Which Scan should I have – Navigating the Medical Imaging Maze

Each week in my team consultation practice with specialist GP Dr Bruce Whelan; we hear grave concerns from patients about the radiation risks from diagnostic scans. Unfortunately many cancer patients say no to two imperative diagnostics tools; biopsies and scanning procedures.

Each week in my team consultation practice with specialist GP Dr Bruce Whelan; we hear grave concerns from patients about the radiation risks from diagnostic scans. Unfortunately many cancer patients say no to two imperative diagnostics tools; biopsies and scanning procedures. Usually this is a result of consulting the doctor who never sees a patient and offers a one size fits all approach – yes it’s Dr Google! It is true that medical scans are a source of radiation – however the Health intelligence australiabenefits of knowing as much as possible about your cancer and where it might be located in your body far outweigh the risks. Death from Cancer is not such a great option either I tell my clients.

This is why I interviewed Dr Nevil Chimon on Navigating the Cancer Maze internet radio Select this link to listen

Dr Nevil Chimon researches and develops radio tracers for medical imaging. The science, processes & advances of imaging techniques, & the radio-pharmaceuticals that magically make our inner parts visible to doctors for more accurate diagnosis; is the topic for today’s Navigating the Cancer Maze. Dr Nevil Chimon shares his passion and invaluable information for cancer patients about the different types of cancer & the best medical imaging to assist diagnosis. This is information that you need to know! All patients become intimately involved with the process of cancer imaging, & the relationship often lasts for 5 or more years.

BIOGRAPHY:  Dr Chimon is a medical science graduate of UCLAN, BSc (Hons), Manchester University, MSc & NUS, PhD, with Post-Doctoral training in Molecular Imaging & Radiochemistry completed at the Paterson Institute for Cancer Research & Wolfson Molecular Imaging Centre, UK. Nevil has over 10 years of experience within the pharmaceuticals industry. Holding positions of increasing responsibility within MNCs and SMEs has provided him with broad exposure to projects involving drug discovery & imaging diseases, including cancer & dementia. Strategically, he recognizes an opportunity exists to leverage on molecular imaging technology to both accelerate drug discovery and improve the healthcare of patients by using PET-CT and PET-MRI multi-modality imaging.

Dr Nevil Chimon BSc (Hons), MSc and NUS, PhD,
Dr Nevil Chimon BSc (Hons), MSc and NUS, PhD,

During his 7-years based in Singapore, Dr Chimon has established the first Preclinical CRO imaging facility, obtained GMP licensing for the RadLink cyclotron facility, performed the first clinical trial with a proprietary radio-tracer for Bayer Pharmaceuticals, & manufactured new tracers to detect cancer. To Listen to my interview with Dr Nevil Chimon: CLICK HERE

As a Cancer Patient – You need to Know your imaging options so you make an informed choice:

Different imaging methods use different technology and provide different types of images. This means they have different benefits for showing what is happening inside the body (e.g. for showing bone, soft tissue or tumours). Imaging methods also have different potential advantages and disadvantages, including exposure to radiation.

Here are just a few of the New Scanning devices and procedures  you need to know about:
Prostate CancerPSMA (Prostate Specific Membrane Antigen) PET-CT – A PSMA study, also called a ProstaScint® scan, is an imaging test to locate and determine the extent of prostate cancer. PSMA studies are performed on newly diagnosed prostate cancer patients to determine if the disease has spread to pelvic lymph nodes. The study is also performed on patients who have had their prostate gland removed (prostatectomy) and have an increase in prostate-specific antigen (PSA) blood levels.

The study involves a special molecule called a monoclonal antibody developed in a laboratory and designed to bind to the prostate-specific membrane antigen on cancer cells. This antibody is paired with a radioactive material called Indium-111 that can be detected by a gamma camera. When injected into the patient’s bloodstream, the radioactive antibody travels and attaches to cancer cells. The gamma camera then produces three-dimensional images of the tumor and its location inside the body. This study is performed over as many as three days. On the first day, the patient first receives an intravenous (IV) injection of the radioactive antibody. Imaging is performed in two sessions, separated by 24 or more hours. Each imaging session will last between two and four hours. The camera rotates around the patient, who remains still.

  • Molecular imaging and prostate cancer? Molecular imaging is used to:
    stage treatment: by determining the exact location of a tumor, the extent or stage of the disease and whether the cancer has spread in the body and plan treatment by selecting the most effective therapy based on the unique molecular properties of the disease and of the patient’s genetic makeup
  • Choline C-11 PET scan is an imaging test used to help detect sites of prostate cancer that have returned despite treatment (recurrent prostate cancer). It may be used when other imaging has not been helpful. Choline C-11 PET scan is a positron emission tomography (PET) scan that uses a special chemical tracer called Choline C-11 Injection.
  • Valuable links:
    11E_The use of Choline PET_CT in prostate cancer imaging_Tara Barwick

    Targeted therapies offer new options for prostate cancer treatment
  • Breast Cancer:  MRI:  Some women, particularly those under the age of 50 and who are at high risk of developing breast cancer due to a strong family history or a genetic mutation, are encouraged to undergo annual breast Magnetic Resonance Imaging (MRI) as part of their regular screening routine. MRI is sometimes a more effective screening tool for younger women, especially those with dense breasts. MRI scans are very expensive — up to $700 AUD per scan. There is a Medicare rebate for women at high risk of developing breast cancer.
  • Mammograms A mammogram is an X-ray of the breast and is the most common form of breast imaging. There are two types of mammogram — screening and diagnostic.
    Screening mammograms: Screening mammograms are used for women who do not have any symptoms of breast cancer and who have not had breast cancer in the past. If you are aged 40 or over, have never been diagnosed with breast cancer and currently have no symptoms of breast cancer, you can be screened free of charge at a BreastScreen Australia clinic.
    Diagnostic Mammograms Diagnostic mammograms are recommended for women who have a previous history of breast cancer or who are at high risk of developing breast cancer. Several X-rays are taken in order to obtain views of the breast/s from different angles. You will need a referral from a doctor for a diagnostic mammogram.
  • More info at http://www.bcna.org.au/living-breast-cancer/follow-care/breast-imaging

Diagnosing NETS (neuroendocrine tumours).

  • Ga68 DOTATE is a somatostatin receptor agent used in the imaging of well-differentiated neuroendocrine tumours. For poorly differentiated neuroendocrine tumours; standard F18 FDG-PET remains the imaging of choice for diagnosis. Dr Nevil Chimon discusses NET imaging options and the latest developments in my interview with him on Voice America.

Different types of imaging

  • X-rays (plain radiography) – Uses X-rays to show images of bones, tumours and other dense matter
  • Advantages: Quick, non-invasive and painless
    Can help diagnose various diseases and injuries, including broken bones, cancer and infections
    Disadvantages: Very small increased risk of cancer in future from exposure to ionising radiation (x-rays). Risk is greater for children
  • Computed tomography (CT scans) Uses multiple X-rays to produce cross-sectional layers that show detailed images inside the body, including bones, organs, tissues, and tumours.
    Advantages*Quick and painless
    *Can help diagnose and guide treatment for a wider range of conditions than plain X-rays
    *Can detect or exclude the presence of more serious problems
    *Can be used to check if a previously treated disease has recurred
    Disadvantages*Small increased risk of cancer in future from exposure to ionising radiation (X-rays). Risk is greater for children
    *Uses higher doses of radiation, so the risks (while still small) are in general greater than other imaging types
    *Injection of a contrast medium (dye) can cause kidney problems or result in allergic or injection-site reactions in some people -Some procedures require anaesthesia.
  • Nuclear medicine imaging including positron-emission tomography (PET) Involves injecting, inhaling or swallowing a radioactive ‘tracer’. The gamma-rays emitted by this material are used by the scanner to show images of bones and organs:
    Advantages*Usually painless
    *Can help diagnose, treat, or predict the outcome for a wide range of conditions
    *Unlike most other imaging types, can show how different parts of the body are working and can detect problems much earlier
    *Can check how far a cancer has spread and how well treatment is working
    *Involves exposure to ionising radiation (gamma-rays)
    Disadvantages A PET scan can take 3 to 4 hrs from arrival to departure
  • *Radioactive material may cause allergic or injection-site reactions in some people
    *PET scanners cause some people to feel claustrophobic, which may mean sedation is required
  • Magnetic resonance imaging (MRI) Uses magnetic fields and radio waves to show detailed images of organs, soft tissues, bones, ligaments and cartilage
  • Advantages*Usually non-invasive and painless
    *Uses no ionising radiation
    *Can help diagnose and guide treatment for a wide range of conditions
    *Can provide similar information to CT in some types of investigations
    Disadvantages*Can be a lengthy and noisy procedure
    *Slight movement can ruin the image, requiring retesting
    *Can make some people feel claustrophobic
    *Sedation or anaesthesia may be required for young children or others who can’t remain still
    *Injection of a contrast medium (dye) if needed can cause kidney problems or result in allergic or injection-site reactions in some people
    Can’t be undertaken in some situations (e.g. when a heart pacemaker is present)
  • Ultrasound Uses high-frequency sound waves to produce moving images onto a screen of the inside of the body, including organs, soft tissues and bones
  • Advantages*Usually non-invasive, safe and relatively painless
    *Uses no ionising radiation
    *Does not usually require injection of a contrast medium (dye)
    *Can help diagnose a range of conditions in different parts of the body, such as the abdomen, pelvis, blood vessels, breast, kidneys, muscles, bones and joints
    Disadvantages*Quality and interpretation of the image highly depends on the skill of the person doing the scan
    *Other factors can affect image quality, including the presence of air and calcified areas in the body (e.g. bones, plaques and hardened arteries), and a person’s body size
    *Use of a special probe (e.g. for the oesophagus, rectum or vagina) is required in some ultrasounds
    *Special preparations may be required before a procedure (e.g. fasting or a full bladder)
  • Bone scan? A bone scan is a diagnostic imaging test used to determine whether cancer has spread to the skeleton. A tiny amount of radio-tracer is injected into the patient’s bloodstream and accumulates predominantly in the bones where it can be detected by a specialized imaging device called a gamma camera. The resulting two-dimensional or three-dimensional images can reveal various processes such as bony fractures, infection or inflammation or the likely presence of cancer cells.

Select the following URL to learn about the impact of radiation from Medical Scanning:

Medical imaging and Theranostics (developing molecular diagnostic tests in tandem with targeted therapeutics) are medical sciences that are moving forward at a rapid pace.  Ask your oncologist/radiologist for the latest information about new  scanning machines and techniques for your particular type of tumour.

We see many patients who have foregone critical diagnostic scans due to fears about radiation from scanning devices; mainly after reading  poorly researched information on Dr Google. All cancer situations need proper diagnosing and monitoring. Most medical scans carry a small long term risk from radiation exposure – but to not know about a burgeoning cancer is a far greater risk to life and longevity.

If you need assistance and case management – you can consult with myself and specialist GP Dr Bruce Whelan in a team consultation at our Gold Coast, Qld Practice. I am also available for Skype consultations for distance Clients – We are able to offer world-wide referrals. To Contact myself and Dr Whelan:  Email institute@gracegawler.com

Until next Time….