NB: This is a blog of our personal opinions, and is provided as a brief overview of things we think you might find interesting.

  • Medical Imaging 09 November 2018 | View comments

  • Yesterday was the International Day of Radiology, so let’s take a look at medical imaging.

     

    First of all, I love a good X-ray or an MRI / CT scan.

    However, they are not always appropriate, and just like opioids, or statins, they have been overprescribed recently, and making the news.

    Medical imaging will show you the gross anatomy, and whether it is “normal” or “abnormal” or even “normally abnormal”. It will not tell you whether what it shows is clinically relevant; it just adds to the overall clinical picture.

     

    Imaging carries risks, whether the risks of radiation (X-ray / CT scan) or just the risk of false-positives; that is, an abnormal finding that is irrelevant to the patient’s wellbeing – until they find out, at which point it becomes a negative to the patient’s perception of their wellbeing.

    For example, a researcher called Brinjikji in 2014 found that, if you took MRI scans of a completely healthy people, ½ of all 30 year olds will have a degree of “disc degeneration”; ½ of 40 year olds would have a “disc bulge” and ⅓ of 50 year olds would have some “facet degeneration” (AKA osteoarthritis). This proves that these things can be completely normal, and not lead to any problems – which doesn’t mean that they can’t, just that it’s normal, and doesn’t have to be acted upon.

     

    Imaging of biomechanical complaints should NOT be done “just in case” or “to have a look”; imaging should NOT be done to reassure the doctor or the patient. For non-traumatic, non-complicated cases, the image is highly unlikely to change the treatment plan for the better; but might well change it for the worse. You may feel that your doctor isn’t listening to you when they opt not to send you for imaging, but it will generally mean that they’re simply following current guidelines.

    Imaging absolutely SHOULD be done in cases where there are red flags for a serious pathology (such as unexplained weight loss; loss of swallowing/bowel/bladder control; high fever; or loss of feeling/strength in the legs or arms). It SHOULD be done in patients who don’t recover as expected (such as failing to improve with less-invasive care; or failing to improve significantly after 2 months duration).

     

    You can find out more here:

    www.choosingwisely.co.uk

    www.choosingwisely.org/patient-resources/imaging-tests-for-back-pain

    Reliability of Reading MRI Scans for Low Back Pain

    Incidence of False Positive Findings in the MRI Scans of Symptom-free Individuals

    Colour MRI Scan of the Neck

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