Dear Colleagues,
I am pleased to announce that the Fibroscan program here at The Toronto Liver Centre is up and running. We have also managed to open satellite clinic in various locations. Please see the referral form for details regarding locations. We set the program up in response to your desire for improved access to the device. I wanted to take this opportunity to tell you about our program in more detail.
Referring a patient for a scan:
1. We have included a “Fibroscan-only” referral sheet that your office can use to send patients for a Fibroscan. You will see that there are requirements for recent blood work and other background information; these are simply to help in the interpretation of the results. This specific referral form ensures the patient case does not end up in the general referral side of our clinic.
2. Appointment bookings will be handled like most other referrals- except that they will be expedited.
3. I will personally interpret the results within 2-5 days of the scan.
4. The interpretation of the test will be faxed back to you as a straightforward report.
5. The patient will be returned to your care and supervision after the scan is complete.
Cost:
As you may be aware, there is not yet a billing code associated with the Fibroscan procedure. To assist in paying the technician, administrative support, as well as the annual maintenance costs, we have decided on a initial fee of $90 per scan, however after the pilot project has been evaluated one year after opening the Fibroscan Program, we had to increase the fee to cover the above mentioned costs and the fee now is $90.00 per scan. We have recently acquired CAP (Controlled Attenuation Technology) to measure liver steatosis simultaneously with Fibroscan examination. The cost of CAP is $35.00. CAP cannot be done as a separate examination and can only be added to a Fibroscan examination. The patients will be able to pay by either cash, credit card or debit.
Patient materials:
- We have designed a brochure to help you discuss the benefits of a Fibroscan with your patients. As each patient
case will be different, we leave it up to you to discuss the benefits of the Fibroscan as they pertain to their
disease.
Fibroscan Scientific Background
The prognosis and management of chronic liver disease largely relies on the extent and progression of hepatic fibrosis. For instance, in patients with chronic hepatitis C precise staging of liver fibrosis is essential as fibrosis is the most important predictor of disease outcome. In addition fibrosis stage influences the indication for antiviral therapy. To date, liver biopsy traditionally has been considered the gold standard for evaluating hepatic fibrosis. As you all know, a liver biopsy has limitations including being an invasive and painful procedure. In addition, it has a poor patient acceptance and carries a small risk of life-threatening complications.
One of the most important limitations for a liver biopsy is a sampling error and intra and inter observer variability that may lead to over or under estimation of liver fibrosis stage. Even in the best hands when an experienced physician performs a liver biopsy and an expert pathologist interprets the results, the error rate in disease stage may reach up to 20-30%. Finally, a liver biopsy is not the ideal procedure as a serial assessment of disease progression.
Fibroscan is a novel non-invasive technology that has been gaining popularity for the evaluation of hepatic fibrosis in patients with chronic liver disease of different etiologies. It measures the degree of liver stiffness. The technology utilizes ultrasonic waves hence there is no radiation exposure.
Fibroscan measures liver stiffness in volume then approximates a cylinder 1 cm wide and 4 cm long, between 25 mm and 65 mm below the skin surface. This volume is at least 100 larger than a biopsy sample and is therefore far more representative of liver parenchyma.
Diagnostic performance of transient elastography has been well validated in various liver diseases including chronic hepatitis C, chronic hepatitis B, co-infection with HIV, cholestatic liver diseases including primary biliary cirrhosis and primary sclerosing cholangitis, autoimmune hepatitis and nonalcoholic steatohepatitis. Fibroscan has also been useful in monitoring development of liver fibrosis in patients being treated continuously with potential hepatotoxic drugs, such as patients with psoriasis being treated with methotrexate.
Fibroscan is a very useful tool for diagnosis of early cirrhosis. Confirmatory long term longitudinal studies are being done to confirm the validity of Fibroscan in monitoring of disease progression, screening for complications of cirrhosis such as esophageal varices and hepatocellular carcinoma and also screening for portal hypertension.
It has also been shown that transient elastography is useful in the prediction of the stage of liver fibrosis in patients with alcoholic liver disease. Transient elastography would also be valuable for assessing the severity of recurrent hepatitis C after liver transplantation.
I am very pleased to be able to provide your patient with this relatively new and exciting technology. I hope with this technology at hand you will be able to provide your patients with the best therapeutic decisions and outcomes.
Consultations:
Referrals and Pre-Assessment
The Toronto Liver Centre concentrates on clinic-based out-patient investigation and treatment of colon and rectal ailments using the latest equipment and techniques. These techniques usually give better results than many of the older in-hospital methods, with less pain to the patient and less cost to the insurer.
Appointment Requests
As a specialized clinic, we are not able to accept requests for appointments directly from patients. A referral must first be faxed to our clinic from your primary care physician or family doctor. After this you will need to contact the clinic to book the appointment.
If you need to find a primary care physician, please check the doctor search service operated by the College of Physicians and Surgeons of Ontario.
Please note that patients who are not insured under the Ontario Health Insurance Plan (or any other Canadian public health insurance plan) will be charged directly for professional fees and treatments.
Referral From Doctors
As a Toronto-leading centre for treatment of diseases and afflictions of the colon and rectum, we offer compassionate care and specialized treatments that go beyond the scope of what can be provided in a general medical centre. We welcome referrals from family practitioners and doctors, please use our convenient Referral Form for this purpose.
It is a requirement by the College of Physicians and Surgeons of Ontario (CPSO) that patients undergoing colonoscopy/gastroscopy in a freestanding clinic should have a full history and physical examination before the procedure. Please refer to the CPSO Guideline for Endoscopy Clinics.
The completed form can be faxed to us instead of the referral form to request the endoscopy procedure. If we do not receive a complete pre-assessment from the referring physician, the patient must receive a pre-assessment by our specialist at least 12 days prior to the requested procedure.
For your convenience, the Referral Form for FibroScan/CAP are available as Adobe PDF files. To view and print the PDF file, you can download the free Adobe Reader if you don't already have it, or if you want to upgrade to the latest version. If you prefer to receive the Referral Form by mail or email, please contact our clinic directly.
If you are not a patient of Dr. Magdy Elkhashab at the Toronto Liver Centre, but you or your doctor wish to book an appointment for Fibroscan, please e-mail us at fibroscanbooking@tlccure.com your request indicating preferable location (you will find it on the referral form) and we will get back to you with an appointment booking. You will be required to bring the referral from to your appointment with the referring physician’s information, so please download the form. Alternatively, once filled out, your referring physician can fax the form directly to our office at 416-652-5367 and we will notify the physician and you of your scheduled appointment.
For medico-legal reasons, we are currently accepting referrals for Canadian patients only.
FibroScan Services
Scientific Background
Consultations
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