Radiology Sengkang Hospital

[Mandy Geise]

The Department of Radiology at Sengkang General Hospital provides a wide range of radiological services. There is a dedicated team comprising of radiologists, radiographers, nurses and allied health team who are well-trained in all aspects of radiology and radiography. The team works closely with other clinical departments within SKH to provide a seamless pathway of care for patients.

The services offered ranges from general radiology to specialised radiological procedures that are carried out using a multidisciplinary approach in close collaboration and consultation with patients' physicians to achieve holistic patient care. The department also provides imaging subspecialties in body imaging (gastrointestinal, hepatobiliary, genitourinary), breast imaging, head and neck imaging, vascular and interventional radiology, musculoskeletal radiology and uroradiology.

The department is equipped with dedicated imaging modalities such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Angiography for specialised and interventional procedures. It also has a fully computerised Integrated Radiology Information System from CareStream Health, which provides seamless integration with the hospital systems and the National Electronic Health Records (NEHR) for greater overall efficiency.

Radiological Sciences services within the SingHealth cluster are spread across 7 hospitals and national specialty centres, making it the largest radiology affiliation in Singapore, comprising 50% of public sector radiologists and nuclear medicine physicians. We provide extensive imaging and image-guided intervention services using modern imaging such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), thus providing specialised services to our patients. Every year, we perform more than 1.3 million imaging studies and over 12,000 image-guided interventions. The nuclear medicine (NM) and molecular imaging service in SingHealth performs more than 17,000 NM and PETCT scans every year, with over 5000 clinic consultations and radionuclide treatments annually.

In 2021, Radiological Sciences SingHealth (RSS) was set up as a special unit within SingHealth to enhance the current radiological services by implementing patient-centric seamless care with innovation. This enterprising endeavour of the RSS involves integrating SingHealth imaging appointment slots island-wide into a central pool to ensure that our patients get their investigation and treatment as promptly as possible. Thus, patients may be directed to another SingHealth institution, other than their treating institution, to receive their imaging appointment. This allows patients to have their scan at the earliest availability, and when available, to book an appointment slot at a SingHealth institution closer to their home for greater convenience and accessibility. Imaging services across SingHealth institutions share a common set of treatment protocols and patients remain assured that high standards of care are consistently upheld across all our institutions.

General radiography or x-ray is the foundation of all diagnostic imaging using ionising radiation. This technology uses x-rays to produce an image, which is captured by an image receptor. Plain radiographs are commonly requested by doctors as an initial evaluation upon first consultation or as baseline screening. X-rays may be taken in the x-ray rooms, or at the bedside when necessary.

Fluoroscopy uses a special contrast dye and a continuous stream of x-rays to produce images through which the radiologist can see the body part and its motion in detail. This provides the radiologist with information about the function and movement of the body in real time, which helps them to determine the appropriate diagnosis and treatment for the patient.

Examples of fluoroscopy investigations are: barium-related studies such as barium meal, barium enema, defecating proctography, and video fluoroscopy studies to assess swallowing abnormalities. Water-soluble contrast studies are popular in children and babies to look for congenital gastro-intestinal or urological abnormalities in studies such as water-soluble swallow, micturition cystouretherogram (MCU) etc. Water-soluble contrast scans are also performed in adults, mostly to look for post-surgical status or complications.

Fluoroscopy is also widely used in musculoskeletal imaging whilst performing diagnostic contrast injections for shoulder, wrist and hip joints prior to MRI. Therapeutic joint injections are occasionally performed using fluoroscopy, as are other procedures such as endoscopic retrograde cholangiopancreatography (ERCP), feeding tube insertions, fracture fixations using plates and screws etc.

Intravenous urography is a specialised x-ray examination of the urinary system, including the kidneys, ureters and bladder. A contrast agent (dye) is injected before the scan, and is used to highlight the urinary tract and study the ability of the urinary system to excrete urine. In this procedure, the contrast agent injected into the body will be cleared by the kidneys and excreted out as part of the urine.

Patients are given instructions on how long to fast before the test. Diabetic patients should inform the radiography department before the scan as they may need different instructions on the preparations.

Computed tomography, commonly known as CT scans, combines the use of x-rays and computer systems to generate cross-sectional images of the human body. X-rays that pass through the body are captured and processed by the computer to create clear and detailed images of internal organs and structures. Advances in technology allow the x-ray dose to be tailored to each patient and kept as low as possible.

Bone Mineral Densitometry (BMD) is also known as Dual X-ray Absorptiometry (DXA). It is used to screen for reduced bone densities, also known as osteopenia or osteoporosis, and predict fracture risk. BMD can be used to monitor patients who are on treatment for such conditions.

BMD may also be used to measure body composition, i.e. the amount of bone, fat and muscle in the body, as part of clinical evaluation for patients who are obese or have muscle wastage. BMD involves a low level of radiation, much lower than standard X-ray examinations.

Angiography is the x-ray imaging of blood vessels using contrast agents (dyes) injected into the bloodstream through a thin plastic tube or catheter that is placed directly in the blood vessel, to take images known as angiograms.

Angiography provides information about blood vessel abnormalities, such as narrowing, blockage, inflammation, abnormal widening and bleeding. The contrast agents are injected into the blood vessels to make them visible on X-rays. Angiography is also used to guide procedures that treat blood vessel abnormalities, such as inserting stents.

SingHealth hospitals offer screening mammography, breast ultrasound, breast MRI and breast biopsies. A mammogram is a low-dose x-ray of the breasts to screen for breast abnormalities, especially useful for early breast cancer detection. Mammography may be used with other imaging techniques such as ultrasound and MRI to make a more accurate diagnosis. Breast ultrasound uses sound waves to create images of the internal structures of the breast, whilst breast MRI creates images of higher resolution. Breast biopsies are performed to remove a small amount of breast tissue for testing. Breast imaging services are offered at SGH, CGH, NCCS, KKH and SKH.

SingHealth hospitals and specialty centres also offer scans without radiation, such as Magnetic Resonance Imaging (MRI), which uses a strong magnetic field and radio waves to take detailed images of organs and tissues in different planes of any part of the human body. This allows radiologists to visualise internal structures, especially soft tissues, in the body.

We perform a wide variety of MRI exams such as brain, spine, prostate, cardiac, breast and musculoskeletal MRI. Unlike x-rays or CT scans, MRI does not use radiation by default. Intravenous contrast dye may be used, which improves clarity of the images to make a more accurate diagnosis.

The strong magnetic field used in MRI attracts magnetic objects, including implants, jewellery and metal zippers which need to be removed prior to scanning. Please inform the radiographer if you have any metal implants.

An ultrasound scan uses high-frequency sound waves to examine structures in the body, including large organs, blood vessels, muscles, tendons and ligaments. A scanning probe is placed on the skin which gives off high-frequency vibration, which enter the body and echo back, creating real time ultrasound images. Ultrasound does not involve radiation, and is a relatively safer imaging technique compared to common scans involving radiation. It is non-invasive and can be used safely in children and pregnant women.

Interventional Radiology is a branch of medicine specialising in the use of modern imaging modalities, including digital subtraction angiography, ultrasound fluoroscopy and computed tomography (CT), to guide the performance of minimally invasive diagnostic procedures and treatments in different parts of the body. These treatments offer less risk, less pain and faster recovery, compared to traditional surgery.

The scans and treatments described above use radiation to see inside the body. One of the most common concerns shared by patients in the Radiology department is "How much radiation is involved?"

Effective radiation dose is measured in milli-sieverts (mSv). We are exposed to natural background radiation daily, which is approximately 2.4mSv yearly. This figure varies depending on geographical location, as it depends on the radioactive elements in the air or the radioactive materials present in rocks, soil, or building materials. Nevertheless, we can estimate the effective radiation dose by comparing the average radiation dose from common scans with the dose that we receive daily from background radiation.

c80f0f1006