Download radiology services - Ministry of Health

MOH Information Paper: 2005/ 08
RADIOLOGY SERVICES
By Dr Lim Eng Kok1
INTRODUCTION
Radiology is the branch of medicine that deals with the use of ionising (e.g. xrays 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 survey2 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 Singapore3.
CT
MRI
PET
Public Sector
20
11
1
Table 1: Number of Scanners
Scanners
Private Sector
Total
13
33
11
22
3
4
Scanner (Units per
million population)*
7.8
5.2
0.9
*Note: ‘Total Population’ data as at 18 Aug 2005, based on ‘Statistics Singapore’, the Department of
Statistics Singapore at www.singstat.gov.sg
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 (www.oecd.org).
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: Centre for Radiation Protection, Health Sciences Authority (Data as at end-June 2005).
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MOH Information Paper: 2005/ 08
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.
Table 2: Charges for Common CT Scans
+
Abdomen*
Abdomen
and
Pelvis*
Angiography
Heart
Arteries*
Brain*
Chest*
Neck/
Post-nasal
space*
$424
$676
Not
applicable
$312
$424
$424
$567
$777
$1,040
Not
applicable
$567
$515
$485
$764
Not
applicable
$349
$485
$475
$434
to $525
$452
to $609
$460
$782
Not
applicable
$662
to $856
$750
$893
$434
to $525
$452
to $609
$326
$434
to $525
$452
to $609
$452
$434
to $525
$452
to $609
$452
$473
$840
Not
applicable
$473
$473
$473
$515
$620
Not
applicable
$462
$462
$462
$408
to $609
$453
$765
to $809
$737
$893
to $998
$408
to $534
$340
$408
to $609
$453
$408
to $609
$453
Not
applicable
Not
applicable
Not
applicable
$348
Not
applicable
$452
$541
$808
$890
$365
$475
$507
$554
$769
$998
$368
$554
$554
Raffles
Diagnostica
$525
$924
$1,029
$525
$525
$494
Singapore General
Hospital
$462
$751
$718
$347
$462
$462
Singapore Heart,
Stroke & Cancer
Centre
$790
$790
$1,280
$790
$790
$790
Tan Tock Seng
Hospital
$487
$763
$665
$346
$478
$478
Outpatient
Alexandra
Hospital
AsiaMedic Heart &
Vascular Centre
Changi General
Hospital
East Shore
Hospital
Gleneagles
Hospital
KK Women’s and
Children’s Hospital
Medical ImagingOrchard Total
Diagnostic Centre
Mount Alvernia
Hospital
Mount Elizabeth
Hospital
National Cancer
Centre
National
Neuroscience
Institute
National University
Hospital
RadLink Diagnostic
Imaging
$715
Not
applicable
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MOH Information Paper: 2005/ 08
Abdomen*
Abdomen
and
Pelvis*
Angiography+
Heart
Arteries*
Alexandra Hospital
$424
$676
$312
$424
$424
Changi General
Hospital
East Shore
Hospital
Gleneagles
Hospital
KK Women’s and
Children’s Hospital
Mount Elizabeth
Hospital
National
Neuroscience
Institute
National University
Hospital
Raffles
Diagnostica
Singapore General
Hospital
Tan Tock Seng
Hospital
$485
$764
Not
applicable
Not
applicable
$349
$485
$475
$577
to $709
$547
to $834
$460
$950
Not
applicable
$699
to $1,095
$750
$1,287
$577
to $709
$547
to $834
$326
$577
to $709
$547
to $834
$452
$577
to $709
$547
to $834
$452
$539
to $956
$838
to $1,581
$1,027
$539
to $956
Not
applicable
Not
applicable
Not
applicable
$539
to $956
$348
$539
to $956
$452
$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
Brain*
Chest*
Neck/
Post-nasal
space*
Inpatient
$715
Not
applicable
Notes: 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.
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MOH Information Paper: 2005/ 08
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
MRI Scanner
Field
Strength
(Tesla)
Brain for
tumour*
Common MRI Scans
Liver for
Lumbar Spine
liver
for Backache
cancer*
Knee for
ligament tear
Outpatient
Advanced
Integrated
Radiology
Alexandra
Hospital
Changi General
Hospital
Gleneagles
Hospital
Medi-Rad
Associates
Medical ImagingOrchard Total
Diagnostic Centre
Mount Alvernia
Hospital
National Cancer
Centre
National
Neuroscience
Institute
National University
Hospital
Orchard Imaging
Centre
Raffles
Diagnostica
0.35
$725
$725
$515
$515
1.5
$701
$773
$630
$630
1.5
$969
$969
$714
$714
1.5
$1,197
$1,197
$725
$830
0.3 & 1.5
1.5
$520
to $1,250
$840
$1,250
to $1,681
$840
$398
to $567
$683
$398
to $882
$683
1.5
$1,008
$1,008
$620
$714
1.5
$767
$978
$721
$721
1.5 & 3.0
$767
to $978
$968
Not
applicable
$714
Not
applicable
1.5
$827
$827
$735
$735
1.5
$945
$945
$683
$683
1.5
$1,050
$1,050
$788
$788
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MOH Information Paper: 2005/ 08
MRI Scanner
Field
Strength
(Tesla)
RadLink Diagnostic
Imaging
Singapore General
Hospital
Tan Tock Seng
Hospital
Brain for
tumour*
Common MRI Scans
Liver for
Lumbar Spine
liver
for Backache
cancer*
Knee for
ligament tear
1.5
$1,150
$1,150
$643
$836
1.0 & 1.5
$943
$943
$680
$680
1.5
$968
$968
$714
$714
1.5
$701
$773
$630
$630
1.5
$969
$969
$714
$714
1.5
1.5
$1,393
$1,373
$1,393
$1,392
to $1,869
$902
$795
$1,011
$987
1.5 & 3.0
$968
Not
applicable
$714
Not
applicable
1.5
$827
$827
$735
$735
1.5
$1,181
$1,181
$866
$866
1.0 & 1.5
$1,018
$1,018
$755
$755
1.5
$968
$968
$714
$714
Inpatient
Alexandra
Hospital
Changi General
Hospital
Gleneagles Hospital
Medi-Rad
Associates
National
Neuroscience
Institute
National University
Hospital
Raffles
Diagnostica
Singapore General
Hospital
Tan Tock Seng
Hospital
Notes: 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.
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MOH Information Paper: 2005/ 08
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.
Table 4: Charges for Common PET Scans
PET/CT Whole Body Scan
(without intravenous contrast)
PET/CT Whole Body Scan
(with intravenous contrast)
Outpatient
Medi-Rad
Associates
AsiaMedic
PET/CT Centre
Singapore General
Hospital
Not applicable
$3,098
$3,098
$3,623
$2,310
Not applicable
Not applicable
$3,833
$2,310
Not applicable
Inpatient
Medi-Rad
Associates
Singapore General
Hospital
Note: All charges quoted are inclusive of Goods & Services Tax (GST).
Feedback to MOH
If you have any comments or questions on the information paper, you can email us directly at
[email protected]. Alternatively, you can also fax or write to us at:
Ministry of Health
College of Medicine Building
16 College Road
Singapore 169854
Tel: 6325 9220
Fax: 6224 1677
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