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  • Nicholas Licameli

Should I Get An MRI?

Should I get an MRI?

Radiographs ABSOLUTELY have their place in healthcare, however they must be used correctly.

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Whenever we are considering administering a test, whether it be an X-ray, MRI, or functional test, we must ask these very crucial questions…is the test valid and in fact test what it claims to test (validity), are the results reliable if we retest (reliability), and will the results of the test change my treatment approach, improve my patient’s outcomes, or possibly reduce the overall cost of treatment? If the answer is no, why waste the time (and possibly money) doing the test in the first place? It is fairly well established in the literature that the results of imaging such as X-rays and MRI’s do not always correlate to symptom presentation. In other words, what we see structurally on an image is sometimes not what we see functionally in the human being in front of us. Believe it or not, the same EXACT image can be interpreted differently when analyzed by different qualified healthcare practitioners! This means that radiographs are not always valid or reliable and the results typically do not change the course of treatment or improve outcomes. Oh, and they’re usually expensive!

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Sometimes too much information can be a bad thing. I know my grandparents had sex, I just don’t care to know the details. In the case of low back pain due to improper load management, why pollute someone’s mind with “moderate disc protrusion at L3, mild-moderate herniated nucleus pulposus at L5, central stenosis with compression, degenerative disc disease, foraminal narrowing, and corona virus of the spine? How do we know that those things weren’t present years prior to the current onset of pain and actually have nothing to do with the current situation? I don’t see the benefit unless it is truly warranted. Radiographs should be used to rule out red flags including constant dull/achy pain that cannot be relieved for reproduced, loss of bowel/bladder control, history of cancer, episodes legs giving out, fever, traumatic injury such as a car accident or a fall, numbness/tingling, awakened by pain, warmth and tenderness to the touch, young active female with low back pain, suspected fracture, etc.

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Things like herniated discs and rotator cuff tears are actually quite normal in asymptomatic people, especially as we age. Trying to diagnose pain using a radiographic image is similar to looking at a picture of an old rotary phone (not an iPhone…a good old fashioned telephone without a screen!) and trying to decide whether or not it is ringing. Tough to say right?

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