Please be advised of the following changes in regards to payment for diagnostic imaging.
health-med-212-bulletin-payment-diagnostic-imaging-referred
Some patients with certain chronic liver diseases are at increased risk of Hepatocellular Carcinoma (HCC). Canada Diagnostic Centres offers regular HCC screening exams for patients who benefit from this surveillance. These patients will be assigned a HCCRAD score of one of the following: NA/0/1/2/3/. The criteria of which is outlined below:
NA – Not applicable: Patient demographics do not currently indicate high enough risk for HCC to warrant ongoing screening with ultrasound every 6 months
0 – Exam limited or non-diagnostic.
Liver evaluation or follow-up with an alternate modality (such as CT or MRI) is recommended.
1 – No mass or suspicious findings.
No sonographic evidence of worrisome liver mass or nodule. Follow-up ultrasound in 6 months.
2 – Lesion is 10 mm or less in size.
This finding warrants close ultrasound follow-up in 3 months.
3 – Liver nodule/mass greater than 10mm in size detected.
This finding warrants diagnostic testing to assess for features of Hepatocellular Cancer (HCC.) Referral to Hepatologist for definitive work-up recommended.
Breast MRI
Screening in Women at Higher-Than-Average Risk: Recommendations from the ACR
BIRADS* Interpretation Guide:
- BI-RADS 0: Imaging investigation not yet complete.
- BI-RADS 1: No abnormality; return to regular screening.
- BI-RADS 2: Definitely benign finding; return to regular screening.
- BI-RADS 3: Probably benign finding (<2% likelihood of cancer); 6 month follow up recommended.
- BI-RADS 4: Suspicious for malignancy (2-95% likelihood of cancer); biopsy recommended.
- BI-RADS 5: Malignancy until proven otherwise (>95% likelihood of cancer); appropriate action must be taken.
*Breast Imaging Reporting and Data System (American College of Radiology)
General Recommendations
Screening
Canada Diagnostic Centres is adopting Alberta’s 2013 Towards Optimized Practice guidelines on breast cancer screening. In summary these suggest:
- Annual mammographic screening for women age 40-49 who chose to begin screening early;
- Biennial mammographic screening (every two years) for women age 50-74 with average risk for breast cancer, but annual screening for those with higher risk;
- Biennial mammographic screening to continue if appropriate for women 75 and older;
- Consideration of screening ultrasound as an adjunct to mammography in women with dense breast parenchyma, as identified by a Radiologist.
For further reference, the Canadian Association of Radiologists recommends annual screening beginning at age 40 for all women, every one to two years from age 50-74, and from 75 onward if they are in good general health.
Diagnostic Studies
Imaging tests do not detect all breast cancers. If there is ongoing clinical suspicion for malignancy despite a negative imaging work-up, further management based on the clinical findings alone should be pursued including possible biopsy.
Diagnostic Categories (2013 CAR Reporting Guidelines)
| Patient Group | Category Name | T-Score Value | Z-Score Value |
| 50 Years and older | Normal | >= -1.0 | |
| Low bone mass | Between -1 and -2.5 | ||
| Osteoporosis | <= -2.5 | ||
| Under age 50 | Within expected range for age | > -2.0 | |
| Below expected range for age | <= -2.0 |
Fracture Risk and Treatment
Canada Diagnostic Centres follows the 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada, and the 2013 Canadian Association of Radiologists Technical Standards for BMD Reporting, to interpret BMD exams and to derive a 10 year absolute fracture risk for each patient 50 and older. Treatment is based primarily on this risk level.
Pharmacologic fracture prevention therapy should be offered to those at High risk, and should also be considered for some patients with specific clinical factors otherwise placed at Moderate risk.
Vitamin D supplementation, adequate dietary Calcium, and targeted exercise are recommended for all patients.
Patients with a T-score of -2.5 or lower (Osteoporotic) should have biochemical tests including:
- 25-Hydroxyvitamin D level, serum calcium (albumin corrected), CBC, creatinine, alk phos, and TSH;
- Those with vertebral fractures should also have serum protein electrophoresis as well.
View clinical practice guidelines quick reference guide from osteoporosis.ca
General Information
The Osteoporosis Society of Canada recommends that BMD be performed at least once in all patients aged 65 and over, in addition to other potential indications in younger patients.
The International Society for Clinical Densitometry recommends that follow up Bone Mineral Densitometry studies be performed on the same machine at the same centre as the previous study, for maximum sensitivity and accuracy in assessing change.
(Provided by the Canadian Association of Radiologists)
The 2012 CAR Diagnostic Imaging Referral Guidelines are intended for physicians and are aimed at assisting them in making decisions regarding appropriate imaging studies for specific cases. These Referral Guidelines are not intended as a means of restricting the physician’s role in the process of decision-making regarding the imaging studies to be requested. The Referral Guidelines are evidence-informed and are based on expert opinion or case studies. They should not be used to diminish in any way the freedom of attending physicians to determine and order imaging studies for their patients for whom they have the ultimate responsibility. Discussion between the radiologist and the physician, particularly during multidisciplinary team meetings, must always take precedence.
Section A: Central Nervous System
Section B: Head and Neck
Section C: Spine
Section D: Musculoskeletal System
Section E: Cardiovascular
Section F: Thoracic
Section G: Gastrointestinal System
Section H: Urological, Adrenal and Genitourinary Systems
Section I: Obstetrics and Gynaecology
Section J: Trauma
Section K: Cancer
Section L: Pediatrics
Section M: Breast Disease
https://car.ca/patient-care/referral-guidelines/
Radiation Safety
Is medical radiation safe?
In short, yes. Media reports sensationalizing the risks associated with radiation are a popular topic.
However, there is an old adage that a little knowledge is a dangerous thing, and this certainly applies to the complex issue of medical radiation.
While caution is appropriate in children especially, reflex avoidance of all radiation is not necessary or helpful, should not be confused with Choosing Wisely, and should not prevent patients from receiving the Best Test First® for their condition when indicated (be that a CT scan or other investigation.)
We refer you to this article – Radiation Risks of Medical Imaging: Separating Fact from Fantasy (Radiology 2012).
