Is the Cost Squeeze at Ontario’s Medical Imaging Clinics Putting Accessibility at Risk?
When the pros and cons of Ontario’s healthcare system are debated, the focus is almost always on doctors and hospitals. Very little attentions is paid to another key segment of our healthcare system – Ontario’s 1,000 medical imaging clinics. Read Part 1, Part 2 and Part 3.
Mammography in the News
May 2013 – please read this document regarding mammography in the news and updates regarding mammography at our clinic.
Bone Density Testing Interval and Transition to Osteoporosis in Older Women
You may have heard about the study “Bone Density Testing Interval and Transition to Osteoporosis in Older Women” (Gourlay et. al., NEJM, Jan 19, 2012) which analyzed post-menopausal women enrolled in SOF (Study of Osteoporotic Fractures). This study concluded that estimated BMD testing intervals can be as long as 17 years for those with normal BMD or “mild osteopenia” (defined in this article as a T-score of less than -1.0 and greater than -1.5) and 5 years for “moderate osteopenia” (T-score of less than or equal to -1.5 and greater than -2.0). The article has generated a great deal of interest in the lay press and medical wire services.
Protest letters against anti-screening propaganda
Click here to read the first of two protest letters against the anti-screening propaganda. 40 screening experts from all over the world signed the Lancet letter, expressing that “enough is enough” and pointing out the source of all this negative campaign.
Click here to read the second article against the anti-screening propaganda.
Response to Canadian Task Force Mammography Recommendations…
To our patients:
You are probably aware of the LATEST controversy regarding screening mammography. At the end of the day, each patient is going to make a decision that she feels is the best for her. However, before you take the latest Canadian Task Force recommendations seriously and stop having regular mammograms, remember that if there is one thing we know about breast cancers (if not all cancers) it is that “BIG IS BAD”, “BIGGER IS WORSE” and “SMALL IS ALWAYS BETTER THAN BIG”!, and remember these FACTS that no amount of scientific scrutiny or statistical manipulation can refute.
Read response from Paula Gordon, M.D., FRCPC
Subs for Seniors Fundraiser returns for its best year yet
By: Tracey Coveart / The Scugog Standard
When Mr. Sub owners Spiros and Dimos Vovos wanted to give back to their community, no one -not even the brothers – knew that their Subs for Seniors day would become an annual event that raises thousands of dollars for seniors at the local nursing home. In two years, thanks to the generosity of their sponsors and the support of their customers, the brothers have raised $7,800 for the residents’ Fund at Community Nursing Home Port Perry and the Vovos boys are hoping Wednesday, June 1, will be their best event yet.
“It just keeps getting bigger!” said Spiros, who now has 13 sponsors and more clamouring to get in on the fun. “We’re hoping to raise $5,000 this year.”
The Vovos brothers will donate one dollar for every 12-inch sub and fifty cents for every six-inch sub sold that day to the local nursing home to enrich the lives of seniors living there. The Vovos brothers will also hold a donation draw on June 10. A minimum $5 donation will get customers in on the draw for some fabulous prizes: a pair of Blue Jays tickets donated by Port Perry resident Steven Fox; a pair of Jays tickets for the June 12 game against Boston donated by Mr. Sub Port Perry, a Nescafe Dolce Gusto Coffee Machine donated by Krups, a Broadstone six-man dome tent donated by Canadian Tire Port Perry and a Sony Blue Ray Player donated by Mr. Sub Port Perry.
Just some of the events that residents were able to enjoy last year thanks to the Subs for Seniors donation include visits from Zoo to You and the Super Dogs, a trip to WindReach Farm, a spin with the Blue Nights Motorcycle Derby, a carnival fun fair with Bellybutton the Clown and an outdoor movie night in the parking lot featuring The Sound of Music.
According to program aid Brenda Carberry, monies raised through Subs for Seniors this year will pay for a field trip in August for 25 lucky residents to Eaglewood, wheelchair accessible lodge in Pefferlaw, complete with horses and pigs, fishing pond, campfire and an accessible tractor ride through the bush.
Residents journeyed to the lodge last year with some staying for the day and others bunking out for two nights.
“The residents wanted to go out for dinner so we took them to a fancy restaurant in Pefferlaw,” said Brenda and they loved sitting outdoors around the campfire roasting marshmallows and dipping them in Bailey’s Irish Cream! We even made the wish of one who has since passed away come true. He wanted get on a horse again and we got him riding.”
The money from Subs for Seniors allows the nursing home to offer more “community based programs,” said Program Director Leisa Saunders. “Sometimes our budgets don’t allow us to do what we really want to do with our residents and this fundraising helps to offset the costs so we can develop more programs for more people. We’ve had a big turnout to many of the events, with residents, families, staff and volunteers all coming out to enjoy the entertainment. Because it’s affordable we can take a much broader approach to our activity programming.”
And for Spiros, that’s what it’s all about.
“We’re helping to bring entertainment to seniors who can’t get out on their own to enjoy things anymore,” said Spiros, who was invited to the home for the Zoo to You event in July. “The sunroom was packed with residents and family members and children. It was priceless to see how excited and happy people were. The buzz in the building was electric.”
The ‘Dr. Oz Show’ and thyroid shields: the saga continues…
What’s a woman to do? Should she believe one of the most trusted cardiologists in North America or expert radiologists specializing in breast imaging? You may have been left with such questions if you watched the “Dr. Oz Show” episode on thyroid shielding that aired April 14.
The program was dedicated to clarifying whether individuals should wear thyroid shields when having radiation-based procedures such as mammograms and dental x-rays. While radiology advocates believe the shields are unnecessary for mammography, women across the U.S. have been asking for the protection after an email went viral in March based on advice Dr. Mehmet Oz gave in a show that originally aired last year.
This week’s episode was ostensibly intended to set the record straight, with Oz, the cardiothoracic surgeon who hosts the show, inviting experts from dentistry and radiology to comment on the email controversy and the pros and cons of thyroid shielding. But a combative Oz defended his original advice, and ultimately turned the show into a lecture for health professionals on the necessity of listening to their patients.
Rising thyroid cancer rate
The backstory for the controversy is the rising incidence of thyroid cancer, which has increased fourfold since the 1970s. The original episode in 2010 said that some of the increase could be due to radiation exposure from dental x-rays and mammograms, and advised the use of thyroid shields to reduce risk — advice that prompted statements of opposition from imaging organizations.
Appearing on this week’s show to represent healthcare professionals were luminaries from radiology and dentistry, including the following:
Dr. Daniel Kopans, director of breast imaging at Massachusetts General Hospital
Dr. Phil Evans, director of the University of Texas Southwestern Center for Breast Care
Dr. Jocelyn Rapelyea, associate director of breast imaging at the Breast Imaging and Intervention Center of George Washington University
The show exuded the atmosphere of a pep rally, with Oz pointing out that many doctors did not agree with his recommendation for women to wear a thyroid shield when having a mammogram. “I’m taking on my critics,” he stated emphatically, and from that point on he barely let the invited radiologists get an informative word in edgewise.
“My warnings sparked a firestorm,” Oz said. “You turned the medical community upside down by demanding thyroid guards while getting x-rays. I want you to have the power. It’s about your right to control your care.”
The invited guests pointed out the impracticality of Oz’s advice, indicating that the radiation dose exposure to the thyroid gland after 40 years of annual mammograms would be less than the background radiation received by sitting in a television studio for 60 minutes.
In addition, using thyroid shielding could affect the diagnostic quality of a mammogram, and images might be compromised altogether, requiring a retake and doubling the amount of radiation exposure to the breast.
Images from a patient who underwent mammography with a thyroid shield. The image on the left is a mediolateral oblique view demonstrating the thyroid shield obscuring the upper posterior breast along with a degraded image. The image on the right was repeated without the shield and shows normal breast tissue. All images courtesy of Dr. Phil Evans.
When Kopans commented to Oz that “if you are going to promote thyroid shields for mammograms, your audience should be wearing them now” to protect the thyroid gland from normal background radiation levels that cumulatively are much greater, Oz interrupted him. Oz stated that the protection was for a dose that a thyroid gland was receiving in one second rather than spread over 30 minutes, and why not protect oneself during that one second?
Kopans’ comment that radiation dose was cumulative, and if Oz wanted his audience to protect their thyroids they should wear a thyroid shield 24 hours a day, was ignored by the television host and appeared to fly over the heads of his studio audience.
A technologist positioned for a mammogram with the thyroid shield in place. Part of the thyroid shield is underneath the compression paddle and would cause a portion of the breast to be obscured on the mammogram. Evans and Rapelyea both stressed that thyroid shields, however well intentioned, could compromise a mammogram and require that it be performed again. Evans showed examples of such images. Rapelyea explained that a patient’s body shape and mobility might prevent her from wearing a thyroid shield due to positioning requirements. She explained that in the past week, as patients at her center were demanding thyroid shields, approximately 20% of screening mammograms had to be repeated.
Oz acknowledged that this could be a problem, along with the concern raised by Evans that fear of radiation could scare many women away from having mammograms. He told his audience members to get their mammograms because they save lives, and to listen to breast imaging specialists if they say that for specific reasons an individual cannot wear a thyroid shield and have a successful mammogram.
But his concluding remarks to the television audience fit the tenor of the show:
“Mammography makes a ton of sense, but you have the right to ask for a thyroid guard,” he said. “This is only going to happen if you make it happen. If you don’t ask those tough questions, there isn’t going to be any change. But if you do ask them, you have the power to make us doctors adjust to you and customize your care.”
Recent American media reports (e.g. Dr. Oz) have highlighted the use of the thyroid shields/collars during routine mammography as a means to minimize exposure to radiation during the procedure. This has raised concerns amongst Ontario Breast Screening Program (OBSP) clients.
ACR-SBI Statement on Mammography Radiation
Some Americans have expressed concern, due to an erroneous media report, that the small amount of radiation a patient receives from a mammogram may significantly increase the likelihood of developing thyroid cancer. This concern is not support in scientific literature.
Read ACR-SBI statement…
Do you need an Ultrasound in Toronto?
Traumatic and non-traumatic causes of soft tissue pain, masses and other symptoms constitute a large percentage of visits to a physician.
Clinical assessment and X-Rays used to be the only tools available to
the physician for investigation of such symptoms.
Over the past 15 years or so, Musculoskeletal Ultrasound has been used increasingly to manage patients with muscle, tendon and other soft tissue pathology.
Musculoskeletal Ultrasound in our Toronto Medical Clinic is used for ailments, both common and more esoteric alike such as :
o rotator cuff tendinitis and tears,
o heel pain from plantar fasciitis
o Achilles tendon xanthomatosis
o and suprascapular notch cysts,
Musculoskeletal Ultrasound has become an indispensable tool in modern medicine today and at the Toronto Centre for Medical Imaging (TCFMI) clinic, we have more than 15 years experience in Musculoskeletal (MSK) Imaging. Most of the Sports Medicine physicians in the downtown Toronto core refer their MSK cases to TCFMI. Family physicians in the area also access our expertise.
Before you go to an X-ray clinic in Toronto, consider your other options.