What is your personal experience with MRIs? Was your last one fun? How much did it cost whoever paid for it? Did it make a real difference in your outcome?
I am a 78-year-old American man in robust general health and with good comprehensive health insurance all my adult life and I have never had an MRI.
Until 2010, I had also never had a CT scan. And I’m proud of that.
Why …
I’m proud that I’ve never had an MRI or CT scan
Thankfully, there have been more news stories recently illustrating the overuse of tests.
Specifically with cancer screening, the PSA test and mammograms have come under increasing scrutiny.
I think this type of media attention is long overdue, as the public needs to be aware of the potential downsides of diagnostic tests.
Now comes the MRI.
A recent piece in the New …
The media’s role in educating patients about MRI overuse
Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital’s bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The …
Why radiology is the cornerstone of any hospital
With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is:
Are we willing to let our physician colleagues exert influence on our care decisions?
Taking a case from my field: at a conference this past week I met a radiology resident …
Our easy access to imaging has led to overutilization
By now you’ve probably seen the internet jokes that compare the mammogram experience to having your breast squashed in a refrigerator door. A few years back, I joined the club of women who have our annual mammograms, and I can’t say that I disagree with the imagery of the jokes. However, the benefits of early detection far outweigh the discomfort, so I’m willing to put up with it.
I’d like to …
Practical tips for a more comfortable mammogram
Dr. Eric Appelt was born to be a superstar. During his career, he has redefined what it means to be committed to medicine, and he embodies the practice of perseverance on a daily basis. I am proud to say that he is one of my role models as I continue my medical education.
As a young man growing up in Brenham, TX, Appelt was the kind of son every parent …
Eric Appelt and his extraordinary commitment to medicine
Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each …
The radiation delivered by CT scanners has gone largely unregulated
Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue – a practice called “self-referral” – unless the facility is located in their own practice.
This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less …
Physicians referring patients to a diagnostic facility they own
Radiology has transformed into a core subject of medicine, since imaging procedures are getting more and more crucial to clinical decisions. Whether these developments, be it over-diagnosing or unnecessary radiation on the one hand or a more detailed and enhanced way of diagnostics on the other, are …
How Microsoft Kinect can help in radiology to view a CT or MRI
Are medical students and new doctors overly reliant on tests and technology to make diagnoses?
That’s an interesting thought I had when reading the latest TIME.com piece from emergency physicians Jesse M. Pines and Dr. Zachary F. Meisel.
In their article, they give reasons why doctors order too many tests.
Of course, they cite defensive purposes, saying, “once a doctor has presented an …
Are doctors ordering too many tests, or practicing a new standard?
Many patients erroneously believe that x-rays and CAT scans have no risk.
In their minds, they are non-invasive studies that can cause no harm. Since there are no incisions or anesthesia, they regard the experience as having the same risk as taking a family photograph. How wrong they are. In my mind the danger from non-invasive radiology studies may surpass the risk of hard core medical treatment. True, radiology tests won’t …
CT scans and x-rays draw patients into risk and overutilization
In a report from the Archives of Internal Medicine, it was reported that most hospitalized patients (82%) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. Of the physicians, 67% thought the patients knew their name and 77% of doctors thought the patients “understood their diagnoses at least somewhat …
Pay close attention to what doctors say to patients
Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.
For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular …
Appendicitis in children and radiation exposure from CT scans
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Radiation is emitted in various forms. Recently, CT scan radiation has preoccupied (or “absorbed”) the attention of the public and media. As explained: “X rays, γ rays, and neutron beams are considered ionizing radiation. Ionizing radiation may break molecules into pieces, creating ionic free radicals that can be very damaging to tissue.”
For this reason, it is imperative that the use of radiation is only by highly trained personnel and that …
Radiation risks of CT scans need to be taught to patients
“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.
His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.
Here is where the problem began. Everything about Dave’s exam and story pointed …
Some MRI places have good quality machines, others are obsolete
A recent article in the New England Journal of Medicine touched off another salvo about how non-clinicians have no problems judging the abilities of clinicians in the world of medicine.
The article begins by presenting the case of a woman who awoke with facial paralysis and then went to the emergency department. On arrival, she received CT scans and MRI scans of her brain. When those were normal, she was diagnosed …
The difficulty of regulating x-ray radiation in the ER
by Scott Cowsill
A third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images.
As pointed out by Robert Centor, MD, “one cannot easily develop rules for testing because the presentations that we see vary so greatly.” That being said, guidelines for diagnostic …
Decision support can help doctors order scans
With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics.
Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the average healthcare consumer can understand imaging much easier than the diagnosis related groups (DRGs), hospital facility fees or insurance contracts that have a much greater impact on the cost of health …
Clinical judgment and when neurologists should order an MRI
Those who hate hospitalists believe that students and residents are choosing hospital medicine over primary care so hospitalists are to be blamed for the primary care shortage. They also believe that the rise of hospital medicine has made primary care less attractive. Then, there is the salient argument that care transitions are more inherent and vulnerable due to hospitalists.
Of course this hatred is not new. As a …
Hospitalists are killing primary care, and other myths debunked
by Kristina Fiore
Medical imaging for cancer patients and resulting costs have increased over the last decade, particularly in positron emission tomography (PET), researchers have found.
Annually, use of the diagnostic screen rose significantly between 1999 and 2006 — ranging from 36% in lung cancer to 54% in breast cancer, Kevin A. Schulman, MD, of Duke University, and colleagues reported in the April 29 Journal of the American Medical Association.
Imaging costs also …
Medical imaging is increasing in cancer patients
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