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X-Rays, Ultrasounds, MRI’s OH MY! How Diagnostic Imaging Doesn’t Always Paint a Perfect Picture


Technology. It’s something that we all benefit from on a daily basis, from our smartphones to our smart TV’s, everything is getting smarter, faster.

Much like other industries, the health sector has benefitted greatly in recent years from a rapid growth and expansion of its technology. We are able to detect severe life-threatening diseases and injuries with much greater accuracy than ever before. But what is the cost of these great improvements in the tools that health professionals use? Can technology in the health sector be a disservice?

At some point in our life, we will all experience diagnostic imaging. Whether it is an x-ray, ultrasound, bone scan, or MRI, these technically advanced tools are meant to help inform our health providers about what is going on inside the body.

Although medical imaging seems like the right thing to do, particularly if your trusted health care provider is ordering it, often times patients are sent for imaging when it is not needed. Current research indicates that between 10% and 20% of medical imaging studies ordered are unnecessary or completely inappropriate. 

Imaging doesn’t tell the full story

Advanced imaging does not tell the whole story! Here is a typical scenario. You’ve injured yourself and now you are experiencing low back pain. You see a doctor to find out what’s going on and explain your symptoms. Without a proper physical examination, you are given pain medication and a requisition for imaging. At your follow-up appointment, your doctor tells you that the imaging shows something that is causing your pain and recommends a course of action based on the imaging results alone. Does this sound familiar?

There is a plethora of research that has looked at the correlation between diagnostic imaging and pain. Check out these interesting studies below:

• In one study on the lower back, healthy, middle-aged subjects (30-60 years old) with no physical symptoms of pain were sent for MRI imaging.  The study found that 80% of asymptomatic participants could be diagnosed with at least one mild disc protrusion or herniation in the lower back. 

• Another study looking at MRIs of shoulders of participants who had no symptoms, revealed that 34% had rotator cuff tears. This increased to 54% when over 60 years of age, yet these people experienced no pain!

• In a study investigating people with knee osteoarthritis, MRI imaging concluded that 76% were found to have meniscal tears without any symptoms or pain.

• A study of MRIs done on the cervical spines (neck) of 1,211 participants (20-70 years old) found that 87.6% had a bulging disc. For those in their 20s, 73.3% of males and 78% of females had bulging discs, again without pain.

Imaging doesn’t prove the source of pain

The data reveals that having an imaging finding such as a rotator cuff tear, bulged disc or osteoarthritis does not always result in pain. In other words, imaging findings and clinical symptoms are two different things. What a doctor finds on your MRI report may not explain the reason why you are experiencing pain. 

An imaging test is a brief snapshot in time and doesn’t provide the full picture! Unfortunately, many health providers rely only on imaging findings to direct their plan of management instead of guide it. These technologies then replace physical exams, sometimes leading to inappropriate treatment or a delay in receiving appropriate care.

The research above also highlights the importance of undergoing a comprehensive history and physical examination for your problem. A competent clinician often will be able to diagnosis the source of a patient’s pain by examination only, and then rely on imaging as needed to evaluate the extent of the problem. 

Moreover, important to consider that imaging modalities are performed in a static controlled environment and rarely provide information as to what is happening when a patient is weightbearing and moving. For a patient who has pain with movement but no pain at rest, it is possible that a test may not explain what is happening when the patient is painfully moving. Therefore, a physical examination that observes the patient moving under more active conditions is a must!

What you should know as a patient

As a patient, how is this information important to you? It is likely that we will all have to undergo some form of imaging at least once in our lifetime. There are a few steps you can take to protect yourself from unnecessary or misleading tests and become informed.

1. First off, have a chat with your health provider about the benefits and risks to receiving a test as some studies use ionizing radiation and exposure to it may not be necessary if the test is unlikely to change the course of your management. Also, if you are being referred to a new doctor who does not have your background medical information, be proactive and have copies of your past imaging results to avoid being sent for any unnecessary testing. 

2. If a health provider orders a test for you without physically examining you, seek out a qualified health provider who will. This cannot be emphasized enough. If a patient shows signs of a disc height loss or bulged disc, this degenerative process has taken years to occur and is likely not the reason for a patient’s two-week episode of pain. However, more often than not, a test is performed, disc height loss is visualized, and the patient walks away with an understanding that their disc degeneration (that they have likely had for years) is what is causing their new pain.

3. Finally, if an advanced test is ordered for you, do not sit and wait for the fate of this test to determine your outcome. There most likely will be many steps you can actively take about receiving treatment or care while waiting for your imaging test to take place. This will only help you in the long run.

It is important to be informed about your health and to understand how medical technology can assist in healthcare. Don’t be a VOMIT (Victim of Medical Imaging Technology).

– Dr. Sean Sutton, Dr. of Chiropractic