Language is the bedrock of clinical practice, and more often than not, a simple description of your symptoms is enough for your clinician to formulate an accurate diagnosis. But there are instances where the message isn't truly clear and an imaging study is needed. Unfortunately, very few people understand the role of each type of study and just how useful some of the less-expensive tests are.
An X-ray is the most common imaging study. X-rays are used to visualize primarily the skeleton, but are also useful to detect changes in certain soft tissues. For example, an X-ray may be taken to observe changes in the shape and size of the heart and lungs. An increase in size is suggestive that the heart is filled with fluid or there is another cardiac problem that needs addressing. The lungs should be completely transparent because they are filled with air.
Perhaps the most common utilization of X-ray is to examine bones after trauma or during a routine screening for joint pain. X-rays are most useful to detect changes in bony anatomy. They are the first-line test to rule in a broken bone and are also able to discriminate damage done to certain soft tissues in the spine, for example, the lumbar disc. X-rays can see a loss of disc height with is associated with bulging and rupture.
Because they have been well-studied and are the least expensive test to order, they are the most frequently used of all the imaging studies.
Computed tomography, CT, is a step up from using an X-ray. CT scans are capable of diagnosing a broken bone with nearly 100 percent efficiency. Unlike an X-ray, CT scans are able to detect changes in any soft tissue in the body. They are more expensive to perform than an X-ray yet less expensive than an MRI.
CT scans have a wide range of application and are used to diagnose joint pain, fractures and organ system or metabolic problems. They can also help to differentiate a cancerous mass from normal tissue and will alert clinicians to changes occurring deep inside the bone much faster than a standard X-ray.
An MRI is the imaging study of choice for most practitioners because it offers the most information when trying to formulate a diagnosis. Magnetic resonance imaging technology involves using a magnetic field to vibrate water molecules that live in your tissue to create a picture. This picture has a high resolution when compared to CT and X-ray, therefore helping clinicians differentiate various anatomical structures.
The primary problem with MRI is that it is a highly sensitive test. This means it may lead a clinician to believe there is a problem when one does not exist. While an MRI can obtain an accurate snapshot of a particular area, they are only useful when matched with a thorough physical exam. Each person has anatomical anomalies that are normal for their body and it is important for your clinician to take this into consideration.
Because it offers the best resolution of anatomical structures and the technology is still considered a breakthrough advance in medicine, it is the most expensive of all the imaging studies. Because of the rising cost of health care, insurance companies have instituted limitations on the use of these tests. Now, most patients receive an MRI only if they plan to undergo surgery or have an invasive procedure, as MRI is useful in guiding this process.
MRI is so expensive to order that it is often cheaper to undergo a full course of physical therapy and fix the problem than it would be to have taken an MRI and been no closer to recovery.
After an injury, the first inclination of many patients is that they need an MRI to see what's going. Clinically, it is a rare occurrence to actually need an MRI to diagnose these problems. X-rays and CT scans are generally sufficient to rule out dangerous pathology and begin with an effective course of treatment. Don't be disappointed if your doctor does not order an MRI — the probability is that you won't need it anyway.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly. Questions may be submitted to Joe by e-mail: joedivincenzo@comcast.net.
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