Advanced Technology Delivers Bespoke Liver Scans Enhancing Liver Disease Diagnosis

InFocus Issue 21, January 2021

Liver Scan Brisbane at Brisbane Private Hospital provides a service of excellence for patients requiring Fibroscan®, with or without the need for Specialist Consultation. Complex technology backed by robust clinical data, allows a simple scan conducted by Specialist Nurse Nicola Rahman to provide a reliable method of estimating liver fibrosis. This may avoid invasive methods such a liver biopsy, allowing for prompt initiation of health interventions where necessary.

Patients are at risk of fibrosis/cirrhosis in the majority of liver conditions and diseases, including Abnormal Liver Function Tests, Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Steatohepatitis (NASH), Alcoholic Liver Disease, Hepatitis B, Hepatitis C, Haemachromatosis, and therapeutic drug use (e.g. Methotrexate, Amiodarone and many anti-depressant medication). 

Risk of fibrosis is increased in patients with Diabetes and Cardiac Disease. Over time, the accumulation of liver fat may lead to liver fibrosis which can result in cirrhosis (severe or irreversible fibrosis). The presence of fibrosis and its sequelae has a substantial impact on a person’s morbidity and mortality. It is beneficial to identify the presence of liver fibrosis before it becomes severe and complications arise.

Ms Rahman said Fibroscan®, uses vibration controlled transient elastography (VCTE) to assess liver fibrosis or stiffness. 

“Shear waves are propagated from the probe and ultrasound follows the shear waves, measuring the speed at which the waves travel to a particular depth in the liver and back again. The greater the degree of fibrosis the ‘stiffer’ the liver - the faster the wave response, the greater the fibrosis. 

“A Fibroscan® takes approximately 15 minutes and causes no discomfort to the patient and in the majority of patients prevents having a liver biopsy. We also provide a non-invasive measurement of steatosis or the amount of fat in the liver - the Controlled Attenuation Parameter (CAP™). It is based on the attenuation of ultrasound signals from the Fibroscan®, expressed in dB/m and combines with the fibrosis measurement to track the progression of liver disease. Risk factors for Hepatic Steatosis include but are not limited to obesity, diabetes and excessive alcohol consumption.”

Ms Rahman said a Fibroscan® is not performed in isolation – the current standards suggest assessment is optimal if used in conjunction with the individual patient’s clinical data (Liver Function Tests, Platelet count & BMI). This provides the patient, General Practitioner and Specialist all the information required for that individual’s assessment. All reports are reviewed by Professor Tony Rahman (Hepatologist & Gastroenterologist) as part of the governance process around quality assurance and patient safety.

She said a referral was not essential but preferred, which included a patient’s full name and date of birth, indication for Fibroscan®, FBC and liver function tests (preferably within 4 -12 weeks), and their contact details for the report. Patients are required to fast for three hours prior to the scan, but drinking water is fine, and if a consult with Professor Tony Rahman is also required, this needs to be stated on the referral.

Liver Scan Brisbane is part of the Brisbane Gastro Clinic, providing specialist services in Gastroenterology, Hepatology, Endoscopy, Colonoscopy and Nutrition. All scans are performed by Specialist Nurse, Nicola Rahman. Ms Rahman has an extensive career in Liver and Intensive Care Nursing, and progressed to the role of Sister, managing the world-renowned referral Centre for patients with liver disease at King’s College Hospital, London UK (1996). She then commenced a Regional Transplant Co-ordinator Post in Oxford, UK (1998), before returning to London as a Nurse Educator at St Thomas & Guy’s Hospital. Ms Rahman was also the first In-House Donor Transplant Coordinator in the UK in 2000 at St Georges Healthcare, London, a trial project which was successfully rolled out nationwide in 2002 in UK hospitals.

Following a family career break Ms Rahman returned to Intensive Care Nursing before the move to Brisbane, Australia eight years ago. She was appointed as Clinical Research Co-ordinator, Wesley Research Institute Clinical Trials Centre and in 2015 employed by Brisbane Gastro Liver Clinic, with the development of the Liver Scan Brisbane service. Her experience of patients with Liver disease gives her a unique understanding of the patient’s health issues when being referred for Fibroscan®.