The other day I was asked by an insurance company to give my reasoning for ordering an MRI within the first 3 days. OK, in that case, why order or take an X-ray, why do an exam, why do any orthopedic tests? Before I go off too much, here was my response, and by the way, if you want more reasoning, just let me know.
Dear Sir or Madam,
When ordering an MRI within the first 3 visits, here are just a few of many reasons for doing so:
·X-rays only show a portion of the patient’s potential injuries, it will not show a soft tissue injury; an injury which could possibly be adversely effected by certain types of treatment.
·When coming up with a treatment plan, a physician needs to know what he or she is treating and what the proper course of care would be, such as needing to be referred out for a surgical consult or any other specialist.
·It is imperative that conditions be diagnosed as soon as possible in order to treat the problem before further injury occurs.
·An MRI could find a soft tissue injury which could be dangerous to continue to work at their job, an injury that could have been missed on an x-ray.
If you need further reasoning or have questions, please feel free to call me at the number above.
Sincerely,
Brian Starry, D.C.
Visit us at All Injury Rehab for more information and to set up an appointment.
Cat scans are a specialized type of x-ray. The patient lies down on a couch which slides into a large circular opening. The x-ray tube rotates around the patient and a computer collects the results. These results are translated into images that look like a “slice” of the person.
Sometimes a radiologist will decide that contrast agents should be used. Contrast agents are iodine based and are absorbed by abnormal tissues. They make it easier for the doctor to see tumors within the brain tissue. There are some (rare) risks associated with contrast agents and you should make sure that you discuss this with the doctor before arriving for the examination.
CT is very good for imaging bone structures. In fact, it’s usually the imaging mode of choice when looking at the inner ears. It can easily detect tumors within the auditory canals and can demonstrate the entire cochlea on most patients.
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MRI
MRI is a completely different animal! Unlike CT it uses magnets and radio waves to create the images. No x-rays are used in an MRI scanner.
The patient lies on a couch that looks very similar the ones used for CT. They are then placed in a very long cylinder and asked to remain perfectly still. The machine will produce a lot of noise and examinations typically run about 30 minutes.
The cylinder that you are lying in is actually a very large magnet. The computer will send radio waves through your body and collect the signal that is emitted from the hydrogen atoms in your cells. This information is collected by an antenna and fed into a sophisticated computer that produces the images. These images look similar to a CAT scan but they have much higher detail in the soft tissues. Unfortunately, MRI does not do a very good job with bones.
One of the great advantages of MRI is the ability to change the contrast of the images. Small changes in the radio waves and the magnetic fields can completely change the contrast of the image. Different contrast settings will highlight different types of tissue.
Another advantage of MRI is the ability to change the imaging plane without moving the patient. If you look at the images to the left you should notice that they look very different. The top two images are what we call axial images. This is what you would see if you cut the patient in half and looked at them from the top. The image on the bottom is a coronal image. This slices the patient from front to back. Most MRI machines can produce images in any plane. CT can not do this.
Contrast agents are also used in MRI but they are not made of iodine. There are fewer documented cases of reactions to MRI contrast and it is considered to be safer than x-ray dye. Once again, you should discuss contrast agents with your physician before you arrive for the examination.
Visit us at All Injury Rehab for more information and to set up an appointment. |
After a traumatic injury, such as one that might be sustained in a vehicle accident, while playing sports, or just bending over to pull a weed, you go to your Doctor to get it checked out, or at least I hope you do. Your Dr. will do a thorough evaluation, take X-rays, and show you the findings. Some of the things X-rays are great for showing include the following: fractures, dislocations, misalignment, certain types of pathology, osteoporosis, and disc sizes. When just looking at an X-ray, you are only getting about 1/3 of the big picture. Sometimes your Physician feels that it is necessary to get a bigger picture of what’s going on and he or she will order an MRI. There may be many reasons why it was felt that more than an X-ray was needed, weather it be positive orthopedic tests that raise a red flag, the mechanism of injury, details from the patient history, or radiating pain. But what is an MRI, and why is it so much better than an X-ray alone? MRI stands for magnetic resonance imaging. They show soft tissue, not just bones, so a torn ligament, a disc bulge, a torn meniscus, or a lesion can be discovered. The possibilities are near endless when it comes to an MRI. The procedure uses magnets, not x-rays, and is painless, safe, and has no side effects. So the next time you get checked out after an injury, make sure that your Dr. gets the full picture when it is warranted.
Visit us at All Injury Rehab for more information and to set up an appointment.