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

Flexible Appointment Options

Olympic Radiology offers many appointment options for patients and referring offices. Communication is the key to ensuring we schedule appointments to best meet the clinician and patient expectations.

Patient convenience: We have found that some patients were surprised to learn that we had a Poulsbo location available but were scheduled in Bremerton, or vice versa, and would have preferred the other. For best patient satisfaction, ask them which location may be more convenient to where they live or work.

Morning and evening appointments; walk-in exams without appointment: Patients can often be seen before or after work. They can also walk-in without an appointment for x-ray and sinus CT exams.

Urgent exams: We can often accommodate same day or next day appointments. Please advise the scheduler when you call. We will work with your office, the patient and insurance pre-authorization requirements to see your patient as soon as possible.

Changing needs: Sometimes patient needs change after the appointment is initially scheduled. Or, the patient was not in the office during scheduling and the location, date or time is not convenient for them. Please give us a call, or advise the patient to do so. Our schedule changes due to rescheduling or cancellations so new selections may become available. If a patient’s exam needs to be canceled, please let us know so we can offer that appointment to another patient.

Working together with you and your patient, we can accommodate your patient’s needs in a timely, convenient and appropriate manner..

DSHS Now Requires Pre-Authorization for Imaging

Effective for dates of service on and after October 1, 2011, DSHS will require web-based prior authorization requests for covered outpatient advanced imaging services performed on eligible Medicaid clients.

DSHS and Qualis Health are partnering to provide web-based access for utilization review and prior authorization for outpatient advanced imaging services. OneHealthPort will provide secure access and logon. The authorization must be obtained online.
Only selected CPT codes are required for Qualis Health review. (See chart below)

HOW TO OBTAIN PRIOR AUTHORIZATION
The physician or designated personnel must submit a review to Qualis Health through a web based, secure system (iEXCHANGE) - log in through One Health Port.
iEXCHANGE will collect basic patient information for those imaging procedures requiring pre-service review, as well as, completion of a medical necessity questionnaire embedded in the iEXCHANGE case.
Qualis Health will forward completed reviews to WA Medicaid for final determination. Qualis will issue a case reference number – this is NOT the authorization number
Medicaid will fax final determination information including the authorization number to the requesting provider.

RECONSIDERATION PROCEDURES
Qualis Health has a procedure in place for providers to request a re-review for advanced imaging services. The physician or practitioner may request a re-review of the denial by fax by completing the Advanced Imaging Request for Review form found on the Qualis Health website

More for You and Your Patients

Olympic Radiology has made progressive changes in 2011, with a focus on providing our referring offices and patients more.

More convenience
Opening a new location in Poulsbo provided convenient access to quality imaging for those who live or work in Bainbridge Island, North Kitsap and the Olympic Peninsula.

More clinical options
In 2011 we began offering new technology for clinical decision making, such as: Open MRI, Prostate MRI, and MRI Guided Prostate Biopsy.

More service
We created a dedicated scheduling team to work with you and your patients. We also upgraded our phone system for your convenience to offer hotlines for billing questions, medical records and our services manager.

Navigating the Pre-Authorization Process

Many insurance carriers now require prior authorization for MRI, PET/CT & CT services. They may call it “benefit advisory number” or “RQI Number”. Pre-auth may also be required for other imaging services, such as Nuclear Medicine studies, Fluoroscopy, and Ultrasound.

We at Olympic Radiology understand that navigating the pre-authorization process may sometimes seem burdensome or confusing to referring clinicians and staff. We are available to help you through this.

Most insurance carrier’s Radiology Benefit Management services (RBMs) subcontractors have made their policies and rules very clear that radiology facilities must follow compliance requirements, and may not get too involved in securing preauthorization approval. So while we cannot obtain the authorization for you, we can be your partner in the process.

As your partner, we can help by giving you the tools to ensure the proper exam is authorized and scheduled. Should you have any questions about proper CPT codes, or other pre-authorization or procedures questions, our billing department can be reached at (360) 415-7280.

A copy of our Pre-Authorization chart with requirements and instructions for common carriers can be found here.. Updated hard copies of this chart are being delivered this month. If you need additional copies, please contact Allyson at (360) 616-0340.

Pre-Auth Tips: Before the Call

In our experience, providing the following in a timely manner to insurance carriers can make the difference.

• patient name and vital information
• ordering physician name
• imaging provider information (NPI, Tax ID)
• exams requested, including modality and what body part
• patient diagnosis, including clinical symptoms
• treatment (if any) that has already occurred and the results

General Time frame for Obtaining Pre-Authorization from Common Carriers

Are you curious how long it may take an insurance carrier, or their benefit management company to obtain prior authorization (sometimes called benefit advisory, RQI number, etc) after the initial contact?

Below is a guideline for some common carriers based on recent examples.

Aetna: 72 hours
Cigna: 72 hours
CHPW: 48 hours
Group Health: 5 days unless marked urgent
Regence: usually 30 min if contacted by phone
Premera: usually 30 min if contacted by phone
WA state L&I: 72 hours
Self insured L&I: 72 hours
Tricare: 4-5 days
OWCP : depends on case, sometimes up to 4 days

Please consider the above before scheduling your patients and plan accordingly.

Changes in Your Practice?

If you have added any new clinicians to your practice, or if you plan to add a new clinicians, please let us know. We can update our database to include all of their information, and set up PACS access for them before their first referral is ordered—making that first referral smooth and simple.

In addition, if a clinician has left your practice, or will be leaving soon, let us know as well. This ensures that our database is up to date and report delivery is timely and accurate.
Please contact our Services Manager, Allyson at (360) 616-0340 or Allyson@olympicradiology.com to discuss any changes.

Cutting-Edge Technology Available for Cancer Diagnosis and Staging

PET/CT in-office suite
Olympic Radiology has been providing PET/CT services to the community for over ten years. Positron emission tomography (PET) combined with CT is state-of-the-art imaging that allows physicians to pinpoint abnormalities in cellular activity often indicating cancer, heart disease or neurological disorders.

We are now pleased to offer the first and only in office PET/CT suite in the West Puget Sound at our new Poulsbo location.

The location of Olympic Radiology Poulsbo makes it convenient for residents of Bainbridge Island, Kitsap County, and even nearby Jefferson and Clallam Counties. Having this technology available in house for local residents ensures that appointments can be scheduled quickly, and travel time minimized. Our comfortable patient recliners and bright, spacious imaging suite help create a pleasant experience.

New technology for prostate cancer
Working closely with local Urologists and Radiation Oncologists, Olympic Radiology now offers comprehensive prostate MRI and MR guided prostate biopsy. We are pleased to be the first and only practice in Washington state to offer these important tools.
Click here to read more about prostate MRI and MR guided prostate biopsy

Scheduling Tips

Certain basic information is helpful when calling to schedule a patient for an exam.

• Patient’s name, date of birth, phone number and insurance carrier.*
• Type of exam being requested and reason (i.e. symptoms and diagnosis)
• Any other pertinent information, such as special needs of patient (i.e. wheelchair bound, claustrophobic)
• Any prior images of the body area we examining so we can compare any changes

Referral forms provide schedulers, technologists, and radiologists with valuable information about your patient and the exam requested. Knowing the reason for the request, the provisional diagnosis or symptoms, or if there are prior exams for comparison eliminates the need for additional clarification calls to your office. This information does not need to be on Olympic Radiology’s form—we will gladly accept a referral sent from your own EMR system.
The patient experience is improved without any delays that may be created by the need to resolve conflicting information, and reduces the need for additional or repeat exams.

*Many insurance carriers require a form of pre-authorization. Contact our billing department at (360)415-7280 for assistance.

Prostate MRI and Biopsy

Working closely with local Urologists and Radiation Oncologists, Olympic Radiology is now offering comprehensive prostate MRI and MR guided prostate biopsy.

Other than skin cancer, prostate cancer is the most common cancer in American men. About 1 man in 6 will be diagnosed with prostate cancer during his lifetime. Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 36 will die of prostate cancer.

Clinical studies have shown that MRI utilizing new technologies including specialized coils for high resolution and signal to noise, diffusion weighted imaging, and dynamic contrast enhanced imaging with computer aided detection (CAD) can be of benefit in localizing prostate carcinoma within the gland, assist in staging disease, and provide a template for radiotherapy treatment planning.

There are currently only a few other practices in the country offering this technology, with the closest being in California.

For more information, clinicians may contact our radiologists at (360) 479-6555.

PACS Upgrade

Olympic Radiology has upgraded our PACS (Picture Archive Communication System) to offer you more options and features for viewing patient reports and images.

Active x download
Effective June 21st, Active X controls will need to be re-installed on a computer in order for the upgrade to be effective, and for you to continue to view images. This download will only need to be completed ONE TIME on a computer. If you have any issues with downloading Active X online, the files are available on CD. Please contact Allyson at (360) 616-0340 or Allyson@olympicradiology.com to request a copy.

Click here for a description of the enhanced features

Convenience. Comfort. Quality. No Compromise

With Olympic Radiology‘s 2nd location now in open in Poulsbo, local residents do not need to compromise convenience, comfort, or quality for medical imaging. Our office in North Kitsap’s new medical complex, Cascade View Medical Center, is conveniently off of Highway 3 and Highway 305—just 10 minutes from the Agate Pass Bridge, 10 minutes from the Hood Canal Bridge, and 8 minutes from Silverdale.

Our warm, inviting office was designed for comfort before and during the exam. Beautiful furniture, designer colors and accents help create a relaxing feeling from the minute you walk in the door. Our bright, spacious exam rooms with new cutting edge equipment ensure the best quality imaging.

Never Feel Confined Again

The Philips Panorama High Field Open MR in Poulsbo provides an almost 360-degree panoramic viewing angle and spacious patient aperture ensuring a comfortable, relaxing MRI experience for anxious, elderly, large or claustrophobic patients. And while patients relax, clinicians get high-field strength to see things previously unseen on an open MR system. The high-field performance is comparable to a 1.5T.

Click Here to view image clinical image comparisons of a 1.5T and our High Field Open MRI.

To schedule an Open MRI, please call us at (360) 479-6555

Phone number updates

It’s now even easier to reach the Olympic Radiology Department you need. Direct phone numbers have been established to better serve you.

Scheduling/Main Phone Line: (360) 479-6555
Billing/Insurance/CPT info: (360) 415-7280
Fax: (360) 479-8327
Medical Records/Reports: (360) 616-0339 *NEW!

CT dose reduction technology

Recent concerns over radiation exposure from imaging studies have left some patients inquiring about the radiology studies ordered by their physicians. Some of these studies use radiation to obtain the picture, including CT. The amount of radiation exposure varies by procedure, but typically radiation doses from imaging exams are relatively small and the clinical benefit of an exam far outweighs the risk.

From the start of residency training, radiologists are taught to apply the principle of As Low As Reasonably Achievable (ALARA) when performing radiologic exams. We 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.
In some studies, such as sinus CT (with large contrast between bone and air), thin parts such as the neck, or air filled lungs, a very minimal dose is utilized to provide diagnostic images.

Olympic Radiology offers CT exams in Bremerton and Poulsbo. If you or your patients have any questions about low-dose CT, please contact Olympic Radiology at (360) 479-6555 and ask to speak with one of our radiologists.

In Poulsbo, PET+CT=Clear Answers

In order to better serve the community, our Poulsbo location now offers the first in office PET/CT in the West Puget Sound. Our comfortable patient recliners and bright, spacious exam room help create a pleasant experience. Having this technology available in house for local residents ensures that exams can be scheduled just days after requested, and travel time minimized.

Positron emission tomography (PET) combined with CT is state-of-the-art imaging that allows physicians to pinpoint abnormalities in cellular activity often indicating cancer, heart disease or neurological disorders. Olympic Radiology has been please to provide PET/CT services to the community for over ten years.

Ultrasound with a clear image: Speckle Reduction Imaging

Ultrasound is one of the most widely used diagnostic tools in modern medicine, and is relatively inexpensive compared to many other tests. Using ultrasound, we can evaluate size, structure, and movement of the body's internal organs as well as pathological lesions. The technology can be highly effective in examining the liver, gallbladder, spleen, pancreas, kidneys, thyroid and parathyroid glands. Blood flow can be viewed with real time duplex imaging and is useful for evaluating the carotid arteries, the aorta with its larger branch vessels, and extremity deep veins.

Olympic Radiology’s ultrasound in both Bremerton and Poulsbo produces clear images, due to the system’s advanced Speckle Reduction Imaging capabilities. Speckle is an inherent imaging artifact that appears as “graininess” and often obscures anatomy in ultrasound images. Speckle reduction produces a sharper view of fine details when examining organs such as the thyroid and superficial parts like muscles.

Same day appointments available

Working closely with local Urologists and Radiation Oncologists, Olympic Radiology will be the first facility in Washington state to offer comprehensive prostate MRI and, with a referral from a Urologist or Oncologist, MR guided prostate biopsy.

Clinical studies have shown that MRI utilizing new technologies including specialized coils for high resolution and signal to noise, diffusion weighted imaging, and dynamic contrast enhanced imaging with computer aided detection (CAD) can be of benefit in localizing prostate carcinoma within the gland, assist in staging disease, and provide a template for radiotherapy treatment planning.

For more information, clinicians may contact our radiologists at (360) 479-6555.

OPEN for Business in Poulsbo this Spring

This spring, Olympic Radiology will open our second location in Poulsbo. At that location, we will add the latest in advanced MR scanning-a Philips Panorama High Field Open MR, featuring the best of both worlds: an open design and high-field (1.5T-like) performance.

Once you see our Panorama HFO capabilities, it will change the way you think about open MR imaging.

Some highlights of the new system include:
·    Vertical, high-field strength magnet for exceptional image quality and speed
·    Unique open design for maximum patient comfort
·    45 cm field of view for large coverage area
·    Integrated-body coil for large patients
·    Full range of high-end applications

You can now provide virtually all your patients--large, small, claustrophobic, or elderly--with a more comfortable MR experience AND 1.5T-like quality images to enhance your diagnostic confidence.

To view clinical image comparisons of a 1.5T and the new HFO MR, click here

New MRI Technology for Prostate Cancer Available Only at Olympic Radiology

Working closely with local Urologists and Radiation Oncologists, Olympic Radiology will be the first facility in Washington state to offer comprehensive prostate MRI and, with a referral from a Urologist or Oncologist, MR guided prostate biopsy.

Clinical studies have shown that MRI utilizing new technologies including specialized coils for high resolution and signal to noise, diffusion weighted imaging, and dynamic contrast enhanced imaging with computer aided detection (CAD) can be of benefit in localizing prostate carcinoma within the gland, assist in staging disease, and provide a template for radiotherapy treatment planning.

For more information, clinicians may contact our radiologists at (360) 479-6555.

Nuclear Medicine Rebounds from Dose Shortage

Our Nuclear Medicine department is pleased that the Moybdenum-99 shortage has ended, and that our exam capabilities have been fully restored. Many nuclear medicine imaging procedures use a critical—but scarce—medical isotope known as Molybdenum-99. Over the past year and a half, physicians and patients alike had to cope with a severe isotope shortage due to an extended and unanticipated shutdown at that Chalk River reactor in Canada. Chalk River operations resumed in August.

Nuclear Medicine is valuable in determining if many organs, such as kidneys, lungs, stomach are functioning properly. It can be used to determine a patient’s blood volume, vitamin absorption and bone density. These tests can show the precise location and extent of disease for many cancers and heart conditions.

Thank You for Your Valuable Feedback

Thank you to all area clinicians and medical office staff who completed our 2010 survey. Responses are being reviewed and results will be provided to you in the coming weeks.  This annual survey is very valuable to determining how Olympic Radiology can best serve you and your patients. Results are analyzed and new programs and tools designed based on your feedback.

In our 2009 surveys, you told us that quality is your most important factor in determining where to refer a patient for imaging. As a result, we implemented a patient satisfaction survey process to insure that our staff was providing exceptional service. Results were quite positive, as 99% of patients ranked the overall quality of care they received as “excellent”. Radiologist qualifications are also important to referring offices, so we made sure staff and patients were aware of the education and training of our physicians through our “Meet the Physicians” and “Your Radiologist” programs.

Patient choice in where to refer increased significantly in 2009 according to your re-we developed our “Your MRI” brochures, and provided education materials for offices regarding our billing and payment options for uninsured patients, or patients who may be putting of testing because of cost concerns.

As always, we will continue to work with you to develop ways to make our relationships even stronger. Your feedback is very valuable in shaping this process.

Insurance and Billing Tools for Radiology

We understand that knowing which exams require pre-authorization and how to obtain that for your patients can sometimes be a difficult, tedious process. Many insurance carriers require the referring office to obtain pre-authorization for exams, but we are here to help in anyway we can. You may contact our billing department at (360) 415-7280 with any questions.

Our Insurance Pre-Authorization chart is a resource that we designed to help guide you through the process. The chart includes common carriers, which exams do or do not require pre-authorization, and how to obtain the authorization from the carrier. Information was last updated in November 2010 and is now double sided to include more carriers.

Insurance and billing options can also be quite confusing for patients. Olympic Radiology has developed a new tool for your offices to share with them; a brochure entitled “Your Options: Understanding Insurance and Billing”. “Your Options” educates patients on pre-authorization, provides a list of contracted carriers and networks, and informs of discounts for the uninsured (including our sliding scale based on income). “Your Options” brochures are available to all practices free of charge. Please contact Allyson at (360) 479-6555 or by e-mail to arrange delivery of copies to your office.

October is Medical Ultrasound Awareness Month

October is Medical Ultrasound Awareness Month. This is our opportunity to increase the public's awareness of the importance of the imaging modality. Because the modality utilizes sound waves, and not x-rays to generate images of internal organs and structures, ultrasound is utilized to examine patients of all ages. Ultrasound is one of the most widely used diagnostic tools in modern medicine, and is relatively inexpensive compared to many other tests.

There are several areas of specialization in the field of diagnostic medical ultrasound, including:

• Abdominal ultrasound—evaluation of all the soft tissues, blood vessels, and organs of the abdominal cavities (e.g., liver, spleen, urinary tract, and pancreas).
• Breast ultrasound—evaluation of breast abnormalities that are found with screening or diagnostic mammography.
• Obstetric/gynecologic ultrasound—evaluation of the female reproductive system.
• Vascular ultrasound—evaluation and analysis of the hemodynamics (blood flow) of peripheral and abdominal blood vessels

Click here to read Dr. Bradley Brown's Letter From the Radiologist about Medicare's free AAA ultrasound screening

You Make a Difference

Olympic Radiology recognizes the significant contributions that so many make to our community.
We would like to express our thanks and gratitude as you are saluted over the next few weeks. It is our pleasure to work with you.

Nuclear Medicine Week: October 3 — October 9
National Physician Assistant Week: October 6 — October 12
Medical Assistant Recognition Week: October 18 — October 22
National Nurse Practitioner Week: November 7 — November 13
National Radiologic Technology Week: November 7 — November 13

Spotlight on Our Technologists

In honor of National Nuclear Medicine Week, October 3rd—October 9th, National Radiologic Technology Week, November 7th — November 13th, and National Ultrasound Awareness Month, October, Olympic Radiology would like to salute and thank our skilled, dedicated technologists.

Diagnostic Radiologic Technologists use some of the most technologically advanced equipment and computer technology in the medical field to acquire and manipulate images, so that clinicians may better diagnose and treat an injury or disease. While performing the exam, our technologists also take into account the patient's physical, emotional and mental ability and the nature of injury or disease suspected or present. Their communication with patients and radiologists is critical to solving problems.

Each of our technologists have completed an associate degree or bachelors degree program with an in-depth study of anatomy, biology, physics, and radiation safety as well as a clinical rotation where they worked side-by-side in radiology departments with doctors, nurses and experienced technologists. Olympic Radiology participates in this education process with students from Tacoma Community College’s Radiologic Science program. These future technologists learn by working one-on-one with our seasoned staff.

All Olympic Radiology technologists have earned The American Registry of Radiologic Technologists certification, the gold standard in the United States for quality. Without this team of talented technologists, we could not provide the quality service the community has come to expect from us in Nuclear Medicine, Ultrasound, MR, CT and X-Ray.

Ground-breaking at Poulsbo's new Cascade View Medical Center

Cascade View Medical Center is currently under construction with an anticipated completion during January of 2011.  The 38,000 square foot facility occupies 2.5 acres within College Marketplace at Olhava adjacent to the entrance to Olympic College’s Poulsbo campus.  This location was chosen by the owners to offer convenient access to residents of Kitsap, Jefferson, Clallam Counties and Bainbridge Island by building adjacent to the Highway 3 and Highway 305 interchange. 

The building will be owned and occupied by a group of local physicians including: endodontist Dr. John Goessman; Dr. Michael Jungkeit of North Kitsap ENT; General Surgeon Dr. Sheila Lally; audiologists Drs. Diane and Scott Raszler of Hearing Advantage; Olympic Radiology; and family practice physicians Drs. Brad and Teresa Andersen, Dr. Mark Hoffman, and Dr. Charles Power of Sound Family Health.

Olympic Radiology will provide open MRI, ultrasound, x-ray and the first fixed PET/CT system on the Kitsap Peninsula at Cascade View.

A ground-breaking ceremony was held Thursday, August 12th.

Click here for more info from Kitsap Sun article

Olympic Radiology Bringing High Quality Medical Imaging to North Kitsap Location

Olympic Radiology is pleased to be a part of a new medical complex beginning construction soon in Poulsbo. 

A group of local physicians will own, occupy and operate the two story facility adjacent to Olympic College’s Poulsbo campus near the Hwy 3 and Hwy 305 interchange. 

Harrison Medical Center will be leasing space in the new building and expects to provide general medical services and laboratory services. 

This new facility will provide enhanced convenience for  residents of North Kitsap County, Bainbridge Island and nearby Jefferson and Clallam counties.

The opening of this second location allows Olympic Radiology the opportunity to introduce a fixed site PET/CT scanner, the first on the Olympic Peninsula.  Olympic Radiology will also provide wide bore MRI, X-Ray, Ultrasound, and CT in an inviting, comfortable, state of the art facility. 

Ground-breaking date and more details will be available soon.  The facility plans to be open in late 2010 or early 2011.

EMR? Get Reports the Easy Way

Consider receiving results via fax-to-EMR or download from PACS.  For your convenience, we can put your patient’s medical record number or other results reference number on the report. Just provide this information on the referral form, at the time of scheduling, or anytime before the final report is issued.

Your MRI - A Patient's Guide

What does it mean to be told that you need to have an MRI? What is an MRI? How will it help me? How do I prepare? What can I expect during the exam? Olympic Radiology created a new brochure entitled Your MRI that helps answer those questions and educate the patient.

Your MRI provides answers and information patients want, preparation instructions, and tips for relaxation during the exam. When given at the time of referral, the mystery and possible anxiety about MRI can be minimized or eliminated.

Your MRI brochures are available to area offices free of charge. Please contact Allyson at (360) 479-6555 or allyson@olympicradiology.com to request copies of for your practice.

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.