MRI Lab : Should the Radiologist ask what the suspected problem is?

[Raul_SJ]

When going in for an MRI knee scan, should the MRI Lab Doctor\Technician question me on what the suspected problem is? (I told them that my referring Doctor thinks it's a possible meniscal tear.).

The MRI Lab Radiologist issued a report, which included:

Posterior horn of the Medial meniscus shows small focus of altered signal intensity extending up to Capsular surface and it appears Iso to hyperintense on all sequences.

Impression: Grade II degeneration involving the posterior horn of medial meniscus.​

Given that there is a degree of subjectivity in interpreting scans and radiologists can have differing opinons based on the same scan, I am wondering if it wouldn't be better if the Lab simply issued its findings without pre-MRI questioning.

That way, the Radiologist's findings and interpretations would not be possibly biased based on the pre-MRI questioning.

 

[Chas Tennis]

In my experience, my Dr prescribed both my knee MRIs with a bit of his preliminary diagnosis information for the radiologist. I believe that a radiologist takes the MRI images and then a specialist - I believe mine have been evaluated by medical Drs - evaluates the MRIs.

Get a copy of the full written report from the imaging lab, it might include some of your Dr's prescription. My prescription might have said 'possible meniscus tear' etc. Read all the other stuff because it includes other observations on most structures of the knee - normal, mild problems, serious problems. Particularly look at the Patellarfemoral joint information that might indicate future problems beyond your current injury. You may be able to improve the posture of your knee and reduce future deterioration.

As part of some new medical changes (Obamacare?), my X Rays and probably MRIs written evaluations are now available on my account on a hospital website. I believe this new internet capability was funded in part by some Fed program, but I'm not certain.

I am trying now to see if I can get a look at my last two knee X rays to see if the joint spacing had changed. The images themselves are not in my medical records.

I am always in favor of everybody learning as much as possible. The radiologist has to take the MRI based on your Dr's written prescription but it's probably a plus that he/she asked questions. Maybe sometimes the MRI specialist MDs themselves participate in the imaging. ?

 

[El Diablo]

Radiology facilities need a preliminary diagnosis to get reimbursed for MRIs by most insurances currently.

 

[LuckyR]

Folks who read XRays or slides under a microscope do not NEED any information to give a reading but like in real life GIGO (garbage in/garbage out). The more information that the guy in the dark room (without the actual patient) has, the better information/interpretation they can give.

 

[RogueFLIP]

When going in for an MRI knee scan, should the MRI Lab Doctor\Technician question me on what the suspected problem is? (I told them that my referring Doctor thinks it's a possible meniscal tear.).

Given that there is a degree of subjectivity in interpreting scans and radiologists can have differing opinons based on the same scan, I am wondering if it wouldn't be better if the Lab simply issued its findings without pre-MRI questioning.

That way, the Radiologist's findings and interpretations would not be possibly biased based on the pre-MRI questioning.

It's best that you tell the MRI technician what the issue may be if asked. This way during the specific angle/cut picture of the area in question, the technician can make sure that it's of the highest quality for the radiologist to read.

In my experience, my Dr prescribed both my knee MRIs with a bit of his preliminary diagnosis information for the radiologist. I believe that a radiologist takes the MRI images and then a specialist - I believe mine have been evaluated by medical Drs - evaluates the MRIs.

Maybe sometimes the MRI specialist MDs themselves participate in the imaging. ?

Most of the time, MRI's are administered by technicians. These pictures and other patient's paperwork are then interpreted by a MD or DO specialist which are Radiologists. The radiologist then gives the final report to your regular doctor or other heath care providers.

 

[rjkeene]

Yes, they need to know

First of all the MRI lab will not due the study without a diagnosis to justify the exam. The lab needs to "code" the reason for the study for purposes of insurance re-imbursement.

In addition it is important for the radiologist to be sure to examine carefully the region of clinical concern.

It is very unlikely the radiologist would "fabricate" an abnormality on the images based on the clinical history provided.

However, finding an imaging abnormality in the area of clincal suspicion does not prove that the MRI abnormality is responsible for the patient's symptoms but must be correlated with the history and physical exam by the referring doctor.

 

[Raul_SJ]

It is very unlikely the radiologist would "fabricate" an abnormality on the images based on the clinical history provided.

However, finding an imaging abnormality in the area of clincal suspicion does not prove that the MRI abnormality is responsible for the patient's symptoms but must be correlated with the history and physical exam by the referring doctor.

I did not imply that the radiologist would fabricate an abnormaility. Only that MRI interpretations can be subjective in marginal cases, and that the questioning could bias his opinion.

With regard to insurance, the MRI was done outside of the U.S. where no doctor referral or insurance was necessary -- any patient could walk into the MRI lab and obtain an MRI by paying out of pocket.

Given the above scenario (no insurance paperwork involved), I think it would be valid for the MRI lab to issue it's findings on the knee MRI without any questioning and let the patient follow up with his personal doctor on the MRI findings.

Don't really see how the patient informing the MRI lab, "My doctor suspects a meniscus tear." serves any purpose. The lab should issue the exact same findings without benefit of that information.

 

[ollinger]

^^ my own experience looking at films and scans corroborates keene's -- they are not so easy to read and you are far less likely to miss something if you have some idea what you might be looking for. You don't bring your car to a mechanic and just say "something's wrong, find it." You tell him what's going on and this tells him where to start looking.