Newsletter Spring, 2014 Volume 3
Message from the Manager In this Edition DEXA Total Body Scanning Page 3 Ankle Brachial Index Page 4/5 OBSP Page 6 3D Transvaginal Sonography Page 7 Pediatric Ultrasound Patients Page 7 French Website MMI is pleased to announce that in response to patient requests, our website is now fully bilingual. MMI is proud to release the 3 rd edition of our newsletter for referring physicians. Back issues of our newsletters can be obtained electronically by visiting the What s New? section of our website. In this edition of our newsletter, you will find information about DEXA total body composition scanning, ankle brachial index (ABI) testing, 3D transvaginal sonography and much more. MMI values our referring physicians and is always open to suggestions on how we can work with you to further improve upon the quality of our services. Do not hesitate to contact me directly at extension 231 with any questions, comments or feedback. Our goal is to provide the best possible diagnostic imaging services to patients and referring physicians alike. We hope that you will continue to use MMI in the future to meet your diagnostic imaging needs. Sincerely, Christina Michelli Extension of Clinic Hours We have recently extended our operating hours. Please visit www.mmimaging.com for our evening and weekend hours. How Can We Serve You Better? We are constantly striving to better the services we offer at MMI. Please encourage your patients to provide opinions on how we can do so. Feedback can be communicated using the suggestion box located in our reception area or by visiting our website. Payment Methods for Self-Pay Patients For Quebec residents, and those patients without provincial health insurance coverage, payment in full is due at the time the services are rendered. In addition to accepting cash and personal cheques, we also are pleased to accept debit and credit cards (Visa, Mastercard, American Express and Discover). 2
**NEW SERVICE** DEXA Total Body Composition Scanning Merivale Medical Imaging has recently started performing DEXA total body composition scanning. This is considered the gold standard for measuring fat tissue mass, lean tissue mass and bone mineral content. This scan is ideal for athletes and those involved in weight loss management and maintenance. Multiple scans can be done over time and changes in body composition tracked. A DEXA scan involves a small dose of radiation to the patient and therefore requires a requisition from a licensed physician. Physicians are asked to send an email request to info@mmimaging.com with their physician number in order to receive our electronic requisition for this test. What is the procedure for a DEXA scan? The client will lie comfortably on the scan table while the scanner passes over the length of their body scanning from head to toe. The procedure takes 6-10 minutes to complete and the client must remain still while breathing normally. What is the preparation involved? The client should wear comfortable clothing without metal, buttons, zippers or underwire bras. Yoga wear and non-restrictive active wear is acceptable. Women should not be pregnant at the time of the scan, or have had a recent injection of a contrast material (such as that for a CT scan, MRI or barium study) or radioisotope injection. 3
Pressure Testing (Ankle Brachial Index) Ankle brachial index is a simple, well tolerated procedure that takes approximately 30 minutes and can be used as a screening before ordering a longer, more involved full arterial Doppler scan. ABI = highest pressure from PTA or DPA/highest arm index ABI 0.8-0.9 minimal claudication ABI 0.6-0.8 moderate claudication (usually single level disease) ABI < 0.5 severe claudication to rest pain (usually multilevel disease) In the normal patient, the systolic pressure in the ankle is equal to or greater than the systolic pressure in the arm; therefore, normal ABI is 1.0 or greater. Patients with atherosclerotic disease have ABI s below 1.0 that are generally proportional to the severity of the disease. Patients who complain of pain only after exercise, which improves with rest (true intermittent claudication) usually have ABIs close to 1.0 prior to exercise and ABI 0.6-0.8 post exercise. It is important to take a good patient history to determine if the patient has true claudication versus pseudo-claudication. Normal patients show no drop in pressures following exercise and may actually show an increase in pressure. Patients with disease will have a drop in pressure below the pre-exercise level that is proportional to the level of disease. If the pressure remains the same in a patient with intermittent claudication symptoms, pseudoclaudication should be suspected and MSK or neurospinal disorders should be investigated. 4
Indications Leg pain as in true intermittent claudication Rest pain Foot ulcers Patient with venous incompetence when pressure stockings are indicated Trauma of the lower legs Contraindications Excruciating pain (cuff intolerance) Presence of DVT Open ulcers/wounds, wound dressings that we do not remove Limitations of Accuracy Medial calcifications or non-compressible arteries as in diabetic patients or those with end stage renal disease with dialysis Large body habitus where cuff artifact occurs Extreme edema of the ankles Things to Consider ABIs over 1.3 are not reliable and likely represent small vessel disease (medial calcifications) We do not exercise and repeat pressures if they are not dependable Although it s sometime considered a disease, claudication is technically a symptom of a disease When stenosis/occlusion in the upper extremity is suspected, recommend a full arm arterial To assess for subclavian steal phenomenon, order carotid and subclavian Dopplers 5
MMI is a Proud Affiliate of the Ontario Breast Screening Program (OBSP) Merivale Medical Imaging has been offering high quality mammography services since 1988. In 2010, we acquired state-of-the-art Full Field Digital mammography units. Along with performing diagnostic mammography and breast ultrasound services, we have been proud affiliates of the Ontario Breast Screening Program (OBSP) since 2002. The Ontario Breast Screening Program is a program that encourages women between the ages of 50 and 69 to undergo regular mammography screenings. Once enrolled in OBSP, you will receive reminders to schedule regular mammography screening appointments until the age of 73. A physician s referral or requisition is not required to participate in this program; however, the family physician can be forwarded a copy of the results. To participate in OBSP a patient must be an Ontario resident who has not has a mammogram in the past 11 months. Patients with a history of breast cancer, patients who have breast implants and those patients with acute breast symptoms (pain, lumps, etc.) are excluded from participating. MMI strives to enhance the quality of care our patients receive by expediting the timing of follow up appointments and investigations. Since January, 2012, MMI has been arranging and coordinating the follow up imaging for all of our patients who require additional imaging because of an abnormal mammogram. All patients are informed of the results of their follow up imaging once the imaging is complete. Any patient requiring a biopsy is advised of the recommended investigation and is given an information sheet and brochure with contact numbers and an explanation of the procedure. MMI will also send the images and the request from our radiologist for a biopsy to the Woman s Breast Health Centre. The Woman s Breast Health Centre will then notify the referring physician of the biopsy appointment. 6
3D Transvaginal Sonography Did you know that 3D Transvaginal sonography is available at Merivale Medical Imaging? This method can be successfully used in the differential diagnosis of benign gynecological pathology such as congenital anomalies of the female reproductive system, submucosal fibroids and endometrial polyps. It is often useful when there is a questionable IUCD position. Our policy is to first perform a conventional 2D pelvic and TVP study, as there are some circumstances in which a 3D scan will not improve resolution. If the results of the 2D TVP are inconclusive, or if there is reason for our radiologist to suggest a 3D TVP, it will be included in the report and the patient will need to reschedule this exam with a new request from her referring physician. When requesting a 3D TVP, please ensure 3D is clearly specified on the requisition so that it can be appropriately booked. Pediatric Ultrasound Patients MMI accepts pediatric for general ultrasound procedures. These include abdominal, pelvic and small parts sonography. 7
Ultrasound X-Ray Bone Mineral Density Mammography Nuclear Medicine 8