Radiologists

[Aaron]

Why are they so different, one scan here says one thing while the other scan is totally different. I also have requested new MRI compared to old MRI and the radiologist said he missed the problem until compared to the old MRI he read and found the same prob. two years later. The same person missed his own previous finding??? So he prints new reading still showing nothing at T6-7 but puts a small addendum that never gets read by doctors saying there was a herniation there. But it never gets seen, I always have to point it out and they say " OH it is still there" but without me showing it would get passed over.

Also I have had my first thorasic MRI and would prefer to show it everytime, but everyone wants new ones. The doctors are in such a time crunch they just scan the MRI and report, but the first MRI the radiologist marked perfectly the location of the herniation and had it outlined in some coloring and it just stands out and is immediatly recognized by doctors and addressed while the newer MRI's do not have the same markings. This may seem insignifigant but when you are dealing with smaller herniations it can make a big difference, I have seen it. Old MRI the doctor says " you have a smaller herniation at T6-7 that is pressing on cord, most likely pain source" : New MRI doctor says " you just have alot of arthritis and DDD, cannot really pinpoint the exact source". This is often the same doctor just years apart when I see him. WTF. Everyone makes mistakes and doctors are hurried, why not have these markings on every MRI?

[dshobbies]

Sorry Aaron,

Welcome to the medical world. For those of us who remember how things worked before the '90s and HMOs, we're aware that though there always existed a difference among the quality and caring of doctors, it is far more evident today.

[mmglobal]

Aaron, look at my Th1-Th2 (circled in blue) in the first picture of this post. The radiologist missed this completely and did not even mention it on his report.

The good news is that most spine surgeons couldn't care less about what the radiologist has to say. However, the radiologist's report gives the surgeon political cover NOT to look at everything and just to focus on the obvious.

I have seen cases in which the radiologist reviews the SAME MRI at different times and comes up with different results. I have also seen where a surgeon reviews the same case data at different times and comes up with different diagnoses and surgical plans.

Sadly, spine is still more of a black art than a science. Many cases are NOT cut and dried.

Aaron... like you, I am discovering that it's even worse with t-spine... they know even less than they do about cervical and lumbar spine.

Mark

[AnnOdom]

I can understand your frustration with radiologists' reports not telling about all the findings on the MRI. I certainly trust my DH's neurosurgeon's opinion of what the MRI shows over what the radiologist reported. I mean, the bone on bone at L4-L5, with anterior lipping of L4 over the anterior portion of L5 is very obvious, when you see the film, yet it's not mentioned in the report. Or, disc bulges are in the body of the report but not even mentioned in the Opinion part of the report. Drives me NUTS! Yep, when HMOs came along, medical care started going downhill, and it's like it's on a greased slide now! All you can do is make sure the MRI is looked at by the doctor, and that he's not just relying on the report.

[Maria]

I remember radiology reports dating back to the 80's and early 90's which seemed to detail nearly everything and then later ones that were pretty abbreviated. I had long thought that the less mentioned/documented the less that there might be to deal with esp. if a doctor is just breezing over a report (as in a follow up visit at one's HMO w/PCP vs. referral visit with Ortho/Neuro). I think the managed care medical community is encouraged to report significant findings only and not those that fall into certain catagories.
Tho then again I'm biased as I worked in Managed Care a number of years and witnessed some pretty bad medical practice especially when Joint Commission of Hospital (JCOH)review visits were expected and medical records were hidden/amended/produced on the spot.

I have to agree w/Ann O.

[AnnOdom]

Ah yes, JCAH visits, and the rush to make sure everything is done "just right!" Been there, done that as I was a Registered Nurse for 39 years, and spent most of my working years in the Operating Room. HMOs destroyed good medical care, and it's been going downhill ever since. That retired orthopod who did Dan's Independent Medical Exam told us that lumbar fusion only has a 10-20% success rate! I'm positive that he was talking about the old-fashioned way of doing them as he told of a patient who's iliac vein was "nicked" and he required 24 units of blood, and almost didn't make it. DID NOT believe that as that vein isn't that large. Probably an orthopod doing the conventional fusion procedure, and grabbed a hunk of the vena cava, tearing it, or worse, the aorta. I've seen the vena cava torn, during a regular lum lam, and the patient didn't require any blood as the scrub tech recognized what had happened, and got the cardiovascular surgeon in there. Poor patient had incisions on his back and abdomen. I may have already told this story, LOL! My brain cell has shorted out and I need to get to bed. Keeping y'all in prayer as I know what it's like to deal with constant, chronic pain~~~constant cervicogenic headaches due to a neck injury on the job.