Monash Imaging research in bone trauma receives top award

Dr Aaron Wong

Monash Imaging radiology registrar Dr Aaron J Wong was recognised for his clinical research in bone trauma, receiving the top award at The Royal Australian and New Zealand College of Radiologists (RANCZR) Victorian branch trainee presentation event last week.

Dr Wong’s research presentation on the “Efficacy of Dual Energy CT Bone Oedema Detection in Suspected Fractures,” highlighted an advanced imaging technique for improving the diagnosis of subtle and occult fractures which are sometimes not detected with standard X-ray radiographs.

Dr Wong said that bone oedema, also known as bone bruising, is commonly associated with trauma, but previously only seen on MRI.

“Dual energy CT is a new form of CT imaging that uses two different spectra of X-rays at different energy levels,” Dr Wong said.

“It enables removal of the calcium signal in bone through image post-processing software, such that bone oedema appears conspicuous.”

Dr Wong’s research demonstrated that in patients who have sustained recent trauma, experience ongoing pain, and have no definite fracture on X-ray, this new, dual energy CT technique will help ensure that a bone injury is not missed.

“Although this feature is only available on newer scanners, like the Siemens Somatom Force CT at Dandenong Hospital, it does not require any additional radiation or scan time,” Dr Wong said.

“The information can be obtained quickly, helping doctors make the correct diagnosis in a timely manner.”

Head of CT and Head of Thoracic Imaging at Monash Health, Professor Ken Lau said Dr Wong’s findings confirm the clinical importance of this CT technique, which could transform future fracture imaging pathways.

“Monash Imaging is proud of Dr Wong’s success, as the Award recognizes the hard work and dedication needed in research,” Professor Lau said. 

Dr Wong will represent Victoria at the RANZCR ASM 'Branch of origin' research presentation in Perth in October. Monash Imaging registrars have won the top award at the annual RANZCR (VIC) Trainee Presentation Event for the past 3 years. 

Dr Wong acknowledges the ongoing support and guidance of his supervisor, Professor Kenneth Lau, and collaborators, Mr Peter Kutschera and Mr Beven Jong. He also thanks Director of Diagnostic Imaging, Professor Stephen Stuckey and Director of research, Professor Stacey Goergen, for promoting the research culture at Monash Imaging.

What's in a name? Everything.

Stacy Goergen published in Ultrasound Obstetrics and Gynecology.

Read article here.

Monash Imaging: from x-rays in a dark room to saving limbs and lives

Dr Chandra with a stent retriever

The field of radiology has come a long way since Wilhelm Conrad Roentgen’s discovery of X-rays in 1895. Ultrasound and nuclear medicine, computerised tomography (CT) and magnetic resonance imaging (MRI) are all commonplace techniques that aid in the diagnosis of disease.

What is not commonly known is that radiologists now do far more than sit in a dark room interpreting images and writing reports for other doctors.

Many of the Monash Imaging radiologists
(Prof Stuckey front, centre)

Monash University’s Dr Ronil Chandra is an interventional radiologist at Monash Imaging, the largest academic imaging department in Australia.  Monash Imaging is also unique with its own university department, at Monash University’s School of Clinical Sciences at Monash Health.

Dr Chandra did his medical training in Melbourne, before specialising in radiology at Massachusetts General Hospital, Boston and Harvard Medical School.   Having trained and worked with some of the world’s best radiologists, Dr Chandra believes the imaging services provided at Monash Health are as good as anywhere in the world.

 “We do amazing work here but very few people know about it,” says Director, Monash Imaging at Monash Health and Head of Department of Imaging at Monash University, Professor Stephen Stuckey.

“We have more than 430 staff including radiologists, imaging technologists, nurses and support staff who support, perform or interpret over 325,000 imaging examinations every year at Monash Imaging—and we also publish over 50 peer-reviewed papers annually, making us one of the most academically productive imaging departments in the country.”

“More than half of all Monash Health Emergency Department patients and almost all patients admitted to our hospitals are serviced by our Department of Imaging,” says Professor Stuckey.

There are a number of sub-specialists in the Monash Imaging team, including nine specialist interventional radiologists.  When not interpreting an image, interventional radiologists may be found inserting a stent into a patient’s brain to remove a blood clot or to treat a brain aneurysm.

Professor Stuckey says interventional radiologists use minimally invasive techniques to treat patients for a range of conditions including cancer, stroke, brain aneurysms and spinal injuries.

”We navigate the body’s natural highways to stop a bleed in the brain, remove a blood clot or to deliver chemotherapeutic agents directly to a cancer site,” says Dr Chandra. “Recent advances in imaging technology are driving this rapid change in clinical practice.”

“Five years ago, a standard CT scan for an emergency patient with acute stroke had fewer than 100 images—now standard CT imaging contains 3000 images,” says Dr Chandra.  “Radiologists need to analyse those images extremely fast to determine the best treatments.”

Radiologists are critical members of the medical team, facilitating rapid diagnosis of cause of illness with imaging techniques, and are increasingly integrated into treatment paradigms using minimally invasive interventional radiology techniques,” he says.

“Our team has become so clinical we see patients in clinic, do ward rounds in ICU and run infusions in the ICU.”

“The reality these days is patients don’t always have a surgeon—they have an interventional radiologist.”

In recognition of their expertise, Monash Medical Centre has recently been designated the second endovascular clot retrieval site in Victoria, with the largest patient catchment area.

“Stroke patients arriving at Monash Medical Centre are met by a multidisciplinary team of specialists including interventional radiologists and stroke physicians, who aim to remove a clot from a patient’s brain in under 60 minutes,” says Dr Chandra.

“We remove clots by inserting a stent retriever into the femoral artery in the patient’s groin and navigating up the neck and into the head.”

“Patients come in unable to speak or move, and as soon as we pull out the clot, they’ve recovered.  Their paralysis is gone.”

“The bottom line is we convert these patients from severe stroke to no stroke or mild stroke, and then they recover,” says Dr Chandra.

Before these techniques were available, patients either died or were left significantly disabled— these minimally invasive techniques not only save lives but patients are usually eligible to go home after 24-48 hours.

Dr Chandra says that while the procedures are costly, the economic benefit to the community is enormous.

“We’re saving on rehabilitation costs and reducing nursing home admissions. Most importantly, we’re returning people back to their families and back to normal life—that is priceless.”

International Day of Radiology is 8 November, the anniversary of Wilhelm Conrad Roentgen’s discovery of X-rays in 1895.

Monash Imaging research transforming modern radiology

"The Phantom" is used to measure
the dose of the CTs

Two Monash Imaging doctors were recognised for their leading research at The Royal Australian and New Zealand College of Radiologists (RANZCR) Annual Scientific Meeting last week.

Head of CT and Thoracic Imaging Clinical Associate Professor Ken Lau and Dr Yin Goh, 5^th year Radiology Registrar at Monash Health won awards for their cutting-edge research presentations at the meeting in Adelaide.

Associate Professor Lau’s poster, 'Imaging techniques in improving image quality of CT angiography: what are the latest?’ received the Wiley-Blackwell best exhibit award.

Clinical Assoc Prof Lau

“I demonstrated the use of the latest and advanced CT technology from different CT manufacturers that is beneficial to the image quality,” said Associate Professor Lau.

“CT technology is rapidly advancing, with a wide spectrum of CT imaging techniques that improve image quality and reduce radiation dose.”

Associate Professor Lau said new CT imaging techniques keep evolving and radiologists are no longer just imaging diagnosticians, but front-line technological experts who are guiding the development and applications of new imaging techniques in appropriate clinical settings.

Dr Yin Goh

Representing radiologists from Victoria and in collaboration with Associate Professor Lau and Dr Sidney Levy, Dr Goh won the Annual Scientific Meeting’s Branch of Origin research competition for her presentation of 'Fine Focal Spot Improves Image Quality in Abdominal CT Imaging'.

Awarded for the most outstanding trainee presentation, Dr Goh received a trophy and $5000 to present her paper at the Radiological Society of North America (RSNA) in Chicago next year.

“My project strives to improve the image quality of CT scans, such that we can make more accurate diagnoses,” said Dr Goh.

“We found that using a fine focal spot improves the image quality of abdominal CT scans without needing to expose the patient to any extra radiation and as radiologists, we are thrilled to have developed this new imaging technique to further improve patient care.”

“These are outstanding achievements from Associate Professor Lau and Dr Goh and further substantiate Monash University’s and Monash Health’s reputation as Australia's notable clinical imaging research centre,” said Director of Monash Imaging and Head of the Department of Imaging at the School of Clinical Sciences at Monash Health (SCS) Professor Stephen Stuckey.

“For Associate Professor Lau they add to an already impressive array of acknowledgements of the high standard of his research to date and for Dr Goh this award is an excellent beginning to her research career.”

“Monash Imaging and the Monash University Department of Imaging are very proud of these achievements,” added Professor Stuckey.

Associate Professor Lau said he was honoured and humbled to receive his award at the Annual Scientific Meeting among so many exceptional posters and presentations.

“This award motivates me to continue exploring the use of advanced CT technology,” said Associate Professor Lau.  “Our research is transforming modern radiology and leading to better patient care.”

Associate Professor Lau thanked Professor Stuckey for enabling and supporting a culture of research in the Department.

Dr Goh said she is extremely grateful for Associate Professor Lau’s continuous guidance, advice and mentoring.