Is Imaging Necessary

By Kayla Kranda – CC’s Staff

Is Imaging Necessary.

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X-ray, ultrasound, MRI, CT scan…..the rate of imaging in the United States is growing at an alarming speed and, unfortunately, patient outcomes are not improving. When considering imaging it is important that the benefits outweigh the risks.

There are multiple reasons to delay imaging.

1. Certain forms of imaging (x-ray, CT, PET) expose your body to ionizing radiation which can cause cellular damage.¹
2. Imaging studies are not cheap. An article from the Journal of the American Medical Association (JAMA) found that the U.S. spends twice as much on healthcare as any other high-income country in the world and heavy utilization of imaging was a major contributing factor.²
3. The results of imaging studies can be misleading. Studies have found seemingly concerning findings on MRI in ASYMPTOMATIC individuals. That’s right, they had NO SYMPTOMS or were being imaged for an unrelated concern, but their MRI showed diagnoses like “degeneration” or “disc herniation.” One study found “disc bulges” present in 30% of asymptomatic 20 year olds, 60% of asymptomatic 50 year olds, and 84% of asymptomatic 80 year olds!³
4. How accurate are they? One study followed a 63 year old female who had 10 MRIs completed at 10 different facilities within a 3 week period.⁴ The study found marked variability in the findings of each MRI result and an alarmingly high number of interpretive errors. Translation: the 10 MRIs showed DIFFERENT diagnoses and multiple ERRORS.

There are some instances where imaging is recommended such as cases of trauma, in those with severe or progressive neurological deficits, or when serious underlying conditions are suspected based on the patient history and physical exam. Imaging may also be considered if you have tried conservative treatment with little to no change in symptoms over a period of time.

Physical therapists are extensively trained to screen for red flags (signs or symptoms that are outside of our scope of practice and require referral to an appropriate provider for further work up) and to perform special tests and measures to best determine your underlying problem. We treat based on these findings and, in most cases, results of an imaging study do not change our recommended plan of care. Consider us first for your aches and pains!

References

1. https://www.cancer.gov/about-cancer/causes-prevention/risk/radiation
2. Papanicolas I et al. Health care spending in the United States and other high-income countries. JAMA. 2018; 319(10): 1024-1039.
3. Herzog R et al. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3 week period. The Spine Journal 17 (2017); 554-561.
4. Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. 2015 April; 36(4): 811-816.