Services

Topics

Services Offered

Computed Tomography

Diagnostic (In addition to all standard CTs)

  • Bone mineral densitometry – QCT bone mineral densitometry
  • CT spine (cervical, thoracic, lumbar)
  • CT colonography/ CT enterography
  • CT angiography – cerebral, pulmonary, mesenteric, aorta & limbs
  • CT venography for pelvic congestion syndrome
  • HRCT thorax
  • CT oncology work up and oncology follow up
  • CT coronary angiogram and CT calcium score
  • CT arthrography
  • Temporomandibular joints (TMJ)
  • 3D Dentascans (accurate life size pan and ortho)

 Interventional procedures

  • Large joint injections; hip, knee, shoulder, with steroids, PRP, Synvisc or Durolane. Shoulder hydrodilatation
  • Others
    • Facet joint, costotransverse, costovertebral and sacroiliac joint injections
    • Nerve root sleeve and epidural injections. Ganglion Impar block for coccydynia
    • Rhizotomy for facet, knee, hip, and, shoulder joints (for chronic pain)
    • Rhizotomy peripheral nerves, Ganglion Impar rhizotomy

Ultrasound

Diagnostic

  • General, abdominal, including Hepatic Elastography
  • Pelvis, follicular tracking
  • Obstetrics including (Patient access to personal images via the web)
    • 1st trimester dating
    • 1st trimester nuchal translucency
    • 2nd trimester anatomy
    • 3rd trimester growth
    • paediatric
  • Small parts, thyroid and breast
  • Musculoskeletal, including all joints, tendons, nerves, lumps and hernias
  • Vascular, including:
    • Abdominal aortic aneurysm assessment
    • Renal arterial Doppler
    • Peripheral arterial Doppler
    • Carotid Doppler
    • Venous thrombosis assessment (upper and lower limb)
    • Chronic venous insufficiency assessment
    • AV Fistula Studies
    • ABI

Interventional Procedures

  • All musculoskeletal injections and aspirations
  • Fine needle aspiration & Core biopsies
  • Platelet-rich Plasma (PRP) injections – tendon tears, osteoarthritis large joints
  • Rhizotomy (RF Ablation) Morton’s neuromas and plantar fascia

Digital Radiography

Full spine imaging with ortho stitching for chiropractors.
Comprehensive digital

Virtual Colonography

What is Virtual Colonography? (Also known as CT colonoscopy, CT colonography or virtual colonoscopy)

A computed tomography colonography (CTC), is a CT scan to look at the colon. In order to study the large bowel, dietary preparation is required, usually for 1–3 days before the scan. This is to cleanse the bowel, and involves taking a prescribed laxative, similar to having a colonoscopy.

Indications for this procedure.

The main purpose of CTC is to look for cancer, or polyps, in the large bowel. Polyps are growths arising from the surface of the colon that may grow into cancers of the colon. A biopsy or removal of the polyps maybe necessary if a cancerous or significant sized polyp is found under CT colonoscopy.

CTC is also excellent for diagnosing diverticulosis (but not for acute diverticulitis). Another use to having a CTC is if a patient has had a difficult or an incomplete conventional colonoscopy, when the whole bowel may not have been completely or confidently assessed.

Preparation for Virtual colonography.

The patient will be given clear instructions by the radiologist carrying out the CTC. A clean bowel is necessary before the test, so that any polyp or cancer can be detected. The exact instructions may differ depending on any other medical issues, such as diabetes, kidney disease or some heart problems. It is important that all these information is conveyed to the radiologist supervising the CTC. Pregnant women should not have this test. The instructions will be provided to the patient as a package comprising of written information, instructions and some laxative sachets collected at least a few days prior to the CTC.

What happens during a Virtual Colonography.

Carbon dioxide is pumped into the colon via a rectal tube using an automated air insufflator. If there is no contraindication, an injection of bowel muscle relaxant (Buscopan) will be administered.

2-3 scans (each usually taking between 3–10 seconds) will be taken; the actual time in the CT scanner room is usually approximately 10–30 minutes.

Are there any after effects of a Virtual colonography?

After the test, the patient may feel a bit ‘crampy’ or ‘bloated’ for a few hours. If this occurs, it usually passes quickly.

What are the risks of a Virtual colonography?

A CTC is the safest way of examining the large bowel. There is a tiny chance of a bowel perforation from having a CTC. This would show up by having worsening abdominal pain. The rate of this rare complication is reported to range from 0–0.03% of patients having this procedure.

When can I expect the results?

Images will be carefully interpreted by our CTC accredited Radiologist. Views are performed using dedicated computer software to navigate through the bowel lumen.

The time that it takes for you to receive a written report on the test or procedure is typically 2-3 days but may depend on:

  1. the urgency with which the result is needed;
  2. the complexity of the examination;
  3. whether more information is needed before the examination can be interpreted by the radiologist.
Morton’s Neuroma

Morton’s neuroma is generally accepted to be a compression neuropathy of the plantar digital nerve.

First line management is non-operative including activity modification, use of appropriate footwear and orthoses. Although the majority of patients will derive some benefit from conservative measures, a significant per centage of patients seek surgical excision.

What is an ultrasound-guided radiofrequency ablation of a Morton’s neuroma?

Radiofrequency ablation (RFA) is a less invasive alternative. It has been used extensively in medicine to treat other conditions such as solid organ tumours, spinal facet joint pain and cardiac arrhythmias. Ultrasound-guided RFA is performed as an outpatient procedure. It involves inserting a needle probe into the neuroma under ultrasound guidance and generating a high frequency, alternating current that causes heat necrosis of the nerve tissue. Ultrasound guidance allows confirmation and accuracy of needle placement. This prevents injury to other local tissues. A local anaesthetic and corticosteroid injection given at the time of the procedure also reduces post-procedural pain and inflammation.

Post-procedure

Patients can be discharged home as soon as comfortable. It is recommended that they rest for the remainder of the day. Elevation of the foot, ice packs and simple analgesics such as paracetamol can be used as necessary.

Complications

Local effects such as pain and swelling can occur. Other minor complications include temporary nerve irritation.

Plantar Fasciitis

Plantar fasciitis (PF) is a common foot complaint that affects both active sportsmen and the physically inactive middle-aged group.

It is believed that PF results from degenerative changes rather than inflammation. As a result, Platelet-rich plasma (PRP) therapy is well placed as an alternative therapy for plantar fasciitis.

First line management is conservative therapies such as non-steroidal anti-inflammatory drugs, physiotherapy including plantar fascia stretching exercises, activities modification, use of shoe insoles. Other therapies include corticosteroid injections and extracorporeal shockwave therapy.

What is an ultrasound-guided platelet-rich plasma injection?

Platelet-rich plasma is the plasma fraction of autologous (from self) blood containing high concentration of platelets and growth factors that have been shown to initiate and facilitate and facilitate the natural healing process.

Pre-procedure

Some medications such as non-steroidal anti-inflammatory medications should be stopped in the 7 days leading up to the procedure. Please consult our staff if uncertain.

Procedure

Blood is withdrawn from a patient’s peripheral vein and centrifuged (spun) to achieve a high concentration of platelets within a small volume of plasma. This process takes about 5 minutes. The platelet rich plasma is then harvested and injected at the site of degeneration under ultrasound guidance.

Post-procedure

Patients can be discharged home as soon as comfortable. It is recommended that they rest for the remainder of the day. Simple analgesics such as paracetamol can be used as necessary.

Complications

Adverse effects are rare but as with any injection, there is always the small risk of infection or injury to nerves or blood vessels. Scar tissue formation and calcification at the injection site are also possible.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) Injection harnesses the healing properties of blood in order to reliably treat pain arising from tendons, ligaments and muscles.

With excessive use and increasing age, pain arising from tendons is becoming more prevalent, particularly in active “baby boomers”. Prior to any proposed PRP, an accurate diagnosis must be made, which usually requires a test such as an ultrasound of the body part to confirm that the specific tendon, ligament or muscle is the source of the patient’s pain.

Once referred for an PRP, the radiologist at Integrated Radiology will then review the patient and discuss the PRP procedure and rehabilitation.

PRP is most commonly used for the treatment of diseased tendons, commonly known as tendinitis. The medical term for this is tendinosis or tendinopathy. With increasing severity of tendinosis, partial thickness tears may form, which if left untreated can result in a full thickness tendon tear. The tendinosis-tear process is simply an increasing spectrum of injury to the tendon. Any tendon can be treated with this procedure and though not used routinely, the procedure may also be used in muscle and ligament tears (“strains and sprains”). A Platelet Rich Plasma (PRP) injection also exploits the healing factors found in platelets. A large sample of blood is taken, approximately 30–60mls which is then spun in a centrifuge. A centrifuge separates the cells in blood, into three main components: red blood cells, white blood cells and platelets. The platelets are then withdrawn and a comparable volume of blood product delivered to the diseased tendon, with the difference from an ABI being an 8–10 times increase in the concentration of platelets delivered. This is theoretically felt to improve the chances of healing, however is as yet unproven.

Vascular Studies

Vascular Ultrasound is a non-invasive ultrasound method used to assess the circulatory system.

Ultrasound can be used to evaluate arterial and venous disease. Vascular ultrasound incorporates doppler principles to assess blood flow through vessels using sound waves that produces images on a sophisticated machine directed by a trained professional. Typically, an ultrasound examination takes approximately 30 -60 minutes depending on the region examined.

The main advantage of ultrasound is that it has no radiation involvement and is relatively inexpensive.

Elastography

Ultrasound Shear Wave Elastography (also known as ARFI or Fibroscan) is a non-invasive method using ultrasound for quantifying tissue stiffness and elasticity.

It is a valuable tool in the diagnosis, staging, monitoring and management of liver disease

The ultrasound machine is capable of generating as well as measuring the speed of shear waves, i.e. vibration wave in tissues, a value is produced, and therefore this value can help determine the “hardness” of the liver tissue. Ultrasound shear wave elastography is a valuable tool as it is low cost, reproducible and easy to perform.

Radiofrequency Treatment

Radiofrequency ablation (RFA) is a safe proven means of interrupting pain signals. A Radiofrequency current is passed through an area of nerve tissue to desensitise the area. It is used to treat pain in various areas such as knees, hips, neck and spine.

Procedure
The procedure will be performed either using C.T imaging or Ultrasound depending on the treatment location.
During the procedure you will be lying on either your back or stomach. A few images will be taken and the Radiologist will then insert a small needle into the treatment location. A local anaesthetic is used to reduce any discomfort and once the needle is in the correct position a small electrode is inserted through the needle to stimulate nearby sensory and motor nerves.
A small RF current will travel through the electrode into the surrounding tissue, causing the tissue to heat and eliminate pain pathways of the nerves.

Preparation
Allow for at least 1 hour for this procedure
Ensure you have a driver
You will need to rest for 2-3 days after the procedure
Check with the receptionists regarding any medications you are taking when making the booking. Please notify them when booking if you are on blood thinning medication or stop smoking medication.

Post Procedure
You may get some instant relief due to the local anaesthetic used in the procedure this will eventually subside. You may experience some discomfort at the needle placement site and symptoms can worsen for a few days following the procedure but will improve over time. It may take several weeks for noticeable effect.
Radiofrequency treatment of nerves can block pain pathways for a prolonged period of time, up to two years. The procedure can be repeated if the nerves regenerate and the pain returns.

What is Interventional Radiology?

Interventional Radiology is an area of speciality of radiology in which minimally invasive procedures are performed using image guidance.

These procedures have less risk, less pain and less recovery time compared to open surgery. Real time images are used to direct the procedures, which are usually done with catheters or needles. The images provide road maps that allow the interventional radiologist to guide these instruments through the body to the areas of interest.

What is an X-ray?

An X‐ray is a picture taken of the inside of the body by a machine that sends out rays of radiation energy.

When these rays pass through skin and muscle they are blocked by the bones and teeth, creating shadow effects. These shadows are captured and displayed on a computer screen.

The different parts of your body have different body tissues which vary in their absorption of the X‐rays. This means bones, soft tissues and other internal features can be seen on the screen in varying shades of grey.

What is a Lumbar Nerve Root Sleeve Injection?

Lumbar Nerve Root Sleeve Injection (NRSI) is the introduction of local anaesthetic and/or steroid into the sheath around the nerve. This is usually requested because the nerve is thought to be inflamed by a disc pressing on it, by scarring after surgery, or from arthritis in an adjacent spinal joint. There are a number of other causes that are less common.

Steroids have a strong anti‐inflammatory effect and hence, reduce pain over a period of time. This treatment may result in permanent remission of symptoms. However, the effect may be temporary, lasting weeks or months. A positive result however confirms the diagnosis, and then other treatments may be applicable.

What is a Facet Joint Injection?

The facet joints are located between the vertebral bones of the spine and are often associated with back pain.

Facet joints can be injected under x-ray or CT guidance with a combination of anaesthetic and anti-inflammatory steroid (such as cortisone) to provide relief from pain. The pain relief can last from weeks to months, however, in some instances no pain relief benefits are perceived.

What is a Calcium Score?

A Coronary Calcium Scan looks for specks of calcium (calcifications) in the walls of the coronary (heart) arteries. These calcifications are an early sign of coronary heart disease (CHD).

In Coronary Heart Disease (CHD), waxy or fatty deposits (known as plaque) build up in the walls of the coronary arteries (the arteries of the heart). This may cause vessel narrowing, reducing the flow of oxygen-rich blood to the heart, resulting in chest pain or discomfort called angina. They may also rupture, with a blood clot forming on the surface, which may partly or completely block the coronary artery. This is the most common cause of a heart attack. Over time, calcifications form in these coronary artery plaques, which can be detected in a Coronary Calcium CT Scan, often long before a patient even experiences symptoms.

Low dose CT can accurately detect and quantify calcified coronary artery plaque, allowing coronary risk stratification. A positive scan confirms the presence of coronary artery disease.

CHD also can lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can’t pump enough blood to meet your body’s needs. Arrhythmias are problems with the rate or rhythm of your heartbeat.

Who should consider having their calcium scored?

  • Smokers
  • Family history of heart disease
  • Other vascular disease
  • High blood pressure
  • High cholesterol (high LDL, low HDL)
  • Diabetes
  • Overweight or obese

Procedure

The technician who operates the scanner will clean areas of your chest and apply sticky patches with sensors called electrodes. The patches are connected to an ECG (electrocardiogram) machine. The ECG will record your heart’s electrical activity during the scan. This makes it possible to take pictures of your heart when it’s relaxed between beats.

The CT scanner is a large machine that has a hollow, circular tube in the centre. You will lie on your back on a sliding table. The table can move up and down, and it goes inside the tunnel-like machine. The table will slowly slide into the opening of the machine. Inside the scanner, an x-ray tube will move around your body to take pictures of your heart. The technician will control the CT scanner from the next room. He or she will be able to see you through a glass window and talk to you through a speaker.

The technician will ask you to lie still and hold your breath for short periods while each picture is taken.

The coronary calcium scan will take about 10 minutes, although the actual scanning will take only a few seconds. During the test, the machine will make clicking and whirring sounds as it takes pictures. The scan causes no discomfort.

You will be able to return to your normal activities after the coronary calcium scan is done.

Once the test finished please make an appointment to see your Doctor to discuss the results.

The results of your study will be available for your Doctor to review within 72 hours of the completion of the test.

Please bring any previous imaging with you on the day of your examination. If you have any questions please don’t hesitate to ask.

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