Tag Archives: MRI

MRI’s Have All The Answers … OR DO THEY???

shrugging shoulders

“Doctor, haven’t you looked at my MRI?”

This is a question that frequently comes up while visiting a doctor’s office. Most patients who have experienced an orthopedic issue at one time or another will probably undergo an MRI to better clarify the cause of the problem.

However, diagnostic studies such as MRI’s are not always the answer and in many ways can lead to more tests, anxiety, and potentially unnecessary and ineffective treatment. For example, numerous medical studies have been published detailing how MRI’s reveal many “abnormalities” which most likely are considered typical age-appropriate changes and most likely don’t need aggressive treatment.

In a landmark study published in the New England Journal of Medicine in 1994, Jensen and his colleagues performed MRI’s of the lumbar spine in close to 100 people who had NEVER had any complaints of back pain. Remarkably over 50% had disc bulges, 30% had disc protrusions, and even 1% had massive disc extrusions, all without having any pain.  Similarly another classic MRI study revealed that the majority of patients will have an “abnormality” seen on MRI of the knee such as a meniscus tear or arthritis but have no pain.  As expected, many of these “findings” become more common with advancing age.

So what are we to conclude with this quagmire of MRI information? The most important factor is considering what every good physician learns in medical school. A good physician should obtain an accurate history and physical and correlate that to the imaging study like the MRI.

“The mystery is in the history” is a good rule of thumb to live by when talking to patients and helping them to sort out what the actual problem is. It is vitally important to correlate the patient’s history and physical examination to imaging tests like MRI and CT scans. In this way, the normal age-related changes seen on these imaging tests can be addressed appropriately and patients will ultimately have better outcomes.

So remember the important question is not “has the doctor seen my MRI?” but more importantly “has the doctor listened and examined me? “

Paul Lento, MD is a triple board certified Physical Medicine and Rehabilitation physician at SOA. He has earned the national honor as a Castle Connelly “Top Doc” four years in a row. Sarasota Orthopedic Associates offers same/next day appointments at our three locations in Sarasota, Lakewood Ranch, and Venice. For more information visit our website at www.SOA.md or call us at 941-951-BONE.

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MRI and X-Rays: Myths and Truth

MRI-Knee-Example  Xray-Left-Knee

First of all, what is the difference between an MRI (Magnetic Resonance Image) and an X-ray (electro-magnetic wave of high energy with very short wavelength)?  The above image on the left is an MRI of a left knee.  The image on the right is an x-ray of a left knee. While they are both diagnostic imaging devices and equally important tools (in some circumstances) for your physician, there are important differences. X-rays are mainly used for evaluating detailed images of bones and sometimes diseased tissue. An MRI is better suited for evaluating soft tissue like tendons, ligaments, muscles, organs, etc. The MRI shows a series of “slices”, allowing abnormalities to be seen from varying angles.

X-Rays

Most X-rays are now digital, like the ones we use at SOA, a safer and more effective technology than the older “films”. The digital aspect also allows easy transport of the images onto a CD for sharing between physicians when needed. The digital x-ray results are immediately available to your physician at your appointment.

Dispelling a myth: Naysayers may have you believe that X-rays aren’t safe because of radiation. Fact is, we are surrounded by radiation on a daily basis and this is known as “background” radiation. The earth itself emits radiation and certain parts of the country, like Colorado, have higher radiation levels than areas near the coast at sea level. Frequent airline flyers receive more radiation than those who don’t fly. Surprisingly, the highest source of radiation is in our homes!

So how does that relate to when we need an x-ray at your orthopedic visit? A typical adult will receive a total dosage of 620 “millirem” each year from background, diet, industrial, and medical radiation with 50% coming from “background” radiation. Put that into perspective with a single hand or foot x-ray at 0.5, a very small amount. In fact, our food contains radiation and we ingest about 30 “millirem” a year just in our diets! Even a can of soda emits radiation.  An interesting website will evaluate your estimated annual radiation at https://www.nrc.gov/about-nrc/radiation/around-us/calculator.html

MRI

At Sarasota Orthopedic Associates, we may utilize an MRI to provide a more comprehensive diagnostic evaluation of the soft tissue structures which are not seen on an x-ray. An MRI may identify a condition much faster than traditional methods, and allow you to receive more expeditious treatment. Our MRI services are readily available to our patients, however many physicians refer to us for scans other than orthopedic conditions because of our state-of-the-art technology. Our Signa HD 1.5 scanner is breakthrough technology with lightning speed and breathtaking image quality. We turn around studies in 24 hours and are many times able to schedule patients on a same day basis.

One of the more fascinating technologies is an extremity MRI, specifically for hand, wrist, elbow, knee, or foot. It’s a compact MRI device allowing the patient to rest outside the scanner, eliminating the magnetic “noise” close to your head! You may even read or nap during the exam. That extremity MRI is available for our patients as well as those referred from other offices.

At Sarasota Orthopedic Associates, our mission is to get our patients back on their feet, back to work, back in the game, and back to life. Check out our website at www.SOA.md or call us at 941-951-2663 for more information. You may also schedule an appointment at the home page of our website.

Sources: SOA.md website; ICRP; ASRT; USNRC