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Diagnostic Centers

Kris-NYKKris-NY Posts: 2,207
edited 06/11/2012 - 8:43 AM in Neck Pain: Cervical
Wanted to open this one up for discussion since it's been bothering me a bit.

I'm lucky to be in an area where there are many many choices for places to go for tests like MRI, CT etc. Big places and small places. State of the art equipment.

My concern is about going to the same place for repeat of tests. When I was first injured I went to a stand-up MRI place that my orthopedist likes. I'll admit that I don't like closed spaces so this is a great relief for me. Then 6 months later I went for a second opinion and the doc poo-pooed the stand-up quality so I went to the only place that she uses. I've been back to them for a second round of tests post-op and am scheduled in about 3 weeks to go again.

I can understand the benefit of having a series of tests for the radiologist to look at. However does anyone else feel that maybe something is missing? I wonder sometimes if they copy what they wrote before or guide their findings to cover their butts if they were wrong before.

So often the doctors just zip through the report and don't really study the films. With these tests being so common and the equipment so expensive I really have to wonder about the quality of the radiologists work. How many people have been asked to come back to re-do a section because it wasn't clear? Could we all really be that perfect at staying still?

I'd love to know how others feel about this and what you have done about it?


  • dilaurodilauro ConnecticutPosts: 9,859
    Part of this has come from newer technology. 10 years ago, there wasn't any option, it was the closed MRI tube. Now there is the sit down MRI, stand up MRI, etc

    Those are good for people who can not go into the tube.
    However, the resolution from the newer devices is not up to par with the conventional method.

    So, when a doctor needs to pinpoint the problem and the previous tests were done in Open MRI's, they might just say, "Got to do it again in a closed one"

    I have never met a radiologist or doctor that just skims the report or images. In fact, to the opposite, my doctors have sat with me, going over the images, showing the bad spots and then explaining the reports.

    The only time I have heard about discrepancies is when it comes to the evaluation and action plan that a doctor wants to do based on a diagnostic test. That can happen, and when that does, its is always safest to get a third opinion so that you have at least two in agreement
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I may not have understood the gist of your post, so if mine is off, I apologize...must be the effects of the lidocaine.

    First of all, are you taking about imaging tests? If so, I can see reasons for sticking with the same place, and reasons to mix it up. The pros: (let's consider MRI, just for example)

    It is advantageous to have the same machine when the radiologist will be comparing imaging from different dates. That just cuts out one differential. I think it is also helpful to have the same radiologist reading the films and writing the reports because they each focus on or emphasize slightly different elements of the images.

    My next thought is completely based on my own prejudice. I think it is better to have imaging done at a medical facility rather than one of the newer independent places that is run strictly as a business. I could give you all the reasons why I think this is true, but for now, you can just consider it my preference.

    I would be willing to go out on a limb and state that I believe all fellowship-trained spine surgeons are very comfortable reading any imaging testing and will read the radiology reports only to save time, etc. Generally a doctor has an idea of what he has in mind when he sends the patient for imaging. The report only confirms what he is anticipating. If there is variance, then he may haul out the films and really study them. But for the most part, I think they quickly glance at the films before meeting with the patient.

    I agree with Ron about having doctors spend time to fully explain a MRI. I have also had one be dismissive and tell me I wouldn't know what I was looking at anyway when I asked to see the films, which were right there on the table between us. The first spine surgeon I ever went to, on the other hand, spent 45 minutes teaching me how to look at a MRI.

    I've always had my imaging looked at prior to me leaving, and told everything was good. When I had the positional MRI in September, it was much harder to hold still and the technician worked with me to get what we needed. He'd had two people faint that week, so he was watching me like a hawk. That was however the place that sent me a radiology report that was pathetic. It was so generalized as to be meaningless and had outright mistakes as well. (example: citing a milding difuse bulging disc at L4-5 when in reality the disc was removed two years ago and I have a cage there).

    I guess I think if you have a place you are pleased with, with a radiologist that writes a fairly detailed report, a place that updates their software as soon as something new comes out so that it remains state-of-the-art, it makes sense to keep going there.

    Do you feel there have been too many requests for you to have tests? I feel like I am missing the point of your thread a bit! I do know that a radiologist can direct the emphasis of the radiology report and does so based on what the ordering doctor is looking for. Obviously the report does not comment on every aspect of the spine. Few of us have such a perfect spine that the report would be pages long if they commented on each and every little thing that is not textbook perfect. I know with my last MRI, we knew the insurance company did not feel my last report indicated instability. I suspect that my surgeon wrote the orders in such a way that this time they knew to focus in on that, in addition to my other, perhaps more obvious, issues. I suspect it was subtle, but I'm pretty sure that's what he did.

  • That sounds pathetic! but it's true. I guess when so much is riding on every sentences that appear on that report I worry about the accuracy. One poorly stated report could have my no-fault insurance denying me further treatment. Or as happened to me, confusing reports meant that I did 5 months of PT and neuro treatments for nothing. I'll never forget my orthopedist asking me why the neurologist wasn't doing something about my herniation!!

    Maybe being a New Yorker I'm just more cynical by nature. I look around these fancy offices and wonder how much the doctors and radiologists really care. It takes alot of fees to cover the overhead. I also think the doctors tend to play cover-your-butt. When I talked to my surgeon about the Horner's he looked at me for a minute and then said he could barely see the difference in my eyes! There wasn't any difference before my surgery - thank you very much!!

    I guess I'm just tired of worrying about every last detail of my medical care. Why can't we trust the doctors and nurses and office people?
  • dilaurodilauro ConnecticutPosts: 9,859
    Just a repossessed New Yorker living in CT

    Funny, I look at those offices and realize how hard and long it took those doctors to get there.

    Now, if I look at some Hedgefund owners, all of 34 years old with 18 Billion dollar incomes, those are the ones I am cynical of.

    In a heart beat, I trust the medical field personnel over those in the business arena.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I agree about that one Ron. Anyone who is making that kind of money scares me!!

    I asked my PT what he thought about this last night. He wasn't necessarily critical of the radiologist but he thought it might be a good idea to go to another place this time. He suggested that I bring the previous films for them to compare to but that they might catch something the other doctor missed.

    I thought about it last night and I am leaning toward this. Can't hurt to have a new set of eyes looking at me especially since things are going back to pre-op.

    I still think they are missing something in the clavical/shoulder area. I've had MRI of shoulder for the rotator cuff and mri of cervical and thoracic. But shouldn't there be something in between? I'm wondering if I can talk to the radiologist before they do the CT scan to see what they think. Might be something just a hair off the scans they are doing.
  • You might as well try a new place. If you can talk to the doctor who is ordering the new MRI, you could tell him your objective and see if he could write the order in such a way that it would point the radiologist in the right direction. Radiologists that look at scans and MRIs usually aren't used to meeting with patients, but you can certainly call and see if you can set something up. At least you might be able to tell them specifically what you are thinking.

    I had an appointment with my "rearranger" today. I hadn't seen him since my surgery was approved, and I told him I felt his report played a big part in the outside doctor seeing my problem. Doug had spent a lot of time going through my MRI frame by frame by frame to find just the right one that showed why I am unstable. It is not clear on every frame. Doug said that, especially now that the images are available on CD, some doctors flip through the images quickly and don't always see everything that is actually there.

    Maybe something similar is going on with you. I think it is always a good idea to shake things up a bit if people start to run out of ideas for treating you...be it new doctor, new imaging place, new PT, whatever it takes!!
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