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Scan spared patient from surgery

A new machine which provides clearer scans of tumours is just one of several firsts offered at Mount Elizabeth Novena Hospital
The Straits Times - September 20, 2012
By: Ng Wan Ching
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Scan spared patient from surgery PHOTO: AZIZ HUSSIN

A 60-year-old woman who had cancer in her vagina was spared from disfiguring surgery because of a new type of scan that produces clearer images of organs in the pelvis.

Computed tomography (CT) scans did not show any spread of her vaginal melanoma beyond the pelvic area.

If this had been true, the cancer would be in stage 1 and surgery would have been performed to remove it.

But the new machine, the positron emission tomography-magnetic resonance imaging (PET-MRI) machine, picked up a 1cm-wide tumour outside the patient's pelvic area.

This meant that the cancer was in stage 4 and surgery was no longer appropriate.

The woman's doctor, Dr See Hui Ti, a consultant medical oncologist at Parkway Cancer Centre, said: "We used this information to decide not to send the patient for the disfiguring surgery and started her on immediate chemotherapy.

"This nodule was small and potentially could have been missed using other imaging modalities."

Singapore's newest hospital, Mount Elizabeth Novena Hospital (MNH), where Parkway Cancer Centre has a clinic, is the first here to use the PET-MRI machine to scan patients.

This is one of a few firsts that the new hospital, which opened on July 1, has scored for the private health-care sector.

The others include an advanced surgical system for brain and spine surgery, and a purpose-built hybrid operating theatre, where both open surgery and minimally invasive procedures can be performed.

Raffles Hospital, for example, does not have the PET-MRI machine or the hybrid operating theatre.

These are fairly new introductions to the health-care scene and the hospital management is evaluating them at the moment, said a spokesman for Raffles Hospital.

The Clinical Imaging Research Centre at National University of Singapore is the only other owner of a PET-MRI machine in Singapore, but uses it for research only.

A spokesman for the National Cancer Institute, Singapore said it does not currently offer PET-MRI scans to patients as there is no established clinical indication for it.

But the machine, which does a PET scan and magnetic resonance imaging (MRI) at the same time, was approved by the United States Food and Drug Administration last year, based on performance tests that compared it with the existing positron emission tomography-computed tomography (PET-CT) device.

In a PET-CT scan, patients are injected with radioactive dye, which will be drawn to cancerous cells and will show these cells on the scan.

MRI uses a strong magnetic field to capture detailed images of the internal structure of the body.

Doing an MRI scan and a PET scan simultaneously, but without a CT scan, gives pinpoint accuracy. The radiation level is also lower than that of a PET-CT scan, doctors said.

The machine improves resolution of the images of structures especially in the head, neck and pelvis, allowing doctors to see better if there is any tumour present and if it has spread, said DrSee.

"We look at every imaging modality as a welcome addition to make better and more accurate clinical judgements so that our patients need not be put through potentially disfiguring surgery if there is no chance of cure," she said.

Conversely, it can also help doctors identify which patients are suitable for surgery if it shows the cancer is in its early stage, she said.

In addition, the significant reduction in radiation dose - between 25 and 50 per cent - to the patient is of great significance to those who need long-term oncology follow-up, she added.

It costs $3,500 to do a PET-MRI scan of the whole body. This is cheaper than an MRI scan of the whole body, which costs $4,000. A whole-body PET-CT scan costs $2,100.

CUTTING-EDGE TECHNOLOGY

Another first for the private sector at MNH is the O-arm surgical imaging system integrated with a surgical navigation system, which is used for spine, orthopaedic and trauma-related surgery.

The O-arm surgical imaging system provides real-time images of a patient's anatomy with high-quality images and a large field-of-view in both two and three dimensions during surgery.

By integrating the O-arm with a surgical navigation system, surgeons are able to perform less invasive, safer and more accurate procedures.

The same navigational system is integrated with the operating microscope that neurosurgeons use for brain surgery.

It also helps surgeons perform surgery on the brain more smoothly, accurately and safely.

MNH is the first private hospital here to have a purpose-built hybrid operating theatre, where both open surgery and minimally invasive ones done using catheters threaded along blood vessels can be carried out.

Traditionally, catheter-based interventions are done in a cardiac catheterisation suite while surgical procedures are done separately in a conventional operating theatre.

The use of the hybrid operating theatre benefits patients with complex conditions. For example, an elderly heart patient with multiple blocked arteries, heart failure, long-standing diabetes and maybe a previous stroke could be treated in the hybrid operating theatre without the need for open heart surgery.

If his most important heart artery - the left anterior descending artery - is blocked along with other lesser arteries, the hybrid operating theatre, with its X-ray imaging system, will allow the heart surgeon to bypass the block using minimally invasive surgery.

It will also allow an interventional cardiologist to clear the other smaller blocks by inflating a balloon attached to a catheter and deploying stents to prop the blood vessel open.

"The patient would not have the increased risk of stroke due to being hooked up to a heart-lung machine in open heart surgery," said Dr Peter Yan, medical director of the Parkway Heart and Vascular Centre, which is located at MNH.

The time taken to do the procedure would also be shorter than that for open heart surgery and the anaesthesia levels would be lower.

This would result in a faster recovery with a shorter stay in the hospital.

The usual length of hospital stay for open coronary artery bypass surgery is between seven and 10 days, but patients who have had a hybrid procedure can be discharged within four to five days, said Dr Yan.

They are seven times more likely to return to work within one month instead of the usual three months for a standard coronary bypass surgery, he said.

The hybrid operating theatre will allow the doctor to quickly convert from a catheter-based intervention to an open-heart bypass surgery if the need arises.

PROVIDING ADVANCED MEDICAL CARE

The investment in cutting-edge technology is in line with MNH chief executive Lee Hong Huei's vision for the hospital to focus on advanced surgical and medical care.

Such care will be more expensive but it offers patients more choices, he said.

So, doctors at MNH - there are currently more than 120 of them - are encouraged to move towards further specialisation and to practise in speciality groups.

Dr Lee said: "With the rapid advancements in the medical field, it is inevitable that we would have to progress towards sub-specialisation (further specialisation). We are essentially providing active support to facilitate the process."

The heart and vascular centre is one such example. It has 12 heart specialists with different further specialisations.

This will eliminate the need for the patient, especially one with a complex issue, to go from clinic to clinic seeking multiple opinions, said Dr Yan.

Other sub-speciality group practices within the hospital include those for neurosurgery, colorectal surgery, hand surgery, spine surgery and ear, nose and throat surgery.

MNH also provides facility services to doctors located nearby, such as Novena Medical Centre, Novena Specialist Centre, Thomson Medical Centre and Mount Alvernia Hospital, as long as they have admitting privileges with the hospital.

Not the most expensive hospital

The newest hospital in Singapore may have the latest technology and the most expensive room at $12,000 a night, but Mount Elizabeth Novena Hospital (MNH, right) is not the most expensive one here, said its chief executive officer.

Most of its charges are comparable with Mount Elizabeth Hospital off Orchard Road, said DrLee Hong Huei.

Currently, regular room rates and hospital fees are pegged to Mount Elizabeth Hospital, its sister hospital under private health-care company Parkway Pantai, he said.

For example, a day's stay in a single room at MNH costs $578 while doing so at Mount Elizabeth Hospital costs the same.

In hospitals, the final bill size of any surgical procedure depends on a few key factors.

These include the duration of surgery, the equipment and consumables used, and whether the patient has any other underlying condition such as diabetes and suffers from complications.

Dr Lee noted: "When bill sizes are off the norm, those are normally associated with some complications."

For example, a patient could have an underlying illness such as diabetes, which goes out of control either during or after surgery.

But so far, the bill sizes for the same procedure performed by the same surgeon in the two private hospitals have been about the same, Dr Lee said.

For example, a procedure to remove a gall bladder costs between $11,274 and $12,274 at MNH.

This is comparable with the median of $13,771 for the same procedure at Mount Elizabeth Hospital.

At another private hospital here, Raffles Hospital, the median is $12,887.

In comparison, patients who stayed in A class wards in public hospitals and did not receive any subsidies from the Government paid less.

The median at National University Hospital was $4,666, while that at Singapore General Hospital was $5,717.

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