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Imaging: Episode 45
In this episode: When should you have imaging done, when is there value and when is it just superfluous.
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Imaging as it value relates to orthopedic injury. Musculoskeletal, the spine, extremities, we won’t be talking about cancers or internal organs. Over the past few years imaging has taken on too much of diagnostic role and less of a confirmation role.
Initial imaging was used to confirm what the diagnostician had found. Now we are seeing more of people using imaging to diagnosis.
When we talk about imaging we are referring to plane films aka X-ray, MRI, CT scan and bone scan. You will see ultrasound a little more these days but it is not nearly as common as the afore mentioned group and so we will not discuss ultra sound in detail today.
Plane film is great at looking at bone and bone relationships. Some really good radiologists can infer more from a plane film then that. You will be able to confirm fractures, dislocations, joint space, bone spurs, osteophytes and in the spine vertebra position. Plane film is relatively inexpensive usually around $100 for a set of images. This is probably the most commonly used and in a good number of cases your insurance company will make you get a plane film before an MRI, CT scan, etc…
MRI is probably the 2nd most common type of imaging. This does a really good job of showing soft tissue as well as bone. This can be done with contrast (T1 or T2) or without depending on what you are trying to find. An MRI is $700 and up so it is a good deal more expensive then a plane film. This type of imaging gives off no radiation and is thus safer then the others.
CT scan is pretty similar to an MRI. It gives off a good deal more radiation so it is not used as often. The image quality is high and depending on what you looking for can in many cases be the best tool to use for the job.
The advantage of MRI and CT over plane film is that there is a good deal more detail and you can almost see the area in almost 3D.
Bone scan is the last type of imaging we are going to discuss today. This is primary used to show where certain bone activity is occurring or not occurring. You see this more often with stress reactions or osteopenia/osteoporosis.