Survival Difference between Surgery and Non-Surgery for the Treatment of Hepatocellular Carcinoma Patients at Liver Centre, Malaysia

Survival difference between surgery and non surgery of HCC

Survival Difference between Surgery Versus Non-Surgery for the Treatment of Hepatocellular Carcinoma Patients at Liver Centre, Malaysia

Azmawati MN 1 , Azmi MT 1 , Krishnan R 2

1Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
2Department of Hepato-Pancreato-Bialiary, Hospital Selayang, Lebuh Raya Selayang-Kepong, Batu Caves, 68000 Selangor Darul Ehsan, Malaysia

Abstract 

Hepatic resection, the only treatment that offers long term survival for patients with Hepatocellular carcinoma (HCC), have shown significant improvement in results over the past decades.

The aim of the study was to compare the survival between patients receiving and not receiving surgery. A retrospective cohort study measured the survival of newly diagnosed cases of HCC patients who underwent treatment in Selayang Hospital from 1 January 2003 till 31 December 2006.

Survival time was measured from the date of diagnosis until the subjects died or until the end of study period (31 December 2007).

Overall survival was significantly longer in surgery group in comparison with non-surgery group with a median survival of 43 and 20 months, respectively (p<0.001).

The following factors were noted to have improved survival duration with surgical resection; Child Pugh Class B patients, tumor size less or more than 4cm and number of nodules less than 3.

Subgroup analysis showed improved survival duration with surgical resection among patients with Child Pugh Class B with tumor size less than 4cm or with nodule less than 3 and patients who had less than 3 nodules, even with tumor size of less or more than 4cm.

Multivariate Cox Regression showed surgical intervention significantly improved survival time for overall patients (Adjusted HR: 1.5) while non-surgery improved survival in patients with tumor size less than 4cm (Adjusted HR: 0.4).

Surgical resection significantly improved the survival duration in overall patients while non-surgical procedure improved survival if the tumor size was less than 4cm.

Keywords: HCC, surgery, survival, Selayang Hospital, tumor size.

Correspondence:
Dr. Azmawati Mohammed Nawi, Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455901 Fax: +6 03-91737825 Email: atienawi@yahoo.com
Date of submission: 25th May 2011
Date of acceptance: 23rd Sept 2011
Date of publication: 03rd Oct 2011

Introduction
Most researchers have found out that Hepatocellular Carcinoma (HCC) was increasing in trend as well as the mortality. HCC accounts for 6% of all cancers worldwide and the fifth commonest cancer in the world. The estimated number of people who develop HCC is 564,000 cases per year worldwide (1). In Malaysia, HCC is one of the commonest malignancies with an age-standardised annual incidence of 2.8 cases per 100,000 populations (2). It accounts for 5.6% of all cancers and 8.1% of all cancer related death in this country. It is the twelfth commonest cancer in men and ranked eighteenth amongst women in Malaysia as reported by National Cancer Registries, 2002 (2). Hepatic resection, the only treatment that offers longterm survival for patients with HCC, has shown significant improvement in results within past decade (3-6). Although few would contest this wellOriginal Research Article Survival difference between surgery and non surgery of HCC Azmawati MN et al. 11 established fact, the paradox is that no randomized study has clearly demonstrated the benefit of surgery especially in liver centre of Malaysia, Selayang Hospital. HCC is often associated with cirrhosis and the remnant hepatic functional reserve is not always preserved well and candidates for hepatic resection are limited (7-9). Recently, HCC have been often treated by nonsurgical therapeutic options such as transhepatic arterial chemoembolization (TACE), percutaneous ethanol injection treatment (PEI) (10), microwave coagulation therapy (MCT) (11) and percutaneous radiofrequency thermal ablation (RFA) (12). The reported 5-year overall survival for surgery ranges from 35% to 60%, whereas the 3-year overall survival for non-surgery ranges from 13% to 26% (13-14). In view of that, we opine that surgery gives better survival for HCC patients compared to non-surgery. This study aims to give evidence based benefit of surgery in HCC patients at the liver centre of Malaysia with regard to survival. It is hypothesized that surgery gives a better survival compared to non-surgery procedures.

METHODS Study Design Selayang Hospital is known as liver centre of Malaysia in which start operated on 2000. Most of hepatobiliary disease was referred here for further management as well as HCC. This study was a retrospective cohort to all newly diagnosed HCC patients by CT Scan in liver centre, Malaysia (Selayang Hospital) from 1 January 2003 till 31 December 2006. All patients were followed up until achieving the primary endpoint (death) or until the end of the study as on 31 December 2007. It was universal sampling with inclusion and exclusion criteria being constructed. Inclusion criteria were based on all newly diagnosed HCC patients with CT Scan from 1 January 2003 till 31 December 2006 and exclusion criteria included multiple cancer. Sample size of 210 was based on study by Verhoef et al (15) with power of 90%. Demographic information (age, gender, ethnic, alcohol intake, hepatitis status) and clinical variables (tumor size, number of nodules, Child Pugh Class, types of treatment) were obtained from medical records. The surgeon decided on the type of treatment that depended on findings of CT Scan in which this study only focussed on tumor size, number of nodules and Child Pugh Class. Small tumor, less nodules involved with Child Pugh class A or early B were considered as candidate for surgical resection. Data was collected between February to April 2009 by review all the variables in medical record. The CT Scan finding was noted in view of tumor size and number of nodules involved. All the patients were followed up for their survival status by registering death and via telephone. Statistical Analysis All data were collected and analyzed with statistical computer software (SPSS 13.0). Categorical variables were compared using the chi-square test and overall survival analyses were carried out using the KaplanMeier methods. Comparisons between different groups were carried out using log rank test. Multivariate analyses for survival were carried out using Cox’s Regression model. Tests were deemed to be significant at the 0.05 levels. The survival status coded as death (1) and censored (0).

RESULTS Demographic A total of 210 HCC patients were evaluated from 1 January 2003 till 31 December 2006 with 123 patients dead and 87 being censored case. Most of HCC patients were aged between 40-60 years, males, Chinese ethnic, with no alcohol intake and positive hepatitis status as shown in Table 1. Out of 210 HCC patients, 114 patients underwent surgical resection and 96 patients received non-surgical procedure. The choice of surgery significantly depended on age group and alcohol status. Majority of HCC patients were Child Pugh Class A in which 65.6% underwent surgical resection while Child Pugh Class B and Child Pugh Class C were mostly received non-surgery procedures. The difference was significant as well as in number of nodules involved. As shown in Table 2, most of HCC patients who underwent surgical resection involved nodules less than 3(59%) compared to only 36.4% patients with nodules more than 3. Out of 210 patients, 128 patients presented with tumor size more than 4cm with 59.4% were having surgical resection. However, only 46.3% of tumor size less than 3cm underwent surgical resection. Survival Overall median survival time for patients having surgical resection was 43 months (95%CI: 31.7-54.3) with a 3-year and 5-year survival rate of 55% and 26%, respectively. It showed that surgery had a better survival compared to non-surgical procedures in which overall median survival time was only 20 months (95%CI: 15.5-24.4) with a 3-year and 5-year survival rate of only 23% and 13%, respectively (Table 3, Figure 1). Survival difference between surgery and non surgery of HCC Azmawati MN et al. 12 Table 1: Demographic of HCC patients Variables Total (n=210) Had Surgery p value Yes (n=114) No (n=96) Age <40 years old 14(6.7%) 12(85.7%) 2(14.3) 40-60 years old 112(53.3%) 54(48.2%) 58(51.8%) 0.02 >60 years old 84(40.0%) 48(57.1%) 36(42.9%) Gender Male 166(79%) 86(51.8%) 80(48.2%) 0.16 Female 44(21%) 28(63.6%) 16(36.4%) Ethnic Chinese 159(75.7%) 87(54.7%) 72(45.3%) Malay 42(20%) 23(54.8%) 19(45.2%) 0.83 Indian 9(4.3%) 4(44.4%) 5(55.6%) Alcohol No 124(59%) 75(60.5) 49(39.5) 0.03 Yes 86(41%) 39(45.3) 47(54.7) Hepatitis Status No 49(19%) 25(62.5) 15(37.5) 0.25 Yes 170(81%) 89(52.4) 81(47.6) Table 2: Clinical variables of HCC patients Variables Total (n=210) Had Surgery p value Yes (n=114) No(n=96) Child Pugh Class A 125(59.5%) 82(65.6%) 43(34.4%) B 80(38.1%) 32(40%) 48(60%) <0.001 C 5(2.4%) 0 5(100%) Tumor Size <4cm 82(39%) 38(46.3%) 44(53.7%) 0.064 >4cm 128(61%) 76(59.4%) 52(40.6%) Number of nodules <3 166(79%) 98(59%) 68(41%) 0.007 >3 44(21%) 16(36.4%) 28(63.6%) Table 3 summarized the differences between HCC patients who underwent surgical resection or not with clinical variables which played an important factor especially before deciding the types of treatment. For the surgery group, the median survival time was better with Child Pugh Class B (25 months, 95% CI: 5.8- 44.2), tumor size less than 4cm (57 months, 95% CI: 44.4-69.6), tumor size more than 4cm (21 months, Survival difference between surgery and non surgery of HCC Azmawati MN et al. 13 Table 3: Univariate Analysis of Survival Figure 1: Kaplan-Meier survival estimates by treatment Variables n Died Median(months) 95%CI 1 year 3 year 5 year p value Overall Surgery 114 54 43 31.7-54.3 74 55 26 <0.0001 No Surgery 96 69 20 15.5-24.4 61 23 13 Child Pugh Class A Surgery 82 34 57 39.2-74.7 75 61 35 0.22 No Surgery 43 22 26 19.9-32.0 86 37 37 Child Pugh Class B Surgery 32 20 25 5.8-44.2 65 47 23 0.04 No Surgery 48 42 13 10.1-15.9 76 14 0.4 HCC <4cm Surgery 37 11 57 44.4-69.6 88 84 30 0.003 No Surgery 41 24 25 17.7-32.3 73 38 25 HCC >4cm Surgery 77 43 21 11.4-30.6 66 39 24 0.005 No Surgery 55 45 15 9.6-18.3 48 0.7 0.7 Nodule <3 Surgery 98 40 57 38.9-75.1 76 62 34 <0.005 No Surgery 68 46 21 15.1-26.8 69 27 13 Nodule >3 Surgery 16 14 12 2.5-21.5 56 19 0.632 No Surgery 28 23 12 9.5-14.5 60 15 13 Survival difference between surgery and non surgery of HCC Azmawati

For full report see:

http://jsurgacad.com/sites/default/files/article/2012/Survival%20difference%20between%20surgery%20and%20non%20surgery%20of%20HCC.pdf

Selayang Hospital - Liver Cancer Treatment, KL

The hepatobiliary unit at the Hospital Selayang, which is now the national tertiary referral centre for liver diseases, receives about 150 patients with liver cancer every year. Beware liver cancer!

Sunday December 12, 2010

This post is on Healthwise

Stand and de-liver

TO a large extent, liver cancer is a silent disease. And when signs and symptoms appear, it may be too late for doctors to offer any form of curative treatment for the cancer.

That means, when you show up at your doctor’s office with symptoms like a bloated abdomen, jaundice, drastic weight loss, and a feeling of heaviness in your upper abdomen, even though there may be treatments to get the cancer under control, your chances of a cure might be limited.

Since its relocation to Hospital Selayang in 1999, the hepatobiliary unit has evolved into a
national tertiary referral centre specialised in the management of critically ill patients
with acute and chronic liver diseases.

Mr R. Krishnan ... Patients
 still come late to us.

Datuk Mr Harjit Singh ... Most of the time, primary liver cancer
occurs in people with some underlying liver disease

Unfortunately, in Malaysia, this is the norm rather than the exception.

“Patients still come late to us,” says Mr R. Krishnan, head of hepatobiliary surgery at Hospital Selayang. The unit, which is now the national tertiary referral centre for liver diseases, receives about 150 patients with liver cancer every year.

“Right now, for the bulk of our patients, there is little we could offer,” says Mr Krishnan. It’s only in less than 25% of cases that we could offer some sort of treatment for their cancer,” he notes.

However, hope is not lost. Liver cancer might be a silent disease, but its risk factors and causes are rather well documented. The trick is to minimise your risk factors, monitor your liver regularly if you have any of the conditions that may lead to liver cancer, and follow the timeless health advice: live a healthy lifestyle.

Know the causes and risk factors

While more recent data is yet to be published, going by the numbers provided in the National Cancer Registry in 2006, liver cancer was then already ranked the sixth most common cancer among Malaysians. It was the fifth most common cancer among males and ninth most common cancer among females in Peninsular Malaysia.

There are two types of liver cancer. Cancers of the liver caused by malignant changes in liver cells are called primary liver cancers (hepatocellular carcinoma). Cancers in the liver that are caused by the spread and retention of cancer cells from elsewhere are called secondary liver cancers.

 “Most of the time, (primary) liver cancer occurs in people with some underlying liver problem,” says Ministry of Health national head of surgical services Datuk Mr Harjit Singh, who is also former head of hepatobiliary surgery at Hospital Selayang.

A lot of them have hepatitis B or C infections, alcoholic liver disease, fatty liver, or any kind of liver disease that can lead to cirrhosis (the formation of scar tissue in the liver). However, the problem is that most people take these things for granted.

“They don’t go for any form of check-ups or screening tests,” says Mr Harjit. “By the time they present with pain or symptoms, the disease is already (at) an advanced (stage).”

According to a consensus paper on the management of hepatocellular carcinoma (primary liver cancer) in Asia that Mr Harjit co-authored, the risk factors for developing liver cancer in Asia include heavy exposure to aflatoxin (toxins produced by a type of fungus), algal hepatotoxins (liver toxins) in contaminated water, betel nut chewing, diabetes mellitus, and alcohol abuse leading to liver cirrhosis.

However, the main known cause for liver cancer in Asia is chronic hepatitis B virus infection. “In Malaysia, it is hepatitis B. But (liver cancer due to) hepatitis C is picking up,” says Mr Krishnan.

That said, these remain as risk factors. There is no guarantee that you will develop liver cancer if you have these conditions. Nevertheless, you have a greater chance of developing it compared to those who don’t.

Care, monitor, and don’t work it too hard

So, how do you prevent liver cancer? You can start by taking steps to prevent or minimise the risk factors and have your liver checked if you have any underlying liver disease.

Getting yourself immunised against hepatitis B is a start. Malaysians who are born after 1989 would have already been immunised as a child under the National Immunisation Schedule, but those born before that will have to obtain their immunisation from their local healthcare providers. There is still no vaccine for hepatitis C.

As both viruses are transmitted through the exposure to infectious blood or body fluids, avoiding and managing situations that may lead to its transmission – like unprotected sex, needle sharing, and transmission from mother to child during delivery – can help prevent one from getting infected.

That is why even for procedures that involve needles like tattoo drawings, body piercings, and even acupuncture, it is important to make sure that the needles used are disposable ones meant for single use, Mr Harjit explains.

Pregnant mothers with hepatitis B can also be given appropriate treatment to prevent the child from being infected as well.

On top of that, those with a family history of liver disease or liver cancer should also get themselves screened regularly through medical checkups.

People who have underlying liver disease must, essentially, follow up with their family physician or their regular GP and get their screening tests done at least every six months, says Mr Harjit.

Even people who are healthy should at least get themselves tested for diseases such as hepatitis B and C, especially when they have reached the age of 30.

“We have almost 2.5 million hepatitis B carriers in this country. A significant proportion of them are at a risk of developing chronic liver disease,” Mr Harjit adds.

A healthy diet and regular exercise also plays a role in preventing liver cancer as well. At the very least, it could minimise one of the risk factors – fatty liver – that is usually associated with excessive consumption of alcohol and the metabolic syndrome (brought about by unhealthy diets and physical inactivity). This will, in turn, minimise your risk of developing liver cancer.

Work with your regular doctors

As the hepatobiliary unit in Hospital Selayang is a tertiary care centre, the patients they receive are mostly referrals from primary care doctors. But both Mr Krishnan and Datuk Mr Harjit emphasises that you don’t have to go to a liver specialist for a normal checkup.

“Ideally, the message is that people should be seen by their primary care doctors,” says Mr Harjit. “If their doctors find any liver problems, like liver masses or tumours, they can refer the patients to us,” he adds.

Source:

http://www.thestar.com.my/lifestyle/health/2010/12/12/stand-and-deliver/

http://thestar.com.my/health/story.asp?file=/2010/12/12/health/7599479&sec=health



Article added on 16 October 2014:

Hospital Selayang hepatobiliary unit

Published: Sunday December 12, 2010 MYT 12:00:00 AM 
Updated: Friday November 8, 2013 MYT 4:16:29 PM

DEDICATED liver services in Malaysia started only in 1992, and was pioneered by Health Ministry director-general Tan Sri Dr Mohd Ismail Merican in Hospital Kuala Lumpur to meet the demands of patients who suffer from complications of liver diseases.

In 1999, this service was relocated to Hospital Selayang, which has since evolved into the national tertiary referral centre specialised in the management of critically ill patients with acute and chronic liver diseases.

In year 2000, the then head of the Hospital Selayang hepatobilary surgery Datuk Mr Harjit Singh commenced the liver transplant service in the unit. Since then, there have been 45 liver transplants done in the centre, with an overall survival rate of 72%.

“A lot of our patients do not know where to go,” says Dr Ismail, who is also currently the head of the hepatology unit in the centre. “There were attempts to do liver transplantation in private centres, but we felt that liver transplantation should be offered to patients in a public facility ... as it is very specialised and very resource intensive,” he adds. The unit is currently the only centre in Malaysia that performs liver transplants.

Besides offering services for complex liver diseases at the Hospital Selayang hepatobilary unit, the Ministry of Health, together with the Malaysian Liver Foundation, also organises biennial Liver Updates to inform local doctors about the latest findings and technology in liver treatment and diagnostics.

The 9th Liver Update, which will be held next year on July 13 to 17 at the Sunway Lagoon Resort hotel, will feature live surgery workshops and talks by international speakers and is open to all healthcare professionals who are interested in liver care.

As the hepatobiliary unit receives more and more patients, it is the unit’s hope to eventually have a liver centre of its own. “Hopefully, with a dedicated liver centre, we will be able to retain our specialists and ask some of them who have left to come back,” says Dr Ismail. A dedicated liver centre could also help the unit meet the increasing demands of liver services in the country, he adds.

http://www.thestar.com.my/Lifestyle/Health/2010/12/12/Hospital-Selayang-hepatobiliary-unit/



Article added on 9 December 2016:

Kudos to Selayang Hospital for superb service

Tuesday, 3 March 2015

OUR father, Mohamed Mokhtar Ahmad Bajunid, was diagnosed with liver and thyroid cancer in December last year.

We can hardly forget that day when the doctors broke the news. We, the children, pooled our resources and tried to offer the best support we could monetarily, physically and emotionally.

We immediately thought of a private hospital or at least a semi-government one where we believed our dad would receive the best treatment.

When we were told to take our father to Selayang Hospital, we were apprehensive in the beginning.

We’ve read many news reports about misdiagnosis and low standard of service and care in government facilities.

We were clearly prejudiced on the onset. We proceeded to the hospital with caution and were ready to jump ship at any time and shoot off to other perceived “better” hospitals.

Little did we know this arduous journey would lift the veil of misconception that had been drummed into us for a long time.

It began with a meeting with Dr T. Haritharan, the hepatobiliary specialist and surgeon. He sat with dad and took his time explaining then answering questions, not forgetting to repeat where needed.

His patience and understanding were exemplary. We shamelessly voiced our concerns about the hospital and asked if dad could be referred elsewhere to which he answered with an affirmative.

Yet, he went on to explain that most specialists they may refer us to were also trained at Selayang Hospital by the very doctors currently practising there.

He assured dad he was in good hands and there was no need to look elsewhere. They would also bring in a specialist, Dr Sarinah Basro, from Putrajaya Hospital to oversee his thyroid cancer.

All this were expressed without any display of drama or ego. It was laid out to us calmly, precisely and in simple terms.

We went home and did our research and found out repeatedly that Selayang Hospital was touted as the best facility for liver and abdominal cancer. We decided to forge ahead based on all the positive reviews. It was no exaggeration.

From the moment dad checked in, through his surgery to his last day in the hospital, he received gracious attention from the nurses, attentive care from the doctors and timely and professional treatment from the specialists.

Even in my father’s most depressed state, an emotion many will face in these type of situations, the doctors, notably Dr Haritharan, treated him – the person – not just the illness.

These doctors are highly respected by their peers and set a strong example for others to follow.

We commend them for their outstanding achievements and exemplary service. Others should emulate their commendable dedicated service.

Our mother, Sirima Binthep, never left his side and was equally treated with kindness and respect by the hospital staff, from the security personnel right up to the doctors.

They seemed to know a little smile and kindly spoken words would go a long way to ease the burdened soul.

Today, with God’s grace, our father has been declared cancer free, just a little more than a month after his surgery.

Though we can finally breathe a sigh of relief, our thoughts and prayers are with those still battling this horrendous disease.

We would also like to thank the entire staff of Selayang Hospital. Thank you Dr Haritharan, Dr Yang Khuan Fatt, Dr Tee Chee Sian, Datuk Dr Harjit Singh, Dr R. Krishnan, Dr Suryati Mokhtar, Dr Lim Kin Foong and the nurses of ward 9B, and Putrajaya Hospital’s Dr Sarinah.

Whatever the future brings, to you we owe our eternal gratitude.

AZHAR SYARAWI

SARINA MOKHTAR

SUVANI MOKHTAR

AZLAN SYARAWI

(Children of Mohamed Mokhtar Ahmad Bajunid)

http://www.thestar.com.my/opinion/letters/2015/03/03/kudos-to-selayang-hospital-for-superb-service/



Others articles:

• Liver Cancer
• Liver Cancer and Coffee
• Fat livers
• Fatty liver may be the next major health woe
• De-liver me from illness
• Selayang Hospital - Liver Cancer Treatment, KL
• Survival Difference between Surgery and Non-Surgery for the Treatment of Hepatocellular Carcinoma Patients at Liver Centre, Malaysia
• Treating liver cancer
• Kidney & Liver Cancer - Treatment options
• Rogue stem cells in liver cancer
• Stem Cell treatment for Liver Cancer

This article is from Healthwise

Also:

http://healthticket.blogspot.my/2016/03/foreign-patients-turn-to-india-in.html


Added on 09 December 2016:

Radiology Department Selayang Hospital

Introduction The Diagnostic Imaging Department provides a wide range of diagnostic imaging services: including CT scanning, Mammography, MRI scanning, Ultrasound scanning, Angiography & Interventional Procedures, Fluoroscopy and General Radiography. The department operates on the paperless and filmless concept using the Radiology Information System (RIS) and Picture Archiving and Communication System (PACS).These systems are fully integrated with the Hospital Information System (HIS) and Electronic Medical Record (EMR). Fully integrated system has resulted in reduction of patients waiting time, rapid access of images and reports by clinicians, and a more efficient workflow. The department provides inpatient and outpatient services  with a total radiological examination of about 125,000 per year. Vision & Mission Vision:  To fulfill the needs of the customer and remain the foremost fully digital radiology  department in Malaysia. Missions: To provide high quality diagnostic and interventional radiology services in an efficient and cost effective manner To use appropriate sophisticated  and up to date technology To take into consideration the needs, comfort and convenience of the patient To work as a team towards providing the highest quality of care for our patient To continue updating our knowledge thus ensuring the best radiological management for our patients Services The department provides diagnostic and interventional services for patients of all  age group and disciplines. Mobile services are provided for the critically ill and  non-ambulatory patient. Emergency radiology services are provided 24 hours a day. Diagnostic Imaging services:  General radiography (Computed Radiography & Direct Digital System)  Computerised Tomography (CT)  Magnetic Resonance Imaging (MRI)  Mammography (Full Field Digital Mammography)   Ultrasonography  Fluoroscopy  Angiography Mobile services:  General Radiography including Forensic Radiography  Ultrasonography.  Mobile C-Arm Image Intensifier. Interventional Radiology Services:  Biopsy  Drainage  Stent insertion  Radio-frequency ablation  Chemo-embolisation  Percutaneous  ablative injections  Fistuloplasty For our patients Locations: The Main Department : 2nd floor. Emergency Unit : 2nd Floor Specialist Clinic Unit : 4th Floor On your arrival our personnel at the reception counter will direct you to the relevant examination room. Examinations requiring special patient preparation:   Ultrasound – Hepatobiliary System / Urinary System, CT, and MRI scans  Special procedures, angiography and interventional examinations  Most gastro-intestinal (GI) and urinary tract examinations including intravenous  urogram (IVU), studies of the esophagus (barium swallow), stomach (barium meal)  and colon (barium enema)  Mammography (breast imaging) To ensure successful examination it is important that you follow any instructions about  examinations requiring special patient preparation that are given and discussed with you at  the time when the appointment is made. Useful things to bring / have with you: Reading materials, puzzles / crosswords, pen  and paper. Belongings and valuables: Please avoid bringing valuables to the department. Please  keep your belongings and valuables (if any) with you at all time. Clothing: You may be asked to change to our examination gown for your examination. Hand Washing And Scrub: Hand washing facilities and alcohol rub are available and encouraged for patient and  visitor use. Our Personnel: Different types of personnel are involved in performing imaging procedures:  Radiologist  Medical Officers  Radiographer  Nurse We can provide an area of quiet and privacy for mothers who need to breast-feed. The department has a water dispenser available for patients and visitors. Toilets are available for both patients and visitors in our waiting area. Opening Hours Monday to Friday 7.30 am to 5:00 pm Saturdays, Sundays & Public Holidays Closed An on-call service is provided 24 hours each day for urgent and emergency procedures. Enquiries: Contact Telephone Numbers: General Enquiries: +6 03 61203233 ext 2134 & 2135 MRI Enquiries &  Appointments +6 03 61203233 ext 2234 Ultrasound Enquiries & Appointments: +6 03 61203233 ext 2151 Angiography & Interventional Procedures  Enquiries & Appointments: +6 03 61203233 ext 2161 Mammography Enquiries & Appointments: +6 03 61203233 ext 2155 All Other Appointments: +6 03 61203233 ext 2134 & 2135 We want to make your stay in our department comfortable. Please bear with us if there is a short delay. We might be waiting for an imaging procedure on another patient to be completed. Please do not hesitate to ask any questions if you think you have waiting for too long. Our personnel are committed to provide the highest attainable standard of care.  We strive to continually improve our service and value feedback:  Please address your feedback to: Head of Department, Department of Diagnostic Imaging, Selayang Hospital, 68100 BATU CAVES. Tel : +6 03 6126 3444 Fax : +6 03 61370857 E-Mail :   daudis@sel.moh.gov.my source:   http://hselayang.moh.gov.my/

http://epjjmedimagingselayang.blogspot.my/p/imaging-department.html

International Perspective Selayang Hospital: A Paperless and Filmless ...

link.springer.com/chapter/10.1007%2F978-1-4757-4041-7_11

by H Rosnah - ‎2004 - ‎Related articles

Selayang Hospital has set a milestone in Malaysian history for being the first hospital in the country to create a “paperless and filmless” environment for its ...

Added on 31 December 2016:

Survival Difference between Surgery and Non-Surgery for the Treatment of Hepatocellular Carcinoma Patients at Liver Centre, Malaysia