A Letter From the Radiologist
June 2009: Specialized Patient Care During Interventional Radiology Procedures

Making Quality Care Affordable

The struggling economy has caused many to be more concerned about healthcare costs. For some, the loss of a job or health insurance causes greater concern. This worry has resulted in many delaying needed care. According to a Kaiser Family Foundation March 2010 poll*, “Nearly six in ten (57 percent) say they have put off some sort of needed care over the course of the year because of the cost.” Even more alarming, this poll found that those currently in ill health are much more likely to report passing up on needed care for cost reasons.

Olympic Radiology understands these concerns, and wants to help make necessary care affordable. We offer several options for both the insured and non-insured.

Quality care made affordable with…

Sliding scale discounts up to 80%1
Pay in full discount of 35%2
Budget Payments
No billing fees or interest

1 Sliding scale discount must meet income qualifications.
2 Pay-in-full discounted rate must be paid at time of service

Patients without insurance: There are a several options, depending on financial circumstance. Olympic Radiology offers a 35% discount when paying in full at the time of service. We also offer discounts of up to 80% on a “sliding scale” based on income level. Payment arrangements may be made for any remaining balance.

Patients with health insurance: Patients should familiarize themselves with the details of their health plan. Many insurance plans will cover a portion of an exam, with patients responsible for the remainder. If the co-insurance is still a stretch for a budget, monthly payments with no interest charges may be arranged.

Olympic Radiology’s financial options ensure that recommended diagnostic imaging is not missed because of cost concerns.

For more information, please contact our billing staff at (360) 415-7280.

*Kaiser Family Foundation Kaiser Health Tracking Poll (March 10-15, 2010). http://www.kff.org/kaiserpolls/8058.cfm

Spring Sports Spoilers

The arrival of spring often means getting outside and participating in outdoor sports. The winter season spent indoors and inactive often means our bodies may not be ready, and injuries can occur. Joint injuries, such as the shoulder, elbow, and knee are common and diagnostic radiology can be valuable in identifying problems. Clinicians may refer a patient for imaging to get a better view of the injury.

Magnetic Resonance Imaging (MRI) has become a staple in the assessment of sports injuries. MRI can detail very subtle abnormalities in the soft tissues of the body, including ligaments, tendons, and cartilage. X-Ray and CT based imaging has a limited role in evaluation of soft tissue injuries, but is helpful in evaluating fractures or bone deformities.

SHOULDER
Shoulder injuries are common in athletes who use their arms in overhead sports such as volleyball, swimming, baseball and tennis. As the arm is lifted, the acromion may impinge on the surface of the rotator cuff causing pain and limiting movement. MRI is most commonly used in diagnosing rotator cuff injuries from degeneration to partial or complete tears.

ELBOW
Repetitive overuse of the arm is the most common cause of tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis). Injury is caused when the muscles and tendons of the forearm become inflamed by certain repetitive movements of the wrist or excessive, constant gripping or squeezing of a racket or golf club. X-ray may be ordered to rule out other causes of pain, such as a fracture or arthritis. Rarely, an MRI may be requested.

KNEE
The ACL (Anterior Cruciate Ligament) is most often injured when the foot is planted and the knee twists to change direction, as is common in many sports. While X-Ray can show damage to knee bones, MRI can show damage to the ligament.
The meniscus is one of the most injured parts of the knee. When inflammation is present, walking becomes more difficult. Signs of inflammation are: stiffness and swelling, tenderness at the joint line, collection of fluid, catching or locking of the knee, and buckling. MRI is very helpful in evaluating the meniscus. A tear is apparent when the normal triangle shape of the meniscus is disrupted, or a portion seen is in an abnormal position.

Calming MRI Fears

MRI is a very important diagnostic tool for a variety of medical conditions. The idea of an MRI may conjure up scary images for some, but many who have been through the exam can tell you that there are ways to make the experience calm, comfortable and relaxing. Taking these few steps can help eliminate the anxiety and fear of the unknown.

Talk to the MRI technologist about the procedure. The technologist can thoroughly explain what is going to happen so you know what to expect. It's important that you tell her what bothers you. She may be able to offer you a wash cloth to cover your eyes, pillows, blankets, or supports so you are as comfortable as possible.

You will be given headphones that you can use to listen to music. This may keep your mind focused on something else. Talk to the scheduling department about the possibility of bringing your own CD or MP3 player to your MRI exam.

Breathe. Gently close your eyes, relax your muscles and let go of the tension. Visualize yourself in a comfortable place. Some patients find the hum of the MRI magnet so relaxing that they even fall asleep. Earplugs can be provided in addition to the headphones to make the experience quieter.

Evaluate your pain level. You will need to remain still for the test. If you are claustrophobic, any pain you may have may increase your anxiety. Talk to your physician if you feel pain medication may be needed. Pain medication and/or sedatives must be taken before the exam in order to be effective. Be sure to communicate with the scheduling staff if you are considering sedation.

The MRI technologist will be able to see you and hear you throughout the exam. You may also communicate with her if you are have concerns or are feeling discomfort. She may be able to help by adjusting the temperature of the room, or by providing additional comfort items.

Taking just a few steps can help you relax and make it through your MRI without worry.

Are Scanners at the Airport Safe?

Do air travelers need to worry about radiation exposure if full-body scanners are used as a security measure at the airport? Not according to the American College of Radiology (ACR). In a statement released in January, the ACR indicated:

An airline passenger flying cross-country is exposed to more radiation from the flight than from screening by one of these devices.
A traveler would require more than 1,000 such scans in a year to reach the effective dose equal to one standard chest x-ray
For more information on the scanners proposed and radiation exposure, visit www.acr.org

For more information on the types of scanners proposed and radiation exposure, visit the news sections at www.acr.com or www.radiologyinfo.com.

Diagnostic Imaging and Radiation Safety

By James Rohlfing, M.D., Olympic Radiology

Advances in medical imaging, with the improved ability to non-invasively diagnose disease in its early and most treatable stages, have been shown to contribute to greater life expectancy and declines in cancer mortality rates. Diagnostic imaging procedures are generally less expensive and associated with less risk than the invasive procedures that they replace. From the standpoint of an individual patient, the benefits of appropriate diagnostic medical imaging are immediate and can even be life saving. However, from the standpoint of the general population, widespread use of medical imaging, especially computed tomography and cardiac imaging, has resulted in increased radiation exposure to Americans, with concerns of potential increased risks of delayed radiation induced cancers. We take these concerns seriously.

From the start of residency training, Radiologists are taught to apply the principle of As Low As Reasonably Achievable (ALARA) when performing radiologic exams.
The advent of fast and powerful multislice helical CT scanners, which allow imaging a patient through multiple phases of contrast enhancement, has created a risk of exposing the patient to higher doses of radiation, sometimes with little additional diagnostic benefit. We believe that It is the duty of the Radiologist to tailor each exam to provide the most diagnostic information at the lowest possible radiation exposure. When performing a CT exam at Olympic Radiology, the following dose reduction strategies are used for every patient:
We utilize dynamic dose reduction technology, which varies the output of the x-ray tube during the scan to provide diagnostic images with the lowest dose. Thin parts such as the neck, or air filled lungs, require a lower dose to provide diagnostic images.
Some studies, such as sinus CT (with large contrast between bone and air), are performed with a very low dose technique.
Multiphasic imaging can be a very useful technique, but efforts are made to limit its use to those situations that require it.

In considering ordering diagnostic imaging exams, especially CT, we recommend adherence to the following guidelines:
In ordering an imaging study utilizing ionizing radiation, the benefit of the study to the patient should outweigh the potential risk of the radiation exposure. Factors that may increase the risk of radiation to a patient include age, as children are more radiosensitive that adults. As there is typically a 20 year lag between radiation exposure and radiation induced cancers, older individuals or those with a lower life expectancy are at very low risk.
While CT remains the most efficacious exam in imaging the neck, chest, and abdomen, MRI (and, for some indications ultrasound) have seen similar improvements in diagnostic power and are free of ionizing radiation. Ultrasound is the preferred modality for evaluation of biliary and gynecologic pathology. MRI is often preferred first line modality for non-GYN pathology limited to the pelvis.
The American College of Radiology, working with clinical experts, has developed appropriateness criteria which are of great benefit in determining the most effective strategy for medical imaging based upon presenting complaint or disease. These can be found at www.ACR.org under Quality and Safety Resources. Or call Olympic Radiology and ask for a Radiologist for any questions concerning exam selection.

PET/CT Service is now available at Olympic Radiology every Monday and Wednesday. Combined PET/CT scans provide images that pinpoint the location of abnormal metabolic activity within the body, providing a more accurate diagnosis.