Collins Street Radiology renovates and installs state-of-the art 3D imaging

Collins Street Radiology located on Level 6 at 15 Collins Street in Melbourne has recently embarked on a major transformation after its original design had become tired and dated after 16 years of service.

The practice was stripped back completely, walls demolished and the floor plan recreated by a leading Melbourne interior designer and built by Newvan Developments. Bespoke cabinetry built offsite and loaded on weekends minimised workflow interruptions. Practice Manager Joy Doig sourced three beautiful grey marble slabs from the Dolomites for the reception desk area, kitchen and patient refreshment area.

Bang and Olufsen sound equipment creates soft auditory ambience in the reception with a one million song playlist on a special tablet. The new sterilisation room has a Mocom autoclave and ergonomic wash up area. Ample cupboard space means clean desktops set off against bright crisp off-white walls.

Machines were disposed of with requisite radiation department certificates or donated to overseas missions/hospitals. Complex cabling was installed with Body Protected Electrical Areas by Prolink and a revised radiation plan was undertaken for the digitally networked Planmeca OPG units and two cone beam (CT) scanners.

Images on these units are saved onto a server and are sent via encryption as JPEGs and PDFs. The practice also has intraoral capability at 24-30 LP, of which up to 6 images can be billed to Medicare. A cooled and lockable server cage is installed behind the remodelled reception. High end post production monitors were installed in each room with colour correction and algorithms to enhance grey scale contrast and resolution.

Medicare rebates

Patients from the suburbs can take advantage of Medicare rebated and reported OPGs and a number of bitewing/periapical images. Medicare still covers up to six PA/bitewing images and the OPG which is a real bonus for the patient and allows dentists to plan a treatment from their laptops. CBCT scans are partially covered by Medicare if referred by a dental specialist but hybrid machines are totally excluded. The current fee of $269.50 attracts a $96 rebate. Free parking is available for patients examinations and images can be printed on traditional film or high resolution paper on an in-house Xerox commercial printer. The images are always sent in a 1:1 format but can also be sent with any magnification factor required.

Radiological reporting

A radiology report accompanies the examination which is reassurance for the practitioner in this highly medico-legalised society. From experience, there is a reasonably high incidence of facio-maxillary abnormalities that must be detected and reported and may be missed by practitioners not used to reading complex radiographs all-day every-day.

Red flags for abnormalities

In fact, Collins Street Radiology uses the "Red Flag" system developed in Scandinavia which flags any abnormality, reports it twice and hands the result and report to the referring practitioner. Abnormal findings are always followed through and documented. A bright red dot is placed on the patient's referral and a green dot after the case has been followed through with the referring practitioner. This is a system used in Helsinki, Finland and has been shown to decrease mistakes and errors. Andrew Collins, the principal radiographer at Collins Street Radiology, trained with this system whilst in Finland. Any abnormality of a potentially insidious nature is handled personally by the person who examined the patient. Cases are documented and anomalised for the CPD programs which are mandated by the Radiology Institute.

Apps and connectivity

The Planmeca cone beam large field unit was added to the practice to cover both Macintosh and PC-based platforms. Surgical implant planning is available on this machine and practitioners can access images on a mobile tablet or computer. Planmeca, like the i-CAT, offer free software apps for these devices.

DICOM or STL

High resolution printed images at a 1:1 scale are provided with a report excluding anatomical and pathological abnormalities with a disc with the patient's unique DICOM dataset and/or stand-alone viewing software. DICOM datasets can be used in third party software such as Nobel Biocare's NobelClinician, Dolphin and a number of implant planning systems. Datasets can also be converted to STL file format which can then be 3D printed for such applications as surgical guides, TMJ prosthesis and jaw reconstructions.

The i-CAT Platinum is still, however the most used and loved of all the machines because of the speed of the scan, the lower radiation dose and sharpness of images. A decision to keep 2D and 3D machines separate was a deliberate choice because constructing OPG images from 3D datasets is always an inferior option.

Routine radiology

Much of the work at Collins Street Radiology is scanning for wisdom teeth extraction, implants and pathology. The latter is the most interesting as there are over 200 manifestations of mandibular anomalies. The other satisfying part is the interaction with other practitioners, especially demonstrating the software imaging applications which are continually evolving. Collins Street Radiology has a significant database of cases which are used for lectures and education with colleagues locally and overseas. The ability to attend conferences and network is a great advantage of this boutique and specialised area of imaging and Collins Street Radiology welcomes friends and referrers to stop by for a coffee and tour the new practice.