This is a common question that I get asked. I am supportive of people wanting to get diagnostic imaging done when they want it. It provides peace of mind and good information. Sometimes, critical information. But, let’s discuss some things.
What Is Diagnostic Imaging?
It is a way to look inside the body without surgery to help find the cause of problems and confirm a diagnosis. Note it helps confirm. The design is not to look for fun or “just in case”.
So, what kinds of diagnostic imaging is there?
This is the most well-known type. X-ray machines produce a high-energy beam that can pass through most of the body. Bones and dense tissue are unable to absorb them though and create a shadow type of image. Check out this helpful video for more information.
X-rays are cheap, fast, and easy to get. Remember, “you get what you pay for” applies. An excellent option for fractures.
Computed Tomography (CT)
You may have heard of this as being a “cat scan”. It is essentially a group of x-rays taken from many different angles. Then computer software combines the “slices” into a complete image. It is much more reliable but gives a larger dose of radiation.
Magnetic Resonance Imaging (MRI)
No radiation needed here. MRI machines use a powerful magnet to construct a very accurate image. There are different kinds but we won’t go into all that. This is essentially the gold standard of imaging – with some exceptions.
This is NOT a complete list but it’s what we’ll stick with.
Accuracy of Imaging
Above I listed them from low to high on the accuracy scale. It is the same pattern when talking about price. That’s why your insurance will cover an x-ray but may balk about ponying up for an MRI.
X-rays can detect a change in bone after 30-50%. Also, many errors take place due to poor technique and positioning.
A CT and bone scan can detect a 3-5% change.
An MRI can detect a 1-3% change in the bone. This is why I call it the “truth tube”.
People Not Pictures
At Whole Body Health Care, we’re interested in helping people – not pictures. Looking at an x-ray, CT, or MRI can be very helpful but it is only a snapshot. Think of it like driving in the car and checking your mirrors. You snatch quick looks in the side and rear-view mirrors frequently. Why not only once? Because it’s changing! If all you had was that snapshot you would struggle to make a lane change 1 mile later.
So it is with a diagnostic image. Doesn’t give context, doesn’t show function, only shows a moment in time. “Ahh!” you think, “So we need to take a lot of images and often.” Wrong, that is also a bad plan. Especially with radiography which gives a dose of radiation. More often than not imaging is not needed or recommended.
Ignorance Is Bliss
There are times when it may be better not knowing what an image would show…
This MRI shows a disc herniation at the L4/L5 level. How sinister! Maybe not. I’m going to teach you a little more.
10 Different MRIs
This patient had 10 studies at 10 different locations with at least 10 different pairs of eyes. The score for agreement liability was low. Interesting little case study.
Asymptomatic means “without symptoms”. No pain or problems.
These 7 different studies tell their story using 12,251 people. That story is that the majority of people have a bad image. Let’s say everybody in Cache Valley (or wherever you’re living) had an MRI taken. It would be shocking to see how many people had a “problem”.
Let’s take our focus back to the MRI image above. What about when there’s a bad looking disc and it IS causing problems?
What this is saying is discs have the potential to heal! Especially with conservative care Size doesn’t matter. Yet, a scary-looking MRI will often lead to surgery. Best practice shows that patients should complete a trial of conservative care first! This is usually at least 2-4 weeks. Unfortunately, too many people are utilizing chiropractic care as a last resort. That’s backward!
The information gathered here shows us that imaging is not the law. There’s more to the story than the picture! Especially if it’s leading people down the road of drugs and surgery.
So When Is It Good?
After a history and exam determine that it would be helpful to confirm a diagnosis. Or after you have failed to respond to a sufficient trial of care.