INSIDE THIS ISSUE• CT Steroid Injections• Radiation Dose• Workers Compensation• Whats new at Clearview• From the Ultrasound Team• Hints and Tips

CL IN ICAL SP TLIGHT

Phone: 02 8319 4863 www.cmifairfield.com.au

FEBRUARY 2018 EDITION 1

Message from Dr JohnstonGreetings from Clearview Medical Imaging.

I am very grateful for all your support over the past year. We have had a year of growth and progress for our radiology practice and the staff at Clearview Medical Imaging are excited about the year to come.

Throughout the past year, it has been a pleasure getting to know you all and gaining a greater respect and appreciation for your commitment and dedication to patient care. Our focus at Clearview Medical Imaging is to work in partnership with our referrers. Together, we will drive better integration enabling us to demonstrate the value we bring to the table: personalised patient care, performing the right study, obtaining the highest quality images and answering the clinical findings to provide improved patient care and achieve better outcomes.

I am excited about the direction we are moving in and would like to give you some insight into where we are going for the year. Clearview Medical Imaging aim to provide the best care possible and continue to build strong relationships with our referrers. As our practice continues to grow, we grow with it by increasing our staff, service and equipment.

I would like to thank you for your on-going support and remind you that we have an “open door policy” in-which I make myself available to answer or discuss any clinical situations you may have.

Kind regards Dr David (Patrick) Johnston FRANZCR Radiologist Clearview Medical Imaging

What are they for?

There are two reasons to perform the injection. The first is for diagnostic reasons – to confirm a particular nerve root or facet joint is causing the patients symptoms. The second, if for therapeutic reasons – to try and relieve the patients pain.

Do they work?

There is good evidence for relief of pain in the short to medium term (typically 3-6 months). For some patients this can be several years. Some people get minimal relief - there are 25 different targets for injection in the lumbar spine, so determining the correct location can be tricky and may take several injections.

What are the risks?

There is a minor risk of bleeding and infection, similar to an immunisation or blood test. For epidural and nerve root injections there is a small risk of damage to the nerves – which is very rare and typically resolves.

What steroid do you use and why?

We use Dexamethasone for back injections as it is by far the safest agent, due to the small particle size. We no longer use Celestone for back injections, however it can be used for peripheral MSK injections.

How do I refer?

Patients require a CT or MRI of the lumbar spine within the last 12 months prior to the injection. You can refer for a specific level / injection, or if the imaging has been done at Clearview we can suggest potential targets based on the imaging. If you have any questions Dr. Johnston is happy to come out and run through a brief presentation, or you can call and speak to him anytime. Our priority is to make sure patients get the best relief with the minimum number of injections.

Radiation DoseHere at Clearview Medical Imaging we care about patient dose. Our GE 128 slice low dose CT is specifically designed to deliver lower dose radiation. Using the unique ASiR technology we can address the issue of radiation by reducing dose on a per-scan basis based on the clinical task.In addition, the dose saving technology combined with reconstruction techniques results in one of the lowest dose 128 slice CT scanners available, achieving doses up to

60% less. We are extremely proud that our GE 128 Slice optima will allow Clearview Medical Imaging to stay at the cutting edge of CT technology through the provision of the best possible images for our referrers. We also consider the patients concerns by reducing radiation dose to extremely low levels while maintaining excellent image quality.

CT Guided Lumbar Spine Steroid Injections

Facet joint injectiondemonstrates the needle in the facet joint.

Translaminar epidural injectionThe white area near the tip of the needle is contrast, confirming an epidural location prior to injecting the steroid.

Nerve root injectionThe white area is contrast outlining the exiting nerve root (dark rounded area). As you can see there is medial extension of the contrast through the exit foramen towards the epidural space.

We require recent imaging on patients before we perform

steroid injections

Workers compensationAt Clearview Medical Imaging we pride ourselves on providing a quality radiology service for our patients whilst working in partnership with our referrers to improve better patient experience and outcomes. One way we do this is by offering a hassle-free workers compensation service for your convenience.Our dedicated customer service team are specifically trained in processing workers compensation cases which includes liaising with claims officers for pre-approvals prior to the patients attending their appointment, saving time and ensuring a stress-free experience, enabling your patients to quickly resume their normal activities and expedite their work rehabilitation pathway.Below is a list of ways in which you can assist us to provide a streamline process for your patients.To obtain an approval we need the following information:

• A referral with accurate clinical history of patient injury and date • Claim number • Case worker contact details • Insurance company detailsSupplying the above information will help us fast track approvals. What we offer:

• Quick appointments booked at a suitable time for the patient • Appointments can be made with or without approval at the booking time • All examinations are reported by our specialist radiologist • Fast turnaround of results with reports being delivered promptly to the referring doctor • There is no out-of-pocket expense to the patient for all approved workers compensation examinations.

If a patient presents for radiologywithin 48hrs of an accident, pre approval is not required.

From the Ultrasound Team

Why it’s important to have a full bladder for obstetric and pelvic ultrasounds

What’s new at Clearview

If your patient requires a pelvic or pregnancy ultrasound, we will need them to have a full bladder. A full bladder allows us to get better pictures so our radiologist can provide you with a more detailed, accurate report. Ultrasound has trouble seeing through the bowel and the full bladder moves the bowel out of the way as well as allowing the ultrasound to see deeper structures. If your patients bladder is not full enough, we may ask them to drink more water and wait. Once the ultrasound is complete and the radiologist is happy with the images, the patient will be able to empty their bladder. Please remember to inform your patients that a full bladder is required when referring for this type of ultrasound.

Have your patients next ultrasound with Clearview Medical Imaging. Our friendly customer service team are ready to take bookings and will explain the preparation required for a pelvic or pregnancy ultrasound. If your patient requires another procedure that involves a preparation, this will be explained during the booking process.

Clearview Medical Imaging - providing personalised radiology for improved patient experience and outcomes.

We have increased our ultrasound service and are very pleased to welcome Milica to the Clearview team. Milica has worked many years in private practice, she brings with her a wealth of experience in ultrasound and a pleasing attitude to patient wellbeing.

CT • XRAY • ULTRASOUND • BIOPSIES • INJECTIONS

Phone: 02 8319 4863Shop M01AFairfield Forum (roof)8-36 Station StreetFairfield NSW 2165www.cmifairfield.com.au

Opening HoursMonday - Friday 8am to 5pm

BULK BILLING AVAILABLE

Cunningham

rdy St

Smart St

Ware St

Station St

Smart St

Horsley Dr

Roof topcar parking

FairfieldForum

ShoppingCentre

NeetaShopping

Nelson St

Nelson St

Enter Here

WE ARE HEREFairfield Forum

Shop MO1A8-36 Station St

FAIRFIELD

Don’t forget to write Medicare indications for the patients who require a pregnancy gynaecological ultrasound. To ensure patients are Bulk Billed, please give detailed clinical notes.

Intravenous Contrast & Renal Function

Renal function tests within the last 6 months should be provided if any of the following refer to your patients: • Known kidney disease (including transplant or a single kidney) • Age > 65years • Diabetic and/or on Metformin

Anticoagulation

Asprin is considered safe for all injections (including lumbar spine epidural injections). Other anticoagulants may need to be withheld for a period of time prior to the injection - however this would be discussed with you first - we would never stop a patients anticoagulant. Peripheral injections such as tendon sheaths / plantar fascia can be performed with all anticoagulants, however there is an increased risk of bleeding. Intra-articular and spinal injections would generally not be performed.

In general an eGFR greater than 45ml/min/1.73m2 is safe for contrast, while an eGFR of less than 30 ml/min/1.73m2 is a relative contra-indication. Cases in between are evaluated on a case by case basis. If there are no renal function tests we are happy to organise them, however it may delay the study.

#1

#2

#3

To make an appointment or for further information call our

friendly customer service team on 02 8319 4863

www.cmifairfield.com.au