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LAKE, SMIT & PARTNERSADDITIONAL INFORMATION

Frequently Asked Questions

 

What exactly is a radiologist?

A radiologist is a specialist doctor who after training for 7 years as a doctor has now specilaised in the field of radiology for an extra 4-5 years and like other specialists such as surgeons, Physicians and paediatricians have sat for exams at the end of their training and are then registered with the Health Professions Council as specialists.

The radiologist's role is to assist other doctors and specialists in diagnosing or confirming suspected clinical conditions and we make use of X-rays, Ultrasound, Mammograms, CT Scans and MRI scans to achieve this.

Some radiologists study further and gain super-specialised skills in specific areas of radiology such as Neuroradiology, body imaging, pediatrics imaging and Musculoskeletal imaging.

Interventional radiology is used to treat diseases with the use of either X-rays, ultrasound, CT, MRI or mammography to perform biopsies, drain fluids, insert catheters, or dilate or contract narrow vessels, or use imaging to carry out pain relieving procedures in the musculo-skeletal system.

What is intravenous contrast?

IV contrast is an iodine based colourless liquid/ dye which is injected into your body intravenously via an IV line. This will be placed into your vein by either a nursing sister or radiographer trained to do the procedure.

The amount of IV contrast required varies, usually in the range or 30-120mls, depending on your body size and type of CT scan requested.

The dye is usually delivered by a pump injector and is NOT radioactive

Administering intravenous contrast for a CT examination improves the accuracy of the examination and assists to highlight differences between soft tissues which would otherwise look the same and is used to highlight blod vessels I the case of a CT angiogram.

As for all medical procedures, there are risks associated with the administration of any substance, including IV contrast. However the benefit, such as an accurate diagnosis, outweighs the small risk of suffering from the side effects (discussed below). The decision to administer IV contrast is made by your referring doctor, based on your signs, symptoms, past medical history and the possible diagnosis.

Most injections of IV contrast occur without side effects. Usually, patients experience a transient warm feeling throughout their entire body, a metallic taste in the back of the throat and/or a sensation of wetting themselves. The warm feeling occasionally may be experienced as a quite intense, hot sensation. All these symptoms disappear very quickly at the time of the study and require no treatment.

The most common side effect is a minor contrast reaction, which occurs in 1% of cases. Symptoms include headache, sneezing, nausea, vomiting, urticarial/hives and swelling and usually settle rapidly. Occasionally medications may be required to help alleviate the symptoms if they persist. This usually involves an anti-emetic (anti-nausea medication) and promethazine (phenergan) for hives and swelling. Phenergan results in drowsiness, and so you would need a responsible person to drive you home. Less commonly, in approximately 0.01% (or 1 in 10,000) of cases a severe (anaphylactoid) contrast reaction may occur.

This includes a rapid or slow heart rate, low blood pressure, an asthma attack (bronchospasm) and rarely complete circulatory collapse/shock. Such reactions require urgent medical treatment and immediate transfer to an appropriate facility, such as an emergency department or intensive care unit. Treatment includes the use of adrenalin, cortisone and rapid injection of IV fluids.. Despite best medical attempts and rapid treatment, a person may die from a severe reaction, however this is fortunately rare, occurring in 0.0001% - 0.00001% (1 in 100,000 to 1 in 1,000,000) of cases.

Unfortunately, there is no way of predicting who will be allergic to contrast until the dye is given. A patient who becomes allergic will usually develop their symptoms within 10 minutes, typically within the first one or two minutes. It is reassuring to note that more than 10,000,000 injections of contrast are given in the United States each year mostly without any side effect..

If you have previously experienced a contrast reaction please tell the receptionist or radiographer. In this case and depending on your previous reaction we may decide to either delay the scan or de-sensitise you with serial doses of oral steroid medication 18 hours prior to the scan which will significantly reduce the reaction or we may need to do the scan without IV contrast or opt for another produre such as an ultrasound or MRI scan.

What is cortisone?

Cortisone is the name used to describe a group of drugs commonly known as corticosteroids. The types of cortisone used at Lake, Smit and Partners include Celestone (Betamethasone), Decasone and Depot-Medrol (Methylprednisolone). Cortisone is used to treat pain in various parts of the body where inflammation is felt to be the cause of this pain. The reason why cortisone is effective in treating such pain is because it is a powerful anti-inflammatory. Cortisone is NOT an illegal steroid medication, such as those steroids used by some disqualified body builders and athletes.

Why inject cortisone?

In regard to musculoskeletal problems, cortisone injections are performed in order to reduce or even eliminate pain associated with a variety of disorders, such as:

  • Bursitis (most commonly subacromial [shoulder]and trochanteric bursitis[hip])
  • Arthritis (any joint may be injected, including joints of the spine)
  • Nerve pain (most commonly for sciatica and carpal tunnel syndrome)
  • Tendinitis and Tenosynovitis (such as plantar fasciitis, trigger finger, DeQuervain's tenosynovitis, Tennis and Golfer's elbow)
  • Other miscellaneous conditions where inflammation is a contributor to the pain, for example frozen shoulder/adhesive capsulitis, Morton's neuroma, ganglion cyst injections and Dupuytren's contracture.

How is cortisone administered?

The skin is prepared using an antiseptic agent. The needle is then guided into the relevant body part using radiological equipment, such as an ultrasound or Computed Tomography (CT) scanner. The guidance allows a high dose of cortisone to be accurately delivered into the area of suspected/proven pain without the side effects of taking cortisone tablets. This gives you the best chance of pain relief, as injections performed without guidance may not work due to incorrect placement of cortisone.

The degree of discomfort during the procedure is generally mild as the needle used is fine and local anaesthetic is mixed in with cortisone. If only one pass is planned (meaning that the needle will only penetrate the skin once) then local anaesthetic is usually NOT injected into the skin. It is our experience that injecting local anaesthetic into the skin in a single pass procedure is actually more painful, as local anaesthetic stings a little prior to taking effect. A greater degree of discomfort may occur if:

  • The underlying inflammation is severe.
  • The area to be injected is severely painful.
  • The needle tip requires to be repositioned several times in order to distribute the cortisone effectively.
  • A previous bad experience has resulted in a fear of needles, or there is a general anxiety/phobia of needles and other medical procedures.

In cases where a cyst, ganglion, bursa or joint is distended with fluid, the cortisone will be injected after an attempt to aspirate (remove) the fluid in order to improve comfort.

Benefits, Risks, Complications and Side-Effects of Cortisone

As for all medical procedures, there are risk associated with the administration of any medication, including cortisone. The chances of cortisone providing you with the benefit of pain relief in most patients outweighs the risk of experiencing a side effect(s) (discussed below).

The decision to inject cortisone is not taken lightly and is carefully made by your referring doctor and based on your signs, symptoms and past medical history, as well as the suspected diagnosis.

Frequently, a trial injection is made where the diagnosis is not clear, however the body region that is to be injected is suspected of causing your pain.

The side effects and risks of a cortisone injection include:

  • Allergy to any of the substances utilised during the procedure, such as the cortisone, dressing, local anaesthetic or antiseptic. This is usually minor and self limiting.
  • The cortisone may result in palpitations, hot flushes, insomnia, and mild mood disturbance. This usually resolves within 24 hours and no treatment is necessary.
  • Infection. Infection is a rare but serious complication, especially if injected into a joint. Most infections take at least a day or two to manifest, so pain at the injection site after 48 hours is considered to be due to an infection until proven otherwise. Even if not definitively proven, you may be commenced on empirical antibiotic treatment.
  • Local bruising.
  • Localised skin and subcutaneous fat atrophy (thinning resulting in dimpling).
  • Hypopigmentation (whitening of the skin) at the injection site. This most commonly happens in injections of the palm of the hand or sole of the foot.
  • Mild increase in blood sugar levels in diabetic patients for several days and may last up to a week.
  • Transient increase in pain at the injection site before the cortisone takes effect. Occasionally this may be severe, however usually lasts only 24–48 hours and is treated with a cold pack, paracetamol and anti-inflammatory medication. If this occurs and you are concerned, especially if the pain is not settling despite the above treatment, then please call contact your referring doctor so that they are able to examine, assess and manage you appropriately.
  • Cortisone injection administered directly into a tendon has been reported to weaken and damage the collagen fibers, thus carrying a risk of delayed rupture. For this reason, cortisone is only injected around the tissue surrounding a tendon and the tendon is rested for one week.

Remember that the side effects of cortisone that are commonly reported in the media, such as osteoporosis, weight gain, acne and diabetes only occur when taking cortisone tablets for at least several weeks. These side effects do not occur with the careful use of cortisone injections.

Are there any alternatives to a cortisone injection?

Since a cortisone injection is used for treating pain, it is an optional procedure. Other options should be discussed with your referring doctor and may include anti-inflammatory medications, exercise, physiotherapy and surgery to name a few. The role of our radiologist is to perform the procedure requested by your referring doctor and therefore ensure that the cortisone is injected safely and into the correct location.

How many cortisone injections are permitted?

There is no scientifically proven limit for cortisone injections, however as a general rule, three injections into the same body part are permitted over a twelve-month period.

Injections more frequent than this are felt to place the injected tissue at risk of softening/weakening, which may be an issue in a joint for example, as this may accelerate arthritis. Also, if you have failed to respond to a series of three injections, then it is probably time your condition was reassessed to find out if the diagnosis correct. Has your condition worsened and are other forms of treatment, such as surgery, more appropriate? If you do require more than three injections in a year, then the risk of the injection must be carefully balanced against the benefits of pain relief.

Fees and Billing Policy

Our Fees

Our fees reflect the service, training and dedication of our professional staff and are in line with that seen in other quality radiology practices that provide the latest technology and state of the art equipment.

Complex and expensive equipment is required to provide an accurate diagnosis and an effective modern radiology practice.

Our fees are in accordance with the tariffs outlined by the various medical aids each year.

There is often a co-payment - this is your share of the amount that the medical aid agrees to pay for a procedure usually a CT or MRI scan. It is not a charge over and above the medical aid tariff.

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