RADIOLOGY SERVICES. By Dr Lim Eng Kok 1

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1 INTRODUCTION RADIOLOGY SERVICES By Dr Lim Eng Kok 1 Radiology is the branch of medicine that deals with the use of ionising (e.g. x- rays and radio-isotopes) and non-ionising radiation (e.g. ultrasound and magnetic resonance imaging) in the diagnosis and treatment of diseases. It is one of the most dynamic fields in medicine today with new technologies and techniques being introduced at a rapid rate. However, some of these advances come at a relatively high cost. This paper presents the results of a survey 2 of the establishments which are licensed to provide top-end radiology services [i.e. Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET)] in Singapore. NUMBER OF SCANNERS Table 1 shows the number of scanners for each service. There are a total of 33 CT, 22 MRI and 4 PET scanners in Singapore 3. Table 1: Number of Scanners Scanners Scanner (Units per Public Sector Private Sector Total million population)* CT MRI PET *e: Total Population data as at 18 Aug 2005, based on Statistics Singapore, the Department of Statistics Singapore at The final column in Table 1 shows the availability of each scanner (measured by the number of scanners per million population ) in Singapore. Availability of highcost radiology services (especially CT and MRI) is often used to gauge adoption and diffusion of medical technology in different countries, with the aim being an appropriate level of adoption. Comparison data for other countries can be viewed at external websites such as that of the Organisation for Economic Co-Operation and Development ( 1 Dr Lim Eng Kok is an Assistant Director with the Healthcare Finance Division, MOH 2 The data for comparison was obtained through a questionnaire survey of public and private sector establishments providing these services. The figures represent average charges (rounded to the nearest dollar) submitted by the establishments. 3 Source: for Radiation Protection, Health Sciences Authority (Data as at end-june 2005). 1

This paper presents the results of a survey 2 of the establishments which are licensed to provide top-end radiology services [i.e. Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET)] in Singapore.

2 I. COMPUTERISED TOMOGRAPHY (CT) CT scanners use a series of X-ray beams to build up images of the body in slices. Unlike X-ray machines, which send one beam of radiation through the body, CT scanners emit a succession of narrow beams as it moves through an arc. This information is then sent to a computer, which builds up a cross-sectional image of the body and displays it on the screen. CT scans can be performed on any part of the head or body. Charges for some common CT scans are tabulated in Table 2. To ensure a like-for-like comparison, the charges compared are for private (i.e. unsubsidised) patients in public sector establishments versus those in private sector establishments. With Government subsidies, subsidized patients in public sector establishments pay significantly lower charges than the ones tabulated here, with the level of subsidies dependant on their ward class. Outpatient Alexandra AsiaMedic Heart & Vascular East Shore Gleneagles KK Women s and Children s Medical Imaging- Orchard Total Diagnostic Mount Alvernia Mount Elizabeth Cancer University RadLink Diagnostic Imaging Singapore Heart, Stroke & Cancer Table 2: Charges for Common CT Scans Abdomen* Abdomen and Pelvis* Angiography + Heart Arteries* Brain* Chest* Neck/ Post-nasal space* $424 $676 $567 $777 $1,040 $485 $764 $312 $424 $424 $567 $515 $349 $485 $475 $782 $452 $662 $893 $452 $452 $452 to $609 to $856 to $609 to $609 to $609 $460 $750 $715 $326 $452 $452 $473 $840 $515 $620 $408 to $609 $765 to $809 $893 to $998 $453 $737 $473 $473 $473 $462 $462 $462 $408 $408 $408 to $534 to $609 to $609 $340 $453 $453 $348 $452 $541 $808 $890 $365 $475 $507 $554 $769 $998 $368 $554 $554 $525 $924 $1,029 $525 $525 $494 $462 $751 $718 $347 $462 $462 $790 $790 $1,280 $790 $790 $790 $487 $763 $665 $346 $478 $478 2

This information is then sent to a computer, which builds up a cross-sectional image of the body and displays it on the screen. CT scans can be performed on any part of the head or body.

3 Abdomen* Abdomen and Pelvis* Angiography + Heart Arteries* Inpatient Alexandra $424 $676 $485 $764 East Shore Gleneagles KK Women s and Children s Mount Elizabeth Brain* Chest* Neck/ Post-nasal space* $312 $424 $424 $349 $485 $475 $950 $547 $699 $1,287 $547 $547 $547 to $834 to $1,095 to $834 to $834 to $834 $460 $750 $715 $326 $452 $452 $539 $838 to $1,581 $1,027 $539 $539 $348 $539 $452 University $541 $808 $890 $365 $475 $507 $630 $1,109 $1,235 $630 $630 $592 $462 $751 $718 $347 $462 $462 $487 $763 $665 $346 $478 $478 es: All charges quoted are inclusive of Goods & Services Tax (GST). * The charges quoted are for scans done with contrast, i.e. a dye (contrast medium) is used to make some tissues show up more clearly. + Angiography: A procedure performed to view blood vessels after injecting them with a dye. 3

University $541 $808 $890 $365 $475 $507 $630 $1,109 $1,235 $630 $630 $592 $462 $751 $718 $347 $462 $462 $487 $763 $665 $346 $478 $478 es: All charges quoted are inclusive of Goods & Services Tax

4 II. MAGNETIC RESONANCE IMAGING MRI scanners use magnets and radio waves to produce detailed pictures of the inside of the body. MRI scans can show bones, muscles, joints, blood vessels, nerves and other structures in great detail. The key component of MRI scanners is the magnet, which determines the scanner s Field Strength, and is rated using a unit of measure known as a Tesla. Higher Field Strength contributes to better image quality and resolution, shorter examination times and greater range of applications for the scanner. Some patients require MRI scans using scanners with higher Field Strength, as additional image resolution is needed to diagnose their conditions. As the costs of MRI scanners tend to increase with the magnetic Field Strength, this value has been tabulated together with the charges for the common MRI scans as it is a possible explanatory factor for differences in charges across establishments (see Table 3). Similar to CT scans, to ensure a like-for-like comparison, the charges compared are for private (i.e. unsubsidised) patients in public sector establishments versus those in private sector establishments. Also, with Government subsidies, subsidized patients in public sector establishments pay significantly lower charges than the ones tabulated here, with the level of subsidies dependant on their ward class.. Table 3: Charges for Common MRI Scans Outpatient Advanced Integrated Radiology Alexandra Gleneagles Medical Imaging- Orchard Total Diagnostic Mount Alvernia Cancer University Orchard Imaging MRI Scanner Field Strength (Tesla) Brain for tumour* Common MRI Scans Liver for liver cancer* Lumbar Spine for Backache Knee for ligament tear 0.35 $725 $725 $515 $ $701 $773 $630 $ $969 $969 $714 $ $1,197 $1,197 $725 $ & 1.5 $520 $1,250 $398 $398 to $1,250 to $1,681 to $567 to $ $840 $840 $683 $ $1,008 $1,008 $620 $ $767 to $978 $767 $ & 3.0 $968 $721 $721 $ $827 $827 $735 $ $945 $945 $683 $ $1,050 $1,050 $788 $788 4

The key component of MRI scanners is the magnet, which determines the scanner s Field Strength, and is rated using a unit of measure known as a Tesla.

5 RadLink Diagnostic Imaging MRI Scanner Field Strength (Tesla) Brain for tumour* Common MRI Scans Liver for liver cancer* Lumbar Spine for Backache Knee for ligament tear 1.5 $1,150 $1,150 $643 $ & 1.5 $943 $943 $680 $ $968 $968 $714 $714 Inpatient Alexandra 1.5 $701 $773 $630 $ $969 $969 $714 $714 Gleneagles 1.5 $1,393 $1,393 $902 $1, $1,373 $1,392 $795 $987 to $1, & 3.0 $968 $714 University 1.5 $827 $827 $735 $ $1,181 $1,181 $866 $ & 1.5 $1,018 $1,018 $755 $ $968 $968 $714 $714 es: All charges quoted are inclusive of Goods & Services Tax (GST). * These MRI scans are typically done with contrast, i.e. a dye (contrast medium) is used to make some tissues show up more clearly. 5

5 $1,393 $1,393 $902 $1,011 1.5 $1,373 $1,392 $795 $987 to $1,869 1.5 & 3.0 $968 $714 University 1.5 $827 $827 $735 $735 1.5 $1,181 $1,181 $866 $866 1.0 & 1.5 $1,018 $1,018 $755 $755 1.

6 III. POSITRON EMISSION TOMOGRAPHY PET scanners use radionuclides attached to biological molecules (radioactive drugs) to produce images of the body by studying how certain areas function and convert energy. Unlike other forms of imaging such as MRI and CT which primarily provide information on what areas of the body look like (anatomical imaging), PET shows how the areas of the body is actually working (functional imaging). All four PET scanners in use locally are hybrid PET / CT scanners. These scanners combine the two modalities (PET and CT), enabling both functional and anatomical images to be collected in a single scanning session. PET is primarily used to either detect disease or to find out how widespread a disease is within a patient. Charges for a common PET scan are tabulated below (see Table 4). Unlike CT and MRI which are proven technologies, PET is new and is still being evaluated in terms of effectiveness. Outpatient AsiaMedic PET/CT Inpatient Table 4: Charges for Common PET Scans PET/CT Whole Body Scan PET/CT Whole Body Scan (without intravenous contrast) (with intravenous contrast) e: All charges quoted are inclusive of Goods & Services Tax (GST). $3,098 $3,098 $3,623 $2,310 $3,833 $2,310 Feedback to MOH If you have any comments or questions on the information paper, you can us directly at moh_info@moh.gov.sg. Alternatively, you can also fax or write to us at: Ministry of Health College of Medicine Building 16 College Road Singapore Tel: Fax:

Unlike other forms of imaging such as MRI and CT which primarily provide information on what areas of the body look like (anatomical imaging), PET shows how the areas of the body is actually working

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