A Publication Of Radlink Diagnostic Imaging (S) Pte Ltd

• Issue No: 02-2009 • Mica (P) No: 253/02/2009

GRAPEVINE BACK PAGE

Service Excellence Funny Bone

Unscramble the following words to find out just some of the many services offered by our team of
gateway w w w. r a d l i n k . c o m . s g

sub-specialized Radiologists at RadLink Diagnostic Imaging (S) Pte Ltd Care • Comfor t • Connect
At RadLink Group of imaging centres, we work hard to ensure that our employees are given the necessary Message
tools and training needed to excel in Service Excellence. This doesn't mean just meeting customers' ELCARNU CIDENEMI from the MD
expectations, but going above and beyond to exceed those expectations. PMHYAMOMGRA

It takes continuous time and
effort to achieve true customer
loyalty and retention, so to
assist us; we operate with three
guiding principles:
■ To offer the best customer
service of any diagnostic imaging
for patients.
We have classified these
comments into three categories:
1. Top-Rated Services
■ “Environment friendly. Can see
that staff working with each other
are very harmonised”
■ “Outst a n d i n g s e r v i c e , v e r y
3. Compassionate Staff Members
■ “I would like to express my
gratefulness to Jeff, the radio-
grapher for his patience and
kindness as I am claustrophobic.”
■ “R e n u k a w a s e x c e p t i o n a l l y
gentle and helped the overall
procedure.”
ENOB YDETISN 2009 is now halfway through to announce that we will start a
and there have been major new service, Sodium Fluoride
TENVTERINLOIAN GYORAODIL
developments within the RadLink PET/CT bone scan. This service
TPE CNAS
group of imaging centres. will commence in August 2009.
TVLAIRU YLNOSOOCPCS
9. Breast Biopsy We are proud to announce that We would also like to unveil
ASORUTNLDU 7. Ultrasound 8. Fluoroscopy;
5 PET Scan 6. Virtual Colonoscopy;
5. we will be installing our second our teleradiology website which
YFLPUOOROCS 3. Bone Density 4. Interventional Radiology;
PET/CT scanner at Singapore allows physicians convenient
1. Nuclear Medicine; 2. Mammography
TBRSAE YBSIOP PET and Cardiac Imaging Centre access to patient images and
Answers:

reassuri n g t h r o u g h p u t , v e r y Pte Ltd. This scanner will be fully reports.

■ To ensure a welcoming environ- ■ “Doris, keep it up!”
efficient a n d p r o m p t . ” operational by September 2009.
ment for our patients.
■ To offer service excellence
■ “Excellent, way to go!”
■ “Azy is very understanding and

to our referring physicians.
Our employees continually strive
to offer the highest in quality,
compassionate care and service
to their customers. This is apparent
in the comments made by patients
in their Customer Satisfaction
surveys below after their stay
at RadLink Diagnostic group of
imaging centres.
approachable!”
Our Team The RadLink group will continue
■ “X - r a y s t a f f w a s a w e s o m e ! The world is also seeing shortage to dedicate itself to providing
Dr June Chong LM, Dr Ng Hweena, Dr Anne Tan Kendrick,
Thanks!” of Tc99m radioisotope due to high quality diagnostic imaging
MBBS, FAMS, ABR, CAQ in MBBS, FRCR. MA (Cantab), BM BCh
■ “Staff were friendly, prompt and shutdown of aging nuclear services and solutions for
Neuroradiology. Special Interest: (Oxon), FRCR (UK), FAMS
did a great job.” Special Interest: Obstetrics /Gynecology Special Interest: reactors. Tc99m isotope is patients.
Neuroradiology nghweena@radlink.com.sg Pediatrics & Women’s routinely used in Gamma imaging
2. Caring Physicians junechong@radlink.com.sg Imaging to help doctors diagnose and
■ “When patient’s friend knocked Dr Wang Wing Yee, annetankendrick@radlink.com.sg
detect serious conditions such
her head, Dr Sheah and clinic Dr Tony Stanley, MBBS, FRCR, FAMS.
MB MCh, FRCR, FAMS. Special Interest: Dr Kenneth Sheah, as cancer and heart disease. Chan Wai Chuen
staff were very concerned.” Special Interest: Respiratory Imaging MBBS, FRCR, MMed (Drad) In response to the shortage of Managing Director
■ “Dr Ng was very polite and went Musculoskeletal imaging wangwingyee@radlink.com.sg Special Interest:
Tc99m isotope, we are proud
beyond the call of duty.” tonystanley@radlink.com.sg Non-Vascular Intervention
and Musculoskeletal
■ “Fabulous! Dr Tony Stanley.”
Imaging
ksheah@radlink.com.sg
@radlink.com.sg

Your comments and enquiries are important to us. New Sodium-Fluoride

We have launched a novel service
which will allow physician access
to their patient images and reports
via a portal www.teleradlink.com
This website offers DICOM images
on web without compromising image
PET/CT bone scan performed
Singapore PET and Cardiac Imaging To know more about us: at Singapore PET and Cardiac
Please contact:
Centre Pte Ltd Imaging Centre Pte Ltd
Group Markets & www.radlink.com.sg
290 Orchard Road #08-06 www.molecularimaging.com.sg
Business Development Manager
Paragon Medical www.radiopharmaceuticals.com.sg
www. radiopharmaceuticals.com.sg
news@radlink.com.sg
news @radlink.com.sg Singapore 238859
Tel: (65) 6836 1318
Our operating hours:
quality. Access to patients’ data is Please send your requests
You can locate us at: Fax: (65) 6836 1381
Monday – Friday: 8.30am to 5.30pm IN THIS ISSUE
RadLink Diagnostic Imaging
through a user id and password, to itpacs@radlink.com.sg. An 290 Orchard Road #08-08 Singapore Radiopharmaceuticals Saturday: 8.30am to 12.30pm FOCUS GRAPEVINE BACK PAGE
Pte Ltd
hence e n s u r i n g p a t i e n t d a t a acknowledgement email and Paragon Medical 2 Virtual Colonoscopy 5 Service excellence
Singapore 238859 41 Science Park Road #01-15/16
confidentiality. Referring physicians set-up details will be provided, Tel : (65) 6836 0808 The Gemini
Singapore Science Park II
are able to view their patient’s so referring physician can have Fax : (65) 6836 8484 FEATURE
Singapore 117610
records at RadLink Diagnostic immediate access to the service. Tel: (65) 6594 0660 3-4 Whole body MRI
Imaging, up to the past 5 years. Fax: (65) 6777 0663

5
FOCUS FEATURE

Virtual Colonoscopy MRI and PET of the Whole Body – The Next Step in Oncologic Imaging?
Computed Tomographic Colonography (CTC) or Virtual Colonoscopy is the most recent technique for TABLE 1 PET/CT is commonly used in oncologic imaging. The functional data on tumour metabolism obtained from FDG-PET provides additional information
detecting colorectal neoplasms. It is a rapid, non-invasive imaging method to investigate the colon and rectum. provides complementary value to anatomical imaging provided by CT. Increasingly, other hybrid systems are being in t u m o u r s u r v e i l l a n c e . F o r
The total examination time is 10-20 minutes. Patient preparation involves a 2 day bowel-cleansing protocol. Cancer Statistics developed to advance oncologic imaging, and researchers are beginning to look at MRI PET as the next frontier. example, lymph nodes which have
This short article discusses the possibilities of using MRI PET. doubled in size from the previous
Indications for Virtual However; individuals at increased Ten Most Frequent Cancers Affecting
examination without significant
Men & Women In Singapore
Colonoscopy risk should be screened every FDG uptake would still be reported
There are several indications for five years. Risk factors would Top 10 cancers affecting and documented as potentially
Advantages and disadvantages Potential applications for Lymph node specific contrast
CT colonography. include: a family history of polyps, a Singapore men metastatic. This size measurement
of MRI versus CT PET/MRI agents have also been used for
family history of colon cancer, Site Ranking No. can also be obtained on MRI, while
1. CTC is performed following 1. MRI provides superior soft T-staging MRI staging of colorectal tumour
or the presence of blood in the reducing the overall radiation dose
incomplete colonoscopy.1-4 Colo-rectum 1 3790 tissue contrast and is advan- PET/CT is used in patients with (e.g. SPIO). However, to date,
stool. that the patient may receive. In
2. CTC can complete the colonic Lung 2 3719 tageous in neural imaging, non-small cell lung, head and widespread use of iron oxide-
axial
evaluation as well as identify the Sensitivity and Specificity of c e r t a i n a b dominal viscera (liver, neck and colorectal cancers. based contrast has not gained mesenchymal tumours, application
Prostate 3 1953 of MRI and anatomical data is more
cause for endoscopic failure.1 Virtual Colonoscopy bile ducts, pancreas and kidneys) However the use of PET/MRI widespread clinical use despite
Low dose CTC was shown Liver 4 1671 and the musculoskeletal system. can be helpful for assessment of at least 10 years of research useful than CT in pre-operative
3. Sychronous carcinomas, which
occur in 5% of cases, may be to have e x c e l l e n t s e n s i t i v i t y musculoskeletal tumours, head and will likely be superceded by planning because neurovascular
Stomach 5 1340
and spe c i f i c i t y f o r d e t e c t i n g 2. MR spectroscopy, diffusion involvement and tissue planes are
d e t e cted when an occlusive and neck lesions, intracranial molecular markers such as FDG.
Nasopharynx 6 1178 imaging, perfusion and functional better defined.
carcinoma does not allow passage colorectal neoplasms >=10mm. 6 tumours, certain breast cancers
Skin 7 928 MRI information can also be
of the colonoscope to complete and liver neoplasms in which the M-staging
Effective dose (including melanoma)
obtained with PET imaging. In patients without established
the colononic evaluation.1,2 coronal MRI component provides greater Pulmonary metastases are
The effective dose of CTC is Lymphoma 8 895 diagnosis of cancer, but with
4. Some patients who require 3. No radiation exposure. This diagnostic and prognostic infor- better depicted on CT rather
estimate d a t a b o u t 8 . 8 m S v elevated tumour markers, the use
colonoscopy cannot undergo (range 4-12 mSv) and carries a Bladder 9 662 advantage is important in imaging of mation than CT due to better soft than MRI. Allowing for yield from
of MRI of the whole body or MRI/
the procedure due to severe risk of 0.002% in a 50 year old Leukaemia 10 621 non-oncological patients or patients tissue contrast definition. FDG-PET to be identical in
PET would be expected to reduce
co-morbid disease, advanced age, individual and lower for older on surveillance for a long time. both fusion modalities, it is
MR specific technologies, such the overall radiation dose received
bleeding disorders, extremely patients. 7 expected that PET/CT would out
Top 10 cancers affecting as MR spectroscopy, can be by the patients. Potentially, this
tortuous colon or prior allergic Singapore women The disadvantages of MRI perform MRI/PET in identifying
include: co m b ined with information can be used in scans for early
reaction to sedation.5 Local data subcentimetre pulmonary nodules.
localisor Site Ranking No. from the PET scan to determine neoplasm detection.
Data from Singapore Cancer Furthermore, due to shorter
Breast 1 6626 1. Substantially longer examina- areas of enhancing scar tissue MRI-PET fusion image demonstrates
Who should have a Virtual Registry, Interim report shows image acquisition times, CT is Technical factors
tion times because of imaging versus remnant tumour in brain increased uptake within brain lesions,
Colonoscopy? that Colon cancer is the top Colo-rectum 2 3206 less susceptible to breathing MRI and PET modalities take a with MRI providing excellent soft
protocols and sequences. tumours.
Most physicians will agree that cancer affecting Singapore men artefact than MRI. long time to acquire data. Clinical tissue correlation
Lung 3 1778
everyone older than 50 years whilst it is the second most 2. Cost. MRI scans are more systems are being developed
common c a n c e r a f t e r b r e a s t Ovary 4 1287 N-staging On the other hand, MRI shows
of age should be screened for expensive than CT. which combine both MRI and will yield maximum information
polyps every seven to ten years. cancer a f f e c t i n g S i n g a p o r e Staging of nodal disease with higher sensitivity and accuracy
Corpus Uteri 5 1262 PET modalities so that data from this fusion modality.
women. (See Table 1) 3. Contraindication to MRI due to PET/CT is likely to be as useful than FDG-PET/CT in assessment
Cost and patient preparation Cervix Uteri 6 1007 acquisition can occur simulta-
fly-through metal implants and pacemakers. as PET/MRI as the combination of liver and bone metastasis. This Conclusion
Stomach 7 863 neously. Even without a combined
The cost of a Virtual Colonoscopy is S$649 (excluding GST). of physical dimensions with is due to the superior soft tissue In future, it is expected that
4. Reduced sensitivity for pulmo- MRI/PET system, fusion imaging
Patient preparations involve a two day bowel preparation protocol. Skin 8 778 me t a b o l i c i n f o r m a t i o n f r o m contrast from MRI. This also clinical PET/MRI systems will
nary lesions, compared with CT. can be performed with software
(including melanoma) FDG-PET would be likely applies for MRI of the breasts. become available and the use
References platforms that allow calibration and effectiveness of this new
Lymphoma 9 677 5. Reduced spatial resolution. comparable. The disadvantage
1. Morrin MM et al, Endoluminal CT colonography after an incomplete endoscopic colonoscopy. AM J Roentgenol 1999;172:913-18 and superimposition of the fusion modality will find its way
2. Copel L et al, CT colonography in 546 patients with incomplete colonoscopy. Radiology 2007;244:471-8 Current CT technology allows up with MRI systems in clinical use Tumour surveillance
Thyroid 10 618 images. into clinical practice.
3. Macari M et al, Usefulness of CT Colonography in patients with incomplete colonoscopy. AM J Roentgenol 1999;173:561-4 to 0.6 mm slices, although newer includes a slower acquisition time Therapy response relies on
4. Neri E et al, Colorectal cancer: role of CT colonography in preoperative evatuation after incomplete colonoscopy. Radiology 2002;223:615-19
5. Arye B, Results of National CT Colonograhy Survey of the Israeli Association of Abdominal Imaging and Israeli Radiological Association. IMAJ 2008: Vol 10:707-712 Source: MRI sequences now allow up to on the MRI, thus predisposing functional PET data and CT It is likely that joint reporting Dr Kenneth Sheah
Singapore Cancer Registry, Interim Report to misregistration artefacts from
6. Macari M et al, Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy 0.9 mm 3D imaging (such as 3D provides anatomical correlation. between nuclear medicine phy- MBBS, FRCR, MMed (DRad)
for detection. Radiology;2002:383-92 (Trends In Cancer Incidence In Singapore
7. Van Gelder RE et al, CT colonography at different radiation dose levels: feasibility of dose reduction. Radiology 2002;224:25-33 2002-2006) SPGR / SPACE sequences). patient motion. Application of RECIST criteria sicians and qualified radiologists Consultant Radiologist

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