Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 209

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 Interpretation and Misinterpretation”

Over the past week, I have been going back and forth via e-mail with a professor from a chiropractic college who has taken a negative position to my supposition that DC's can learn to read MRI's without becoming a diplomate in radiology (DACBR). This doctor, a DACBR, also took issue with my reference of the research article that is highlighted in bimonthly educational flier #69 that 42.2% of radiologists misinterpret the film in reporting both the pathology and morphology. He went ballistic on that reference and felt that I was being inflammatory and was offering a very distorted view of the facts.In deference, I offered to co-author an article on practicing DC's reading their own films in an overread scenario and he declined as he still disagreed with my premise that the average clinician can read MRI's. 

Last night, while sitting with Robert Peyster MD, neuroradiologist, who received his education from Columbia, Downstate and Harvard Universities and has been published over 65 times along with a 35 year career in reading NMR's and MRI's, he weighed in on the subject. 
As a note, Dr. Peyster and myself are creating a follow-up MRI course focused on bulges, herniations, degenerative disc  and lipomatosis (excess fat) disorders. That will take about 6 months to finalize. Dr. Peyster thought the research article quoting 42.2% was grossly inaccurate. His personal experience is that well over 75% of radiologists misread the films. He also feels that chiropractors, because of our intense education on spinal anatomy along with more difficult x-ray interpretation, can learn to become proficient in MRI interpretation in order to determine if the reading radiologist is on target or a second opinion is needed.

Dr. Peyster urges every chiropractor nationally to become proficient in reading the MRI's in order to do overreads of the radiologists and create a "team approach" to advanced imaging. Dr. Peyster also felt the DACBR was fighting for the turf of radiologists at the expense of the public and we, as a healthcare community, need to do better. Should we replace the radiologist? No, but we need to keep it honest.

The moral of the story is that reading MRI's goes well beyond the lawyers. Your patients and your license will often depend on your level of expertise in reading MRI's. I have well chronicled my journey with abdicating the MRI read to a radiologist who doesn't quite get it.

Radiologists do spend a rotation through neuroradiology, studying brain and spine. They spend 40% of their time on spine, which is 4-5 weeks, and then go into their specialty. Some are consistently excellent, while most do not look at spine for many, many years only to be hired to review MRI's because they are cheaper than neuroradiologists. The most frequent comment I get from DC's who have invested the time to take the courses is that they now practice with a level of confidence and are no longer clueless or guessing and they sleep much better at night. It is always better to be "the one in the know."
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