Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 62 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"MRI: What They Missed...Now What?"

When reviewing MRI’s, too many MRI companies simply “SCREW UP” because they don’t think we know better and it is easier for them to do CRAP work. In addition, they do not think we are watching. The immediate result, INACCURATE DIAGNOSES. The sequelae, inaccurate prognoses, treatment plans and increased risk of hurting patients.

In the end, it compromises patient care and many get hurt because a technician was lazy, sloppy or ill trained. Who is at fault? The system? The technician? The interpreting radiologist? The chiropractor? The answer, all of the above. 

Laurie, Doman, Spratt, Tosteson, & Weinstein (2009) found that 42.2% of all interpretations of MRI’s from GENERAL radiologists are inaccurately reporting the morphology of disc lesions on spinal MRI’s. This scenario makes that number significantly worse as the read might be correct, however, what they are reading could be missing the lesion if the slice is taken in the wrong place. 

Lurie, J. D., Doman, D. M., Spratt, K. F., Tosteson, A. N. A., & Weinstein, J. N. (2009). Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations. Spine, 34(7), 701-705.

As the neurosurgeons say, I am the final answer because I know more than anyone else in the spinal world and as a result, am the most coveted by patients, treating doctors and lawyers. Henceforth, neurosurgeons get EVERYONE running after them and most have a 6 week waiting period to get an appointment if you do not have an emergency. 

This consultation is not about the lawyers or the referrals, it is about healthcare, your patients and being the “best of the best,” no different than how the neurosurgeon functions…and this is one giant step toward that end. The issue is that you now know better…and you have the ability to fix it. In the images below, you should see that the reference line, or the slice location, missed the disc. When you look at the sagittal slice, because the slice missed, the axial is not showing the cord at the disc space and you do not know if there is mild cord compression. You cannot make the diagnosis from the sagittal alone as the axial is missing the information. If you cannot see this, you must BECAUSE…it should change the way you treat your patient in conjunction with your clinical examination. 

The solution is 2-fold. First, you should check the T1 weighted image or the STIR view to see if there were slices acquired through the disc and if that fails, second, you MUST have the imaging company re-do the scan. IF you get to that point, you must be VERY angry and demand they do a better job every time or you will not be using their services any longer because you know better and the “jig is up!” You will be watching from here forward to ensure  your patients and your license is protected.

The bottom line, you must get credentialed in MRI spine interpretation and sit for the mini-fellowship in MRI. Credentials and knowledge matter!

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