CT cholangiogram – when should we order one?

12th November 2023, NIA Diagnostic Imaging

epigastric pain

Epigastric pain has to be one of the most common presenting symptoms in primary care. The differential diagnoses include cholelithiasis and cholecystitis. With increasing prevalence of obesity and type 2 diabetes, the prevalence of gallbladder disease is also increasing. Often, abdominal ultrasound can confirm or exclude gallbladder disease but sometimes, the results are inconclusive or we suspect additional bile duct obstruction.…

DVT – how does duplex US look for it?

11th October, 2023, NIA


Deep vein thrombosis (DVT) is a medical condition associated with significant morbidity and mortality. It is vital that a rapid diagnosis can be acquired since DVT can result in severe complications including the development of pulmonary embolism (PE). The consequences of PE can be life-threatening. About 10% of PEs are fatal and 5% will cause death later despite diagnosis and treatment.…

CT-guided spinal injections – what to order?

12th September 2023, NIA Diagnostic Imaging

Back pain has to be one of the most common ailments we see in general practice. Pain may originate from nerve root irritation, facet joint dysfunction, degenerative disc disease or poor muscle function or even osteoporotic fractures. There has been numerous systematic reviews and meta-analyses and most have highlighted how ineffective cortisone injections are in relieving the symptoms in the medium and long term.…

Early breast cancer – close collaboration between GP and radiologist.

13th August 2023, NIA Diagnostic Imaging

A 49-year-old lady presented with pain in her right breast. There is a strong family history of breast cancer. Breast examination was difficult because of “lumpiness” of the breasts. She was referred for a breast ultrasound at NIA. Ultrasound showed two lesions in the right breast – one at 3 o’clock, 2cm from the nipple and another at 7 o’clock, 2cm from the nipple.…

Aortic aneurysm – the silent killer

13th July 2023, NIA Diagnostic Imaging


Aortic aneurysms are known as silent killers as the majority of patients with the condition are asymptomatic and are usually found incidentally during physical examinations or diagnostic imaging studies performed for other reasons (Faiza & Sharman, 2023). Ruptured aortic aneurysms are associated with high mortality rates of approximately 80-90% for patients with ruptured AAAs (Wise et al., 2016) in which “more than 50% of patients die before they reach the emergency room” (Shaw et al., 2023).…

CT Colonography vs Colonoscopy

NIA Diagnostic Imaging, 14th May 2023

Colorectal cancer (also known as bowel cancer) is the third most prevalent type of newly diagnosed cancer and the second deadliest type of cancer in Australia. CRC generally arises from the inner lining of the colon and is often characterised by polyps, which, if left undetected, can transform into aggressive malignancies. Despite the fact that optic colonoscopy is the golden standard for the detection of colorectal cancer, CT colonography (CTC) is regarded as a non-inferior alternative.…

Heart failure in cancer survivors – who is at risk?

13th February 2023, Dr Chee L Khoo

Survival rates amongst our cancer patients have improved dramatically over the years with the advent of better chemotherapy regimen. This is particularly the case in breast cancer and the different lymphomas. One of the adverse effects is cardiotoxicity in patients exposed to anthracyclines which can be life-threatening and can occur immediately or in the longer term.…

Acute appendicitis – combining history with imaging

13th February 2023, NIA Diagnostic Imaging

Acute appendicitis?

A 30 year old woman presented to her GP with a two-day history of right sided abdominal/pelvic pain. There was associated severe nausea. On examination, there was tenderness in the right lower quadrant with guarding. A pelvic ultrasound was requested.

With this request, differential diagnosis may include haemorrhagic cyst, dermoid cyst, ovarian torsion, ectopic pregnancy or endometriosis.…

Bloody nipple discharge – a cause for concern?

14th January 2023, NIA Diagnostic Imaging

Despite the availability of modalities such as mammography, MRI and galactography, ultrasound still has a role in breast imaging. Ultrasound provides high resolution portrayal of normal and abnormal breast parenchyma as well as clear depiction of lactiferous ducts and the terminal duct-lobular unit where masses can form (4). This is particularly useful when investigating women presenting with a bloody nipple discharge.…

Acute Achilles tendon rupture – is non-surgical treatment just as good?

11th May 2022, Dr Chee L Khoo

I was fortunate to have received ample orthopaedic experience in my training days. I was all destined to be an orthopaedic surgeon but changed my mind. I have seen a few complete Achilles tendon rupture and assisted in many successful surgical repair. Conceptually, you can’t imagine how anyone can plantar flex again if the tendon ends are not reattached surgically.…

GLP1-RAs and gallbladder diseases – is there a connection?

biliary system

12th April 2022, Dr Chee L Khoo

It’s almost close to a wonder drug. It is widely used in type 2 diabetes (T2D) for management of hyperglycaemia when the HbA1c is >7.0%. For that indication, it is pretty potent and in clinical trials, can reduce the HbA1c by 1-1.5%. It also assists in weight reduction and thence, reduce the core problem of insulin resistance in these patients.…

EGFR – not the renal one

1st January 2022, Dr Chee L Khoo

This definitely wasn’t in the curriculum when I left med school (alright, it was more than 30 years ago now) but I don’t remember being updated about its relevance. I am talking about the epidermal growth factor receptor (EGFR). It is not really in the realm of general practice as such but we do have patients coming back from the oncologist with a tumour bearing an EGFR gene mutation.…