Care • Comfor t • Connect

NEWS A Publication Of Radlink Diagnostic Imaging (S) Pte Ltd

• Issue No: 01-2008 • Mica (P) No: 050/02/2008

RadLink Diagnostic Imaging has provided state-of-the-art diagnostic imaging services to

the medical community since October 2000.
Our main centre located at Paragon Medical offers the full range of diagnostic scans. This includes our
3T High-Definition MRI, besides the other state-of-art imaging equipment.
We acquired Drs Lim, Hoe & Wong Radiology in December 2005 to help strengthen our presence in the
general practitioner community. With a branch located at Orchard Building and Jurong Point Shopping
Centre, this means more choice and convenience for your patients.
In July 2006, we opened a branch at Toa Payoh providing general radiology services catering to doctors
located in the central areas of Singapore.
In August 2007, we opened RadLink Women & Fetal Imaging Centre focusing mainly on expectant
mothers. This centre offers Ultrasound scanning including 3D and 4D scans by Consultants and
sonographers certified by the Fetal Medicine Foundation (UK).
We have 6 consultant radiologists who are subspecialty trained. Referring physicians would be able to
tap on their depth and breadth of diagnostic experience and collaborative support.
At RadLink, our exceptional imaging quality, compassionate care and accurate interpretations have
made us the preferred diagnostic imaging provider.

Our services
From the simple Chest X-ray to our latest 3T High-Definition MRI that provide clear views of the inner
structure and function of the body, our team of radiology professionals are ready to serve you.
Our 4 imaging centers offer a wide range of diagnostic exams and procedures. These services
include:
• MRI — 3T High-Definition & 1.5T • 64-Slice CT scanner
• Digital Mammography • Ultrasound / Colour Doppler
• Digital Radiography / Fluoroscopy • Bone Mineral Densitometry (DEXA)
Our branches:

• Paragon Branch • Orchard Building • Toa Payoh • Jurong Point

6836 0808 6737 3311 6255 0201 67926119
 New Service
3T High-Definition MRI
at Paragon Branch

Signa HDx 3.0T MRI scanner

Breast study
A new magnetic resonance imaging (MRI) system
at RadLink Diagnostic Imaging #07-13 Paragon
Medical, assists physicians in diagnosing a wide
range of patient conditions and prescribing the right
treatment to expedite recovery.

Our Signa HDx 3.0T MRI system
from GE Healthcare helps doctors
definitively diagnose the most
complex cases. From sports
injuries to life-threatening heart
conditions, doctors can diagnose
them with confidence. The Signa
HDx 3.0T, which is more powerful
than previous generation MRI
systems, uses the latest High
Definition (HD) technology to
produce superb, high-resolution
images while eliminating past
trade-offs.
“MRI technology is now the
modality of choice for most sports
related injuries,” says Dr Tony
Stanley, Consultant Radiologist at
RadLink. “We often read about
MRI technology being used to
help doctors evaluate injuries in
professional athletes. Our new
2
system allows us to diagnose and
characterize sports injuries in
more detail than ever before.” Musculoskeletal study
Magnetic resonance imaging
uses radio waves and a strong
magnet field rather than X-rays
to produce very detailed, cross-
sectional images of the body. MRI
requires specialized equipment
and expertise and allows evaluation
of some body structures that may
not be as visible with other imaging
methods.
“The addition of our new MR
system has given us the ability to Neurological study
provide better care for our patients
with state-of-the-art imaging.” diagnostic power to patients and
“We are pleased to be the their doctors,” says Mr. Hyder
first in the South-East Asia to Mukhthar. More information about
offer the latest in High-Definition the new MRI system is available
(HD) MR imaging technology and by calling RadLink Diagnostic
to provide the highest-quality Imaging at 68360808.
 New Consultant Radiologist:
Full Field Digital
Mammogram (FFDM) Dr Anne Tan
Kendrick
at Paragon Branch
We have installed a GE Digital Mammography
System, Senographe DS at our Paragon branch.
This system incorporates the best of GE’s
technology and the most complete full-field digital
mammography system for all clinical needs.
The main benefits of FFDM are:
Low Dose Exposure — Revolution™ Csi
detector for superb image quality at low
dose
Optimised Patient Comfort — Ergonomic
paddles that shape to the breast
Outstanding Image Quality — Automatically
selects all exposure parameters based on
breast radiological properties
Fullest Field of View — Groundbreaking 24 x
31cm active field of view
Significantly Lower Recall Rate for FFDM
Positive Predictive Value (PPV) Higher for
FFDM
With this new service, we come even closer
to the essence of what’s possible in the early
detection and fight against breast cancer.
We are pleased to inform you that Dr Anne Tan
Kendrick has joined our Diagnostic Imaging Centre
from 1st May 2008.
Dr Anne Tan Kendrick obtained her medical
degree from the Universities of Cambridge and
Oxford after receiving a President’s Scholarship.
She qualified as a radiologist in 1994 and has
worked in various hospitals, including the John
Radcliffe (UK), the Hospital for Sick Children
(Toronto), National University Hospital, Kandang
Kerbau Hospital and Raffles Hospital. As the former
Head of Paediatric Radiology Service at KKH from
1998 – 2004, she was responsible for starting up
the service and growing its clinical, teaching and
research arms. She was also the 1st radiologist
outside America and Europe to receive the Caffey
Award from the Society of Pediatric Radiology for
her work in diagnosing biliary atresia on ultrasound.
She is a member of several academic societies and
is on the board of reviewers for the international
journal, Pediatric Radiology. She has also served on
many hospital and government health committees,
and was the President of the Association of Women
Doctors from 2000-2004.
Dr Anne Tan Kendrick is happy to offer her help
in all aspects of diagnostic imaging, including adult
radiography, fluoroscopy, ultrasound, MRI and CT,
in addition to her special interests in Paediatric and
Women’s Imaging.
Her email is annetankendrick@radlinkasia.com
3
 Our Clinic

The Solitary Pulmonary Nodule

(d) The absence of calcium is of
The solitary pulmonary nodule (SPN) is a commonly encountered clinical little diagnostic value because 40-
entity in both plain film radiography as well as computed tomography 60% of benign nodules and two-
(CT). An understated aspect of the evaluation of a solitary pulmonary thirds of carcinoid tumours do not
nodule is establishing that the opacity seen on the CXR is indeed a true contain appreciable calcium. Also,
intra-pulmonary nodule. Once this has been established, the demographic 5% of malignant tumours may have
features, including the patient’s clinical history, gender, age, smoking calcifications.
history, industrial or environmental exposure and prior malignancy all Cavitation
play an important part in the work-up of the SPN. These are independent
(a) Both malignant and benign lesions
of the imaging characteristics of the pulmonary nodule.
may cavitate.
(b) Malignant lesions tend to have thick
The goal of evaluating the solitary diagnosis and 42% are less than 2cm. irregular walls measuring 15mm and
pulmonary nodule is to establish With the advent of low dose CT for more.
benignity or malignancy. Beside thin routine screening, more small lesions (c) Benign lesions tend to have thinner
section computed tomography, PET- would be picked up. walls, often measuring less than 5mm.
CT and even biopsy may be required. These include infectious granulomas,
• Density and internal characteristics
Wegener granulomatosis, abscesses
DEFINITION Calcification and pulmonary infarcts.
A solitary pulmonary nodule is defined (a) Benign patterns of calcifications Air-bronchograms
as a single, round, fairly well marginated include central, solid, laminated, (a) The presence of air-bronchograms
intra-parenchymal opacity less than diffuse or popcorn. is not a characteristic of malignancy
3cm in diameter. The arbitrary size
(b) Not all calcified lesions are benign except for bronchioalveolar carcinoma
limitation is based on the fact that larger
as these may be engulfed by a scar and lymphoma.
lesions (termed masses) are more often
carcinoma. (b) Air-bronchograms can also be seen
malignant than those smaller than
3cm. (c) Many “non-calcified” SPNs on plain in benign lesions such as organizing
radiographs have calcifications on thin pneumonia, pulmonary infarcts and
section CT. sarcoidosis.
DIFFERENTIAL DIAGNOSIS
A PROPOSED DIAGNOSTIC ALGORITHM FOR THE APPROACH TO AN SPN
Mimics and pseudo lesions seen on
the frontal CXR include bony islands, Solitary Pulmonary Nodule
healing rib fractures, overlapping Pt.<35 yrs. Pt.>35 yrs.
No primary malig. Known malignancy
vascular shadows and thoracic spinal Non smoker Smoker

osteophytes. Many so called SPNs

Radiographic Followup Review of prior radiologic studies
turn out to be multiple lesions on CT.
Most benign SPNs are granulomas, No Prior radiographs No growth over 2 years
hamartomas or intrapulmonary lymph Enlarging lesion Benign calcification on CXR

nodes. Most malignant SPNs are Thin section CT Benign SPN

(granuloma, hamartoma)
bronchogenic carcinomas.
Benign Ca++
Fat in smooth lobulated Absent/eccentric calcification
Benign CT shape (AVM, rounded Radiographic follow up
atelectasis, mucous plug, granuloma) lesion < 3 cm lobulated/spiculated margin
CHRACTERISTICS OF THE SPN
Radiographic follow up
Hamartoma Indeterminate SPN
• Size Thin section x 2 yrs

Larger lesions tend to be malignant. Radiographic follow up

Thin section x 2 yrs
Contrast enhanced CT PET
Biopsy
(TNB,VATS,TBNA)

Although 80% of benign lesions are less

+ enhancement - enhancement + uptake - uptake
than 2cm, small size is not a reliable
indicator of benignity because 15% of Biopsy
(TNB,VATS,TBNA)
Radiographic follow up
Thin section x 2 yrs
Biopsy
(TNB,VATS,TBNA)
Radiographic follow up
Thin section x 2 yrs

malignant lesions are less than 1cm at

4
Tubular or branching lesion
Would suggest benignity such as a
mucocoele which would be readily
apparent on thin section CT.
Fat
The identification of fat is an indication
of benignity and is frequently (up
to 50%) found in a pulmonary
hamartoma, the third most common
cause of SPN.
CT contrast enhancement
Requires pre and post-contrast
acquisitions and is less accurate
in larger lesions (more than 2cm)
because of necrosis. Enhancement of
less than 15HU is almost diagnostic
of a benign lesion. Both inflammatory
and malignant lesions enhance and is
therefore of limited value.
Vascularity
Malignant lesions may have enlarged
supplying arteries or drainage veins.
However, a tangle of vessels is in
keeping with a diagnosis of an arterio-
venous malformation.
• Margins
(a) A smooth, well-defined margin
indicates benignity but 21% are
malignant.
(b) Lobulated margins indicate uneven
growth and suggest malignancy but
25% of hamartomas are lobulated.
(c) Spiculated margins result from
cicatrization of the interstitium and is
a sign of malignancy. Benign lesions
with speculated margins include lipoid
pneumonia, organizing pneumonia,
tuberculoma and progressive massive
fibrosis.
• Growth
(a) The rate of growth can be helpful.
(b) The lack of growth over at least a
2-year period is a reliable indicator of
benignity.
(c) Very rapid growth on the other hand
indicates an inflammatory or infective
cause.
EXAMPLES OF A
SOLITARY PULMONARY NODULE
1 help calculate nodule volume.
Case 1: 27 year old male with lobulated SPN found
on routine pre-employment CXR. A small speck
of calcification is present and a hamartoma or
granuloma is suspected.
2
Case 2: 30 year old female. Pre-employment CXR.
Persistent opacity left lower lobe. CT revealed left
intralobar sequestration.
3
Case 3: 68 year old male with persistent cough.
Screening low dose CT scan picked up SPN.
4 needle aspirates vary widely with size
Case 4: 50 year old male. Biopsy of metastatic
lymph node in neck yielded small cell carcinoma.
CT thorax showed spiculated SPN posterior and
inferior to the heart.
(d) Doubling time is defined as a 26%
increase in diameter.
(e) Computed tomography software can
PET-CT
Some indeterminate nodules will
require further evaluation. The FDG
uptake is measured semi-quantitatively
and can be helpful in some cases.
It is useful in distinguishing tumour
and post-obstructive atelectasis. One
of its principal advantages lies in
mediastinal staging with a high negative
predictive value of more than 90%,
negating mediastinoscopy and biospsy.
Detecting unsuspected metastases
and recurrence are other advantages
of PET-CT. Its main disadvantage is its
high cost.
PATHOLOGIC DIAGNOSIS OF SPNs
Transthoracic needle biopsy
Image-guided transthoracic needle
biopsy is a semi-invasive procedure of
choice for definite characterization of
peripheral SPNs. It is more sensitive
for malignant lesions with a positive
yield of more than 90%. Biopsy for
benign lesions often yield a nonspecific
inflammatory return. Some benign
lesions resist biopsy attempts because
they are too sclerotic.
Bronchoscopy
Bronchoscopy is preferred for central
lesions. Diagnostic yield from brushings,
washings and endo or transbronchial
and location of lesion and experience
of bronchoscopist.
Video-assisted thoracoscopic Surgery
(VATS)
Performed by a surgeon under general
anesthesia and single lung ventilation.
It is less invasive than thoracotomy and
can be therapeutic for small lesions.
Dr Wang Wing Yee
MBBS, FRCR, FAMS
Consultant Radiologist
5
 Stop Press
RadLink Women & Fetal Imaging Centre
TYPICAL SCAN FLOWCHART FOR EXPECTANT MOTHERS
0 week 6-9 weeks
Viability scans
Fig 1. Heartbeat
Fig 2. NT scan
This centre started operations in August 2007 focusing
mainly on expectant mothers. We offer Ultrasound
scanning including 3D and 4D scans by Consultants
and sonographers certified by the Fetal Medicine
Foundation (UK).
Our team of doctors will answer your
doubts and queries through state-
of-the-art imaging techniques.
Services provided at RadLink
Women & Fetal Imaging centre
include:
Viability Scans
These scans ensure the fetus is alive
and is able to date the pregnancy
for women who cannot recall their
last period, have irregular cycles,
or just unsure of dates. This is
extremely useful for those who
have previous miscarriages or
who are experiencing pain and/or
bleeding.
It can also determine the
number of fetuses present and
calculate the expected date of
delivery.
6
11-13 weeks 18-24 weeks
NT scans FA scans
Fig 3. 4 Chambers of heart
Fig 4. Orbits & cerebellum
Nuchal Translucency (NT)
Scan
This is used in the assessment of
the risk of Down’s Syndrome and
other chromosomal abnormalities.
Extensive research has established
that Nuchal Translucency (NT) can
detect 70% of affected fetuses.
The combination of, NT scan and
mother’s blood tests for free Beta-
HCG and PAPP-A improves the
rate of detection by up to 90%.
Fetal Anomaly (FA) Scan
Between 18 to 24 weeks into
pregnancy, the FA scan examines
in detail the brain, face, spine,
heart, stomach, bowel, kidneys
and limbs to ensure normal growth.
It may be conducted also to check
the placental position. Uterine
23-30 weeks 26 weeks onwards
3D/4D scans Growth &
well-being scans
Fig 5. 3D/4D
scans
Fig 6. Growth &
well-being scan
blood flow and umbilical studies
can be performed for those with a
problematic obstetric history.
3D/4D Scans
4D scans are really 3D scans taken
in real-time. They create dramatic
life-like views of your baby moving
inside you. 4D scans enable your
baby’s activity and well being to be
studied in greater detail. 4D scans
can aid in the confirmation of
normal development. Your baby’s
face can be seen best between
23 and 30 weeks into pregnancy.
4D scans can give you a unique
opportunity to bond with your
unborn baby.
Growth and Well-being
Scans
These scans aim to assess how
well the baby is growing. Placental
location, amniotic fluid volume,
umbilical artery and uterine arterial
Doppler can assess blood flow to
detect early intrauterine growth
retardation. For appointments and
enquiries, please call 6836 6288.
 The Lighter Side
Politically Incorrect Medical Dictionary

1. Nitrates — Cheaper than day rates

2. Node — Was aware of

3. Outpatient — A person who has fainted

4. Post Operative — Letter carrier

5. Recovery Room — Place to do upholstery

6. Seizure — Roman Emperor

7. Terminal Illness — Getting sick at the

airport

8. Urine — Opposite of 'you're out'

9. Artery — The study of paintings

10. Barium — What Doctors do when patients

die

11. Caesarean Section — A neighbourhood in

Rome

12. Cauterize — Made eye contact with her

13. Colic — A sheep dog

14. Dilate — To live long

15. Enema — Not a friend

16. Fibula — A small lie

17. Impotent — Distinguished, well known

18. Labour Pain — Getting hurt at work

19. Morbid — A higher offer

Disclaimer: The above stories and articles are meant only to provide a
brief, fleeting distraction from the wretchedness of reality, and are not
intended to be insensitive, callous, or offensive, or to otherwise belittle
the medical profession. Any resemblance to actual persons or events is
purely coincidental.

7
 Diary
2nd June 2008
Relocation Notice for Jurong Point branch
OUR TEAM
Please be informed that as of 2nd June 2008, our Jurong Point branch will
be located at:
1 Jurong West Central 2 Dr Tony Stanley,
#B1A-19C
MB Mch, FRCR, FAMS.
Jurong Point Shopping Centre Special Interest:
Singapore 648886 Musculoskeletal imaging
The contact numbers for this new location remain unchanged: tonystanley@radlinkasia.com
Tel: 6792 6119 Fax: 6792 1170

2nd June 2008 Dr June Chong LM,

Mammography Services now available at Jurong Point branch MBBS, FAMS, ABR, CAQ in
Neuroradiology.
We are pleased to inform that mammography services will be available at Special Interest:
our new branch at #B1A-19C from 2nd June 2008. Neuroradiology
However, this service and Ultrasound service will only be available in the
junechong@radlinkasia.com
morning and strictly by appointment only.
The list prices are as follows:
Dr Ng Hweena,
Mammogram $100
MBBS, FRCR.
Mammogram with Breast Ultrasound $150 Special Interest:
Prices are subjected to prevailing GST. Obstetrics /Gynecology
For appointment, please call our Jurong Point branch hotline at 67926119. nghweena@radlinkasia.com

6th June 2008

Women Fetal & Imaging Centre (WFI) Dr Wang Wing Yee,
MBBS, FRCR, FAMS.
Please take note that WFI is now part of RadLink Diagnostic Imaging. We are
Special Interest:
now situated at #08-08 Paragon Medical (within the premises of RadLink
Respiratory Imaging
Diagnostic Imaging). We provide a comprehensive list of services catered to
expectant mothers. Our services include: wangwingyee@radlinkasia.com
• Fetal Vialibility Scan • Nuchal Translucency Scan (for Down syndrome)
• Fetal Anomaly Scan • Fetal Growth & Well-being Scan
Dr Anne Tan Kendrick,
• 4D Fetal Scan MA (Cantab), BM BCh
Along with our highly skilled sonographers, our Consultants are certified by (Oxon), FRCR (UK), FAMS
the Fetal Medicine Foundation (UK). Please call us at 6836 6288 to make Special Interest:
an appointment. Pediatrics & Women’s
Imaging
Your comments and enquiries are important to us. annetankendrick@radlinkasia.com
Please contact: To know more about us:
Group Markets & www.radlinkasia.com
Business Development Manager Dr Michael Benedict Toh,
Our operating hours:
gmbd@radlinkasia.com MBBS, DMRD, FAMS
Monday – Friday: 8.30am to 5.30pm
You can locate us at: Saturday: 8.30am to 12.30pm Special Interest:
290 Orchard Road #08-08 General Radiology
Paragon Medical
Singapore 238859 michaeltoh@radlinkasia.com
Tel : (65) 6836 0808
Fax : (65) 6836 8484