsumption in order to avoid an insulin reaction.The patient will also change into a hospital gownand remove items such as glasses, jewellery, denturesand hearing aids etc, which interfere with the x-ray.After the CT ExaminationFollowing the CT examination, the patient is requiredto stay on the CT table until the radiographer confirmsthe necessary examination has been obtained. Thepatient can then return to the ward or home.Unless there are other scans scheduled, the patientmay eat normal food and should drink plenty offluid to eliminate any contrast agent from the body.Are there any risks with CT Scanning?CT scanning is a medical imaging procedureperformed to gain further information about apatient’s illness. The risk from medical x-rayexaminations, if it exists at all, is extremely small.The benefits far outweigh the risk.If there are any further queries, please do not hesitateto contact the Radiologist or Radiographer.Types of CT Scan ImagesIsotropic VolumeAcquisition & Multi-planarReconstructionIn older scanners, reconstructionin any plane, except the axialplane, resulted in degradationof the image. In the 64-sliceCT scanner with isotropicvolume acquisition and multi-planar reconstructionimages in any plane are of the same quality.Organs and pathology can be viewed from multiplediretions to improve diagnostic accuracy.3D Imaging and VolumeRenderingIn the 64-slice Scanner,volume rendering allowstissue layers to be strippedaway to show the areas ofinterest. The resultant image canbe viewed in either 2D or 3Dand in their natural anatomical colour. Withreal-timemulti-planar imaging (MPR), the radiologist can viewthe images in any plane instantaneously.Vascular ImagingHead to toe images ofthe arterial system, in colour and3D are performed followingintravenous injection ofcontrast. Arterial catheterisationis no longer necessary. Thisallows precise pre-operativeexamination of vascular disease and accuratepreoperative assessment for stenting procedures.20 • Radiology Multi-Slice (64-slice) CT Scanning Radiology Multi-Slice (64-slice) CT Scanning• 21

Virtual ColonoscopyThe abdomen is scannedin a single breath hold.As well as reviewingthe axial images, theradiologist performsa computer simulatedcolonoscopy. The resultsappear to be as good as aconventional colonoscopy and a virtual colonoscopyensures adequate visualisation of the caecum in everycase. The examination is cost effective as the patientis not sedated and may return to work immediately.The examination fee is also lower than theaverage fee for colonoscopy. The examination isused for the detection of apolyps and early coloniccancer. Symptomatic patients should be referred forconventional colonoscopy or barium enema.Cardiac CTAnatomical diagnostic images of the heart andcoronary vessels are produced in seconds andpost processing allows each vessel to be viewed incontinuity, which provides a quantitativeassessment of stenoses and the assessment of thelipid, fibrin or calcium content of hard orsoft plaque. This examination does not requirehospitalisation or arterial puncture. Positiveexaminations are referred on for interventionaltreatment as necessary. HeartView is ideal for thepostoperative assessment of stents. In addition, acalcium score of the coronary vessels is calculatedto help assess risk.Carotid and IntracerebralVascular ImagingThe angiography producesexquisite detail of thecarotid vessels andintracerebral vessels. Thisonly requires intravenouscontrast and obviatesthe need for femoralartery catheterisation. Angiography of the carotidsand intracerebral vessels can be performed at thesame time as the initial head CT in stroke andsubarachnoid haemorrhage. Perfusion softwareallows immediate assessment of the degree ofischaemia and cellular damage.22 • Radiology Multi-Slice (64-slice) CT ScanningCT OncologyThe CT Oncology offers you a uniqueand innovative combination for diagnosticimaging, evaluation and follow-up in yourdiagnostic oncology setting. Our intuitive syngocomputer-assisted reading tools, combined withintelligent evaluation, automated follow-up, andimage guided intervention, offer you a new level ofconfidence for preventive care, staging, follow-upexams, and real-time guided biopsies.Comprehensive tumour perfusion enables a fastand easy visualisation of tumour enhancementand aids you in differentiating tumours. Fusingimages from PET or SPECT with high resolutionCT images not only helps to better localisetumours, but also in therapy planning. Oursolutions for interventional CT extend yourclinical spectrum towards differential diagnosisand treatment, turning data into a diagnosticoutcome within minutes.Radiology Multi-Slice (64-slice) CT Scanning • 23

PERIPHERALQCTMETHOD TOEVALUATEBONE MINERALDENSITY INOSTEOPOROSISWhat is Osteoporosis?Osteoporosis, characterised by thin, weak bones,can be a silent disease. It often progresses withoutsymptoms. In fact, what may seem like simple backpain could actually be spinal fractures you do not evenknow about.By about age 20, the average woman will haveacquired most of her skeletal mass. Bone mass reachesits peak by the age of 30-35. Afterwards, bone massbegins to decline at a steady rate. After menopause,the rate of bone loss increases significantly.As you lose bone mass, your bones becomethinner and more fragile. Women may lose up to 1/3of the bone mass in their spines in the first 6 yearsafter menopause, making them more susceptible tofractures. When your doctor looks at your bone health,he/she will compare the thickness of your bones tothat of a normal young adult. That comparison ismeasured in units called Standard Deviation (SD)- a mathematical term that describes the differencebetween each individual measurement and the mean(average).When a considerable amount of bone is lost, youreach a point when you have significantly less bonethan normal, a condition known as osteopenia.At this point, you have 1 to 2.5 SD less bone than anormal young adult. With further bone loss, thenormal structure of the bone is disrupted as well. Thisis the onset of osteoporosis, where your bone masswould be more than 2.5 SD below that of a normalyoung adult. Osteoporosis is a disease characterisedby low bone mass and structural deterioration ofbone tissue, leading to bone fragility and an increasedsusceptibility to fractures.Radiology Peripheral QCT • 25

How common is Osteoporosis ?Osteoporosis is responsible for more than 1.5million fractures worldwide annually. Ten millionindividuals already have osteoporosis, and 18million more have low bone mass. Approximately80% of those affected by osteoporosis are women,putting them at increased risk for fracture.A collapsed vertebra may initially be painless, orit may be felt as severe back pain. Later, the patientmay experience loss of height, spinal deformities, orstooped posture.For many women, osteoporosis is a silent disease thatdevelops with few warning signs.After menopause, the bones in the body may becomethinner and weaker. Over time, bone loss can lead toincreased risk of fractures.Each year, there will be more osteoporotic fractures inwomen than strokes, heart attacks, and breast cancerscombined.Up to half of women over 50 years old will breaka bone due to osteoporosis in their lifetime.SymptomsOsteoporosis is often called the “silent disease”because the loss of bone can occur without symptoms.Many women may not even know that they haveosteoporosis until they suffer a fracture. Even whena bone is fractured, the patient may not immediatelyrecognise the true nature of her condition.26 • Radiology Peripheral QCTRisk factorsThe more bone mass you have at age 30-35, the lesslikely you are to develop osteoporosis. There are manyfactors that determine how much bone mass you willhave - genetic, nutritional, and environmental. Whileyou may have control over some of these, e.g., calciumintake, you cannot change most of these factors.Certain people are more likely to developosteoporosis than others. Factors that increase thelikelihood of developing osteoporosis are called“risk factors.” These include:• Being female• Thin and/or small frame• Advanced age• A family history of Osteoporosis• Being postmenopausal, including early orsurgically-induced menopause• Abnormal absence of menstrual periods(amenorrhea)• Anorexia nervosa or bulimia• A diet low in calcium• Use of certain medications, such ascorticosteroids, thyroid replacement therapy,and some anticonvulsantsRadiology Peripheral QCT • 27

• An inactive lifestyle• Cigarette smoking• Excessive use of alcohol• Being Caucasian (white) or Asian, althoughAfrican Americans and Hispanic Americanscan be at risk as wellDiagnosis of Osteoprosis peripheral QCT (pQCT)The most commonly used method of evaluatebone mineral density (BMD) in osteoporosis is theQuantitative Computed Tomography. This allowsselective measurement of the trabecular compartmentof the vertebrae by excluding cortical bone andextraosseous calcifications. pQCT measures the truevolumetric BMD. Please consult your physician formore details.MAMMOGRAM(BREAST X-RAY)The pQCT examinationDuring the examination, the patient lies on a narrowtable, which slides into the doughnut-shaped ring inthe centre of the scanning machine. The x-ray tubethen routes around the patient.The examination will take 10-15 minutes. During theexamination, the patient will hear humming, buzzingor clicking sounds from the CT machine. The tablemoves every few seconds to position the patient for anew scan. Keeping still will ensure clearer images.Are there any risks with pQCT ?pQCT is a medical imaging procedure performed togain information about BMD. The risk from medicalx-ray examinations, if it exists at all, is extremely small.The benefits far outweigh the risk.If there are any further queries, please do not hesitateto contact the Radiologist or Radiographer.28 • Radiology Peripheral QCT

Breast cancer is is one one of of the the most most life life threatening cancers cancers inwomen.in women.If breast cancer is detected early there is a good chance thatIf it can breast be treated cancer successfully. is detected early there is a good chancethat it can be treated successfully.It is up to you – a mammogram could save your life!It is up to you – a mammogram could save your life!What is a Mammogram?A mammogram (breast x-ray) is a picture of thebreast tissue. This picture can show the presenceof cancer well before a lump can be felt. Theseearly cancers can usually be treated successfullybefore they have a chance to spread.What is a Mammogram?A mammogram (breast x-ray) is a picture of the breastWho tissue. should This picture have a can Mammogram?show the presence of cancerWomenwell beforeareamorelumplikelycantobedevelopfelt. Thesebreastearlycancercancersascan usually be treated successfully before they have athey grow older. With the approach of menopausechance to spread.the risk becomes greater, so a regular x-ray isimportant Who should have from a Mammogram? then on. It is recommendedworldwide Women arethat more women likely who are to above develop the age breast of45 cancer seek as mammogram they grow older. screening Withevery approach one to two ofyears. menopause the risk becomes greater, so a regularx-ray is important from then on. It is recommendedworldwide that women who are above the age of 45Most doctors recommend that women with aseek mammogram screening every one to two years.strong family history of breast cancer shouldcommence Most doctorsscreening recommend ten that years women before with the a age strong atwhich family their history relative of breast was cancer diagnosed. should commencescreening ten years before the age at which theirrelative was diagnosed.How is a Mammogram taken?To How get is a a Mammogram clear picture, taken? the breast tissue needs tobe To get compressed a clear picture, for a few the breast seconds. tissueThis needs may to bebriefly compressed uncomfortable. a few seconds. Usually This two mayx-rays be briefly aretaken uncomfortable. of each breast. UsuallyA two mammogram x-rays are taken involves of eachavery breast. low A mammogram dose of radiation. involves The a whole very low procedure dose oftakes radiation. about The 20 minutes. whole procedure takes about 20minutes.30 • Radiology Mammogram (Breast X-ray)How often should I have a Mammogram?Usually once every two years. If there are reasons for amore frequent examination, your doctor will tell you.NOTE: If you have had a previous mammogram,please bring the films with you, if possible.What should I do before I come for a Mammogram?• Women whose breasts become tender beforetheir periods find it more comfortable to havean x-ray during or just after a period.• For convenience, a two piece outfit such asslacks and blouse is recommended whenhaving a mammogram. You will be given agown to wear.• Please do not wear talcum powder ordeodorant. These can show on the x-ray picture.• If you have breast implants, please tell thereceptionist when making your appointment asthe examination will take a little longer.What happens if they find something?The doctor will contact you to discuss the best courseof action.• Most breast abnormalities are not cancerous.• The earlier a cancer is detected, the greater thelikelihood of a successful treatment.Can I be sure that I am alright if the Mammogramresults are normal?Mammography picks up about 90% of breast cancers.There are some cancers which will not be detectedby an x-ray. If you notice a breast lump, pain or anipple discharge, you should see your doctor straightaway, even if the mammogram is normal. It isstill important for a woman who has had a normalresult to continue to have regular mammograms,because changes in the breast develop over time.Radiology Mammogram (Breast X-ray) • 31

What else should I do?As part of total breast care we also suggest you:• Ask your doctor to check your breasts once ayear.• Practice regular Breast-Self Examination(BSE).See your doctor straight away if you notice anychanges with your breasts.ALL YOU NEEDTO KNOWABOUTULTRASOUNDWhere can I get Mammogram?JPMC’s Diagnostic Imaging Department has thelatest low dose mammographic equipment. Theexamination takes about 20 minutes and appointmentsare encouraged.REMEMBER:LOOKFEELACTASKBSE takes only a few minutes each month. It is oneway you can do something for your own health.What do I check for?• Lumps, even if they are painless.• Thickening in your breast.• Any discharge from your nipple.• Any other changes.32 • Radiology Mammogram (Breast X-ray)

What is Ultrasound ?Ultrasound is an easy and non-invasive way tosee the internal structures of the body by sendinghigh frequency sound waves through skin. In anabdominal examination, ultrasound produces imagesto be seen on most of the major organs including theliver, gallbladder, pancreas, spleen kidneys and largeblood vessels.The principle behind ultrasound or “sonar” is thesame as what was used during World War II to locateenemy submarines beneath the sea. The machine,a transducer, sends a brief pulse of sound (abouta millionth of a second long) into the body. Thissound travels into the abdomen and when it reachesa structure, the travelling pulse will send back a littleecho. With the use of high-speed computer, an imageof the organ being examined is seen on the TV monitorof the machine. Sounds produced by the transducerare very high pitched and are unable to be heard byhumans.How long will it take ?The length of time for all examinations willvary depending on the specific reasons for yourexamination. For some studies, such as examinationof the gallbladder for stones, may require only 15minutes. For a complete study of the abdominal organsor pelvis, 45 minutes or more may be required.Will it hurt ?There is little or no pain involved in an ultrasoundexamination of your abdomen, although, there maybe some discomfort from maintaining a full bladder.A gel-like material is applied to your abdomen andthe instrument is then placed on the skin surface toprovide better contact between the transducer and theskin. This gel may feel slightly cold and even thoughit wipes off easily, it is a good idea to wear clothingthat is easily washable.What are the limitations of the examination ?As bone attenuates sound waves, ultrasound cannot beused to examine the bones surrounding the abdomen,such as your ribs. Also, as sound is weakened as itpasses through layers of tissue, results from patientswho are obese are not of the same quality as those ofpeople who are thin.Are there any special preparations for theexamination ?If the gallbladder is to be examined, you should havenothing to eat or drink except water for 6 hours beforethe procedure. This is because food and drink causesthe gallbladder to contract, preventing adequateexamination with the ultrasound.Is Ultrasound safe ?Diagnostic ultrasound has been in use since thelate 1950’s. No known adverse biological effects onpatients resulting from this usage have ever beenreported. Although the possibility exists that suchbiological effects may be identified in the future,current data indicates that the benefits to patientsof the prudent use of diagnostic ultrasound faroutweigh the risks, if any, that may be present.34 • Radiology UltrasoundRadiology Ultrasound • 35

When should an Ultrasound examination of theabdomen be done?There are many reasons for examining the abdomenwith an ultrasound. Among the common reasons whenan ultrasound examination of the abdomen should bedone are :• To look for causes of upper abdominal pain,which may be related to problems of the liver,gallbladder or kidneys.• To detect gallstones.• To determine abnormalities of the liver orspleen.• To evaluate the kidneys for blockage.With the use of ultrasound, the amount of fluidsurrounding the baby, as well as the placentacan be seen. The placenta’s position is helpful indetermining what kind of delivery you will have(vaginal or caesarian) and whether the baby willneed any special medical attention immediately afterdelivery. Early in pregnancy, it may be necessary toscan with a special transducer placed in the vagina tosee the baby.• To look for enlargements (aneurysms) and otherabnormalities of abdominal blood vessels.In some cases, the ultrasound may not be able toprovide all the information your doctor requires, inwhich case, additional studies may be required.Why should I have an Ultrasound examination duringpregnancy ?The most common reason for having an ultrasoundexamination is to determine the approximate ageand position of the baby and to make sure the babyis growing normally. Age can be determined early inthe pregnancy (2-3 months) by measuring the lengthof the baby. Later, at 4-7 months, age is derived bymeasurements of the head and the length of thefemur (the long bone inside the thigh). Thesemeasurements are then compared to a table that listaverages of normal baby growth.36 • Radiology UltrasoundAre there any special preparaton for PelvicExamination ?Depending on how far along you are in thepregnancy, the only preparation you may be askedto make is to have a full bladder by drinking about4-6 glasses of water an hour before the procedure. Thereason for this is that high frequency sound wavesused in ultrasound reveal well through liquid, but notthrough gas or air. Since the uterus is located in thepelvis behind loops of bowel containing gas and air,it is important to fill the bladder (also located in thepelvic area) with fluid to displace the bowel andprovide a clear window for viewing the baby.Radiology Ultrasound • 37

Clinic HoursMondays to Fridays : 8am - 12 noonSaturdaysServices1pm - 5pm: 8am - 12 noon• MRI (1.5 & 3 Tesla) with Cardiac MRI, MR Angiography,Spectroscopy, MR Mammography, Stroke Imaging-Functional/DTI • Multislice CT Scanner (64 Slice) withCardiac CT, Coronary CT, CT Whole Body Angiography, pQCT• Digital Dental CT (Cone Beam CT) - Digital OPG, CEPH• CR Radiography (X-ray) • Digital Fluoroscopy• Ultrasound • CR MammographyFor inquiries & appoinments, please contactTel: +6732 611433 Ext. 2223 / 2246 / 2522 Fax: +6732 612119Jerudong Park BG 3122, Brunei DarussalamEmail: imaging@jpmc.com.bnWebsite: www.jpmc.com.bnDDI_0611