Preparing Patients to Read Their Own Radiology Reports

Preparing Patients to Read Their Own Radiology Reports

 

Increasingly, diagnostic imaging providers use web portals to give patients full access to their own radiology reports. Despite early fears that patients would misinterpret complex medical information, leading to unnecessary anxiety, most studies of direct access to radiology reports suggest that this is a positive step for patients and health care providers alike. When patients take a more active role in their care, they provide an extra level of oversight, reducing the chance of an error. Informed patients are also more likely to ask radiologists helpful questions, potentially preventing unnecessary testing.  

 

In order to realize the full benefits of open access, however, primary care physicians or radiologists themselves should start educating their patients on how to read radiology reports. Otherwise, the fears of the opponents of patient access are more likely to be borne out in the patient population.

 

Here are a few of the key points to emphasize to patients who may be accessing their radiology reports for the first time:     

Explaining Radiology Reports to Patients: The Breakdown

 

Patients may be more comfortable with the radiology report when you explain it section-by-section. Luckily, radiology reports are broken down into six sections, which is a good place to start when explaining the documents to patients. Let patients know that the typical radiology report will include the following: The type of exam performed, the patient’s clinical history, the comparison, the imaging technique, findings, and the radiologist’s final impressions. Encourage patients to ask questions if they encounter anything they don’t understand in any of these six sections:  

 

Section 1: The Basics

 

Radiology reports that begin with naming the type of exam will explain which imaging modality (MRI, CT, X-ray, etc.) was used in the procedure — and, crucially, which part of the body technologists scanned. They’ll also include the time and date, as well as any details about preliminary procedures, like the use of contrast.

 

When discussing this first section, make sure patients understand the basics of the modality, and risks involved. This is a good time, for instance, to mention that MRI scans don’t expose patients to ionizing radiation, or that intravenous contrast has a low incidence of negative side effects.

 

Section 2: The Patient’s Backstory

 

The “clinical history” section of a report includes information such as the patient’s age, sex, and pre-existing conditions or diseases, and any other relevant medical information needed.

 

Patients can find the reason for the scan and, often, a suspected diagnosis in this section. This information helps the radiologist focus the report to each patient’s individual medical situation. Conversations with patients about their clinical histories can ensure that physicians have access to all relevant data before referring the patient for diagnostic imaging.

Section 3: Comparing New Scans to Previous Radiology Reports

 

If the patient has had other imaging done in the past, sometimes those images need to be used as comparisons. The “comparison” section of the typical radiology report is where past images will be mentioned. Typically, radiologists only consult scans of similar regions of the body when making comparison notes.  

Section 4: Technical Details

 

When patients have questions about a radiology report, they often turn up in the “technique” section. Ironically, the details provided here — exact scientific descriptions of the imaging procedure — may not give the referring physician or the patient strongly relevant information.

 

However, the information contained herein is vital for radiologists, who may need to recreate or alter technical procedures in later scans. In reading through the technique portion of the radiology report, physicians may need to explain medical terminology, such as the use of anatomical planes, as well as structures of the body.   

Section 5: The Radiologist’s Findings

This is what every patient wants to know—what was found during a scan. Don’t let patients place too much emphasis on the findings, however; the detailed analysis comes with the radiologist’s impressions, in the final section of the typical radiology report.

 

Here, radiologists provide their notes on the normality or abnormality of the scanned area. Sometimes, patients don’t see a certain organ or bodily structure that they know was part of the imaging procedure. Let them know that this usually just means the radiologist didn’t find anything worth commenting on in that area. That’s usually good news.

Section 6: The Radiologist’s Diagnosis

The “impression” section of a medical report is where patients will find the radiologist’s diagnosis, along with recommendations for future testing for confirmation. Commonly, radiologists offer differential diagnoses, which include any number of potential causes of the patient’s symptoms. This can be confusing to patients new to reading radiology reports, so it can be helpful to spend extra time discussing each of the diagnoses on the radiologist’s list, and planning for future diagnostics that can uncover the true illness.  

The Growth of Portal-Based Radiology Reporting

 

Even if the diagnostic imaging facilities you refer patients to don’t offer online access to radiology reports, odds are they will in the near future. The latest survey found that nearly 80 percent of patients who responded said they preferred to view radiology reports through online portals compared with more traditional methods of reporting. Tellingly, this includes getting the details verbally from their referring physician.

 

Another survey of 617 patients found that 64 percent of the study participants said they wanted to review their radiology reports themselves. An impressive 85 percent reported a desire to see the diagnostic images themselves.

 

In a consumer-driven health care market, these preferences are bound to win out. Prepare patients to read their own radiology reports to improve the efficacy of patient web portals at diagnostic imaging centers.

 

References:

 

Cabarrus, M et al. Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports. Journal of the American College of Radiology. June 2015; 12(6):556-562. DOI: https://doi.org/10.1016/j.jacr.2014.12.009. Accessed March 14, 2018.  

 

Johnson, AJ et al. Access to Radiologic Reports via a Patient Portal: Clinical Simulations to Investigate Patient Preferences. Journal of the American College of Radiology. April 2012; 9(4):256-263. DOI: https://doi.org/10.1016/j.jacr.2011.12.023. Accessed March 14, 2018.  

 

Landro L. Radiologists Push for Medical Reports Patients Can Understand. The Wall Street Journal. September 2014; Web. Available here. Accessed March 14, 2018.  

 

Orenstein B. Reporting to Patients. Radiology Today. January 2013;14(1):22. Available here. Accessed March 14, 2018.

 

Patients accessing medical records online more than ever. Becker’s Hospital Review. July 2016; Web. Available here. Accessed March 14, 2018.

 

MRI Technique Shows Brain Differences in People on Autism Spectrum

Researchers have observed abnormal neural networks in preschoolers with autism spectrum disorder (ASD) using a specialized magnetic resonance imaging (MRI) technique. The discovery gives hope that MRI scanning may one day allow early diagnosis, intervention, and treatment in ASD.

The study included 21 children with ASD and 21 children with typical development (TD).

It took place over four years in the Chinese PLA Hospital in Beijing. The researchers used a special MRI technique called diffusion-tensor imaging (DTI), which allowed them to observe the location, orientation, and anisotropy of white matter tracts in the children’s brains.

 

Other scientists have used a similar technique to study the brains of patients with Alzheimer disease, multiple sclerosis, epilepsy, and other psychiatric disorders. The approach has led to

an improved understanding of topological organization of the brain network in patients with these disorders.

 

There were similarly useful results in the study of preschoolers with ASD. The researchers observed alterations of white matter in the children with ASD compared to children with TD. The scientists were able to correlate the alterations in the white matter networks with delays in verbal communication, object use, visual response, body use, and listening response.

The study also observed increased nodal efficiency in children with ASD compared with TD.

That observation agreed with previous studies that had observed this phenomenon in adults on the autism spectrum. The researchers believe this is a reflection of a delayed maturation process in people with ASD.

 

“Altered brain connectivity may be a key pathophysiological feature of ASD,” study co-author Lin Ma told Science Daily. “This altered connectivity is visualized in our findings, thus providing a further step in understanding ASD. The imaging finding of those ‘targets’ may be a clue for future diagnosis and even for therapeutic intervention in preschool children with ASD.”

Medical professionals from around the world weighed in on the study.

“This discovery gives us a more objective diagnostic method by using MRIs to aid us in the diagnosis of children who do have autism, and also gives us a better understanding of the abnormal differences in the brain,” psychiatrist Dr. Matthew Lorber told HealthDay Reporter.

 

Doctors presently diagnose ASD through observing difficulties with social use of communication and interaction in children. A standardized MRI technique that could identify the disorder could give parents and therapists an earlier chance at intervention and treatment.  

 

It’s still too early to rely on MRI scans for the diagnosis of autism, but the study’s results show that it’s possible. The study also provides other researchers with imaging biomarkers that may speed the development of this technology.

 

References

Abnormal Brain Connections Seen in Preschoolers with Autism.” Science Daily. 27 Mar. 2018. Accessed 29 Mar. 2018.

 

DSM-5 Diagnostic Criteria.” Autism Speaks. 2018. Accessed 29 Mar. 2018.

 

Ma, Lin et al. “Alterations of White Matter Connectivity in Preschool Children with Autism Spectrum Disorder.” Radiology. 27 Mar. 2018. doi: 10.1148/radiol.2018170059. [Epub ahead of print]. Accessed 29 Mar. 2018.

 

Preidt, Robert. “MRI Sheds New Light on Brain Networks Tied to Autism.” HealthDay Reporter. 27 Mar. 2018. Accessed 29 Mar. 2018.

mri-biopsy

Precise Blog – How MRI Scans Can Reduce the Need for Biopsies

How MRI Scans Can Reduce the Need for Biopsies

 

Researchers at the Simmons Comprehensive Cancer Center have authored a study detailing a multiparametric magnetic resonance imaging (mpMRI) technique that predicts a malignant type of kidney cancer without performing a biopsy. The results of the method are impressive, but require more refinement to fully take the place of a biopsy.

 

Doctors frequently find kidney tumors accidentally while conducting CT scans for other reasons.

These scans alone do not yield the necessary information that tells doctors whether they are malignant or benign. Instead, a biopsy is usually performed. These procedures can save lives by correctly identifying the nature of the tumor, but they are also invasive and can cause complications.

 

“Using mpMRI, multiple types of images can be obtained from the renal mass and each one tells us something about the tissue,” Dr. Ivan Pedrosa, Professor of Radiology and Chief of Magnetic Resonance Imaging told the UT Southwestern Newsroom.

 

Identifying malignant masses in the kidney is extremely important because treatment is highly effective before the tumor metastasizes. However, once it spreads to other parts of the body, survival rates are low. Clear cell kidney carcinoma is an aggressive subtype of malignant masses that the researchers.

 

Seven radiologists studied the records of 110 patients with cT1a masses.

 

These patients had all undergone an MRI as well as a partial or radical nephrectomy. The observing radiologists did not know the final pathology findings, but instead relied on an algorithm to judge whether tumors were metastatic.

 

The researchers had 78 percent accuracy when rating that the mass was “probably” or “definitely” clear cell kidney carcinoma. When rating that the mass was possibly carcinoma, they had a 95 percent success rate.

 

The promising results show that biopsies may not be necessary for identifying certain cancers.

 

Because some patients are reluctant to consent to biopsies, this new technique is potentially lifesaving. As it stands, patients who do not want a biopsy may learn important information if an MRI shows that their kidney mass has a high probability of becoming metastatic. This new information could convince them that the pain of a biopsy is worth going through.

 

Using these methods to identify clear cell histology is still a work in progress. The doctors at Simmons Comprehensive Cancer Center will have to achieve a higher degree of accuracy in predicting malignant kidney masses for the method to become mainstream.

 

However, as standardization of imaging protocols and reporting criteria are refined, accurate results should increase. When MRI scans alone are sufficient to identify clear cell kidney carcinoma, doctors will have another powerful tool in the fight against cancer.

 

References:

 

Anderson, Avery. “State-of-the-Art MRI Technology Bypasses Need for Biopsy.” UT Southwestern Medical Center, 2 Jan. 2018. Accessed March 14, 2018.

Canvasser, N. et al. “Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Identify Clear Cell Renal Cell Carcinoma in cT1a Renal Masses.” The Journal of Urology, volume 198, no. 4, Oct. 2017, pp. 780-786. Accessed March 14, 2018.

National Cancer Institute. “Kidney Cancer.” Kidney (Renal Cell) Cancer—Health Professional Version. Accessed March 14, 2018.

 

National Institute of Health. “Clear Cell Kidney Carcinoma.” The Cancer Genome Atlas, National Institute of Health. Accessed March 14, 2018.

Advances in Machine Learning (AI) for MRI scans

Open-Source MRI Dataset from USC Now Available to Researchers

 

The University of Southern California has released an open-source dataset of anatomical brain images taken from MRIs of stroke victims. The dataset is intended to spur advances in machine learning by providing a large set of manually-traced lesions.

 

Manually-traced lesions are useful, but labor intensive.

 

Researchers have attempted to automate lesion segmentation through algorithms. However, this automation is in its primitive stages, and machines cannot yet identify lesions with great accuracy. Thus, manually-traced lesions are still the gold standard, but require a large amount of work from a trained neuroanatomy expert.

 

USC’s dataset attempts to bridge the gap between human tracers and machines. By providing 304 T1-weighted MRIs with lesions segmented by a human, the study’s authors hope computer programmers can develop an accurate lesion segmentation algorithm. The dataset is available for download free of charge here.

 

Strokes are a leading cause of death and disability in the United States.

 

Mortality rates from strokes have steadily declined worldwide, but around two thirds of stroke survivors suffer long-term disabilities that affect their daily activities. This situation has led scientists to focus on what interventions provide the best outcomes for stroke survivors.

 

Doctors have opportunities for intervention at both the acute and chronic stages. In the former, intervention can save neural tissue and promote functional recovery. In the latter, rehabilitation can help long-term recovery.

 

Magnetic resonance imaging can aid doctors in making intervention decisions.

 

Clinical brain images taken within 24 hours of a stroke help doctors determine whether to administer thrombolytic drugs or perform surgery to save neural tissue. Because clinical scans are taken for almost all stroke victims, there have been great strides in using large-scale datasets of these acute scans for predictive modeling.

 

Unfortunately, sub-acute and chronic scans are given less and therefore harder to obtain, making predictions at these levels less advanced. That’s one thing the study’s co-author Sook-Lei Liew would like to change.

 

“The goal of ATLAS is to generate a dataset that machine learning and computer scientists could use to develop better automated algorithms to identify the lesions,” Liew told Health Data Management.

 

Machine learning requires large, accurate datasets to train and to test.

 

Liew hopes that computers will eventually be able to identify biomarkers in stroke patients, making it easier to prescribe the appropriate rehabilitation therapy and treatment. Her next step is to create a separate dataset used to test the algorithms developed using the current dataset.

 

“In machine learning, you always need a training dataset and a testing dataset.” Liew noted. “Even if people aren’t interested in stroke, it’s also an interesting dataset to train any sort of computer vision algorithm because it’s a challenging problem.”

 

References:

 

Slabodkin, G. USC Releases MRI Stroke Dataset To Spur AI Research. Health Data Management. Available here. Accessed February 22, 2018.  

  

Liew, S et al. A Large, Open Source Dataset of Stroke Anatomical Brain Images and Manual Lesion Segmentations. Scientific Data. February 20;(5):180011. doi:10.1038/sdata.2018.11

Accessed February 22, 2018.   

 

Feigin, VL et al. Global and regional Burden of Stroke During 1990-2010: Findings From the Global Burden of Disease study 2010. The Lancet. January 2014;(383)9913:245-255. doi:10.1016/S0140-6736(13)61953-4 Accessed February 22, 2018.

 

The Mammography Quality Standards Act (MQSA): What Physicians Should Know

More than 65 percent of U.S. women aged 40 and over had mammograms between 2013 and 2015, and all of them were protected by a little-known 1992 law called the Mammography Quality Standards Act, or MQSA. Understanding this law is important for radiologists and referring physicians alike, so they can explain it to assure patients that their care meets strict standards of quality. This increases trust between patients and health care providers, ultimately leading to better outcomes.

 

So what does the MQSA do, exactly? The short answer is that it requires diagnostic imaging providers to produce mammogram images that meet high standards of quality. For a longer, more in-depth answer, we need to look back at the years before Congress passed the law, to a time when breast cancer was “the most compelling health threat to American women,” as a 1993 article in the American Journal of Law & Medicine states.

 

(Though breast cancer rates have been decreasing since 2000, one in 8 women in the U.S. will still develop the illness in 2018. More than 40,000 American women are expected to lose their lives to breast cancer that year.)

 

In the early 1990s, the American College of Radiology maintained a set of accreditation standards that required monitoring for mammography equipment and staff qualifications. But those guidelines, strict though they were, were entirely voluntary. And as Dr. Charles Smart of the National Cancer Institute told Newsday in 1991, “Unless mammography is done with quality, there is no use doing it…It isn’t enough to get a woman to get a mammogram. It has to be a good mammogram. And it has to be interpreted by someone who is experienced and trained in it.”

 

That wasn’t always the case at the time. The Physician Insurers Association of America studied the efficacy of mammograms in the early 1990s and found that 35 percent of women with breast cancer actually had negative results on their mammograms. Another study found that image quality and radiation exposure differed greatly from one diagnostic imaging provider to the next.

 

By 1992, the effects of this lack of quality had gained the attention of Congress. They acted to pass a bill that would require all diagnostic imaging facilities that conduct mammograms to meet certain standards of quality and to be issued a certificate from the Secretary of Health and Human Services: The Mammography Quality Standards Act of 1992.

 

What the Mammography Quality Standards Act Requires from Imaging Providers

 

In order to obtain a certificate, diagnostic imaging providers must meet a distinct set of standards, including, in part:  

 

  • They must pass a review of their clinical images at least every three years.

 

  • These images will comprise a random sample and must be inspected by qualified physicians.

 

  • These reviewers must not have a conflict of interest with the sites they inspect.

 

  • In addition to the review of images, facilities must pass an annual survey conducted by a medical physicist.

 

  • All personnel involved in the preparation and reporting of a mammogram must be certified by the Secretary of Health and Human Services.  

 

A major component of retaining accreditation is the quality of mammogram images themselves. Certified MQSA review physicians carefully inspect a representative range of a mammogram-provider’s images. They score these images based on the quality of at least eight criteria:

 

  1. Correct positioning, such that the chance of missing signs of cancer are reduced.
  2. Adequate compression that avoids conflating motion artifacts and actual tissues.
  3. Perfect exposure; neither underexposed nor overexposed.  
  4. There must be enough contrast between light and dark to easily show subtle differences in tissue density.
  5. The image must be sharp, not blurry.
  6. A minimum of visual “noise,” or visible artifacts from the imaging process.
  7. No processing artifacts, such as scratches or lint, may be allowed to obscure the structures of the breast.
  8. All images must include identification and other exam details.  

 

The U.S. Food and Drug Administration oversees the MQSA program, and has approved a small group of organizations as “accreditation bodies,” or entities that can legally provide the accreditation necessary for conducting mammography procedures. The American College of Radiology is the main accreditation body under the MQSA, but the states of Arkansas, Iowa, and Texas can also provide credentials for facilities located within their borders.

 

The Costs of Failing to Comply with MQSA

 

All diagnostic imaging providers that offer mammograms must comply with the quality standards set forth under the MQSA. If they violate any part of the standards, the Secretary of Health and Human Services might issue any of a series of corrective actions, including:

 

  • Providing a plan and a timeline for the facility to correct its violation.
  • The Secretary may order on-site monitoring at the facility’s cost.
  • In egregious cases, the Secretary may order the violator to send notifications to all of their patients, explaining the situation.
  • For certain violations, the Secretary can issue a fine of up to $10,000.

 

Ultimately, violating MQSA regulations can shutter a business in two ways. The accrediting body, such as the ACR, could withdraw a facility’s accreditation. Or the Secretary of Health and Human Services can revoke the certificate. Owners and operators of facilities that lose their certificates may even be banned from offering mammograms for two years.  

 

How Effective is MQSA at Improving the Quality of Mammograms?

 

As of the latest report, 8,726 facilities were certified to perform mammograms in the United States, not including VA hospitals. Inspections turned up no violations for 88.5 of these providers.

 

Patients who are new to mammography may be encouraged to learn that nearly 90 percent of the mammogram providers in the country meet the strict standards of quality required by the MQSA. To learn more about the Mammography Quality Standards Act, see the FDA’s website about the program here.

mri-pacemaker

MRI Scans, Pacemakers, and Implantable Cardioverter-Defibrillators: New Safety Evidence

Patients with pacemakers and implantable cardioverter-defibrillators (ICDs) may safely receive magnetic resonance imaging (MRI) testing according to a study from the New England Journal of Medicine. Currently, implanted devices must meet the Food and Drug Administration’s criteria to be considered MRI-conditional. The pacemakers and ICDs that do not meet these requirements are considered legacy devices, and the federal government considers them unsafe for MRI scans. However, the new study proves that, with adherence to protocols, patients with legacy devices can safely receive MRI scans.

 

The study followed over 1500 patients with implanted devices.

 

The prospective, nonrandomized study followed 875 patients with pacemakers and 634 with ICDs. All patients had implanted devices that were considered legacy devices —  that is, they did not meet the requirements of the Centers for Medicare & Medicaid Services (CMS). Researchers from the University of Pennsylvania performed MRIs on the patients only when it was deemed clinically necessary.

 

The scans were done under strict protocols with physicians on hand to monitor patients. Tachyarrhythmia functions were disabled on the machines and pacing modes were appropriately adjusted on the devices.

 

“We found MRI examinations to be safe in the setting of legacy cardiac pacemakers or ICD systems, when using a safety protocol,” lead study author and University of Pennsylvania professor Saman Nazarian told Cardiovascular Business. “The scans were safely performed even when performing thoracic or cardiac MRI and with patients that were dependent on cardiac pacing for every heartbeat.”

 

A previous study from MagnaSafe found similar results for non-thoracic scans.

 

The MagnaSafe Registry is a multi-center study attempting to determine how safe MRIs are for patients with pacemakers and ICDs. They published findings several years ago that upended the traditional view that MRIs were too dangerous for patients with legacy devices. With similar results to Nazarian’s study, MagnaSafe found that there were almost no clinically relevant problems caused by the scan.

 

This is hugely important because many people with legacy implants are denied MRI scans by Medicare and Medicaid. While doctors may then order computed tomography (CT) scans, MRIs are better at diagnosing certain diseases, particularly in the brain and spinal cord. Nazarian said that if a patient with a legacy device needs an MRI, they should contact a medical center that can safely conduct the scan.

 

“Many centers across the U.S. are capable of performing safe imaging despite your device,” Nazarian said to Cardiovascular Business. “MRI can be instrumental in providing the right data for appropriate treatment planning in the setting of many neurologic, cardiac and musculoskeletal disorders as well as malignancies.”

 

The results from the two studies offer compelling evidence that MR technology is safe for those with implanted legacy devices.

 

According to Robert Russo, a doctor in the MagnaSafe study, more than half of patients with implanted devices will eventually need an MRI. Replacement with an MRI-conditional device is not an option, as the complication risks are too high. Therefore, it’s important to determine the safety of MRI scanning for patients with these legacy devices.

 

The above studies show how MRIs pose minimal risks while bestowing life-saving advantages for those who need scans. The FDA and CMS have not changed their regulations in light of the findings, but the evidence is mounting that they should consider doing so.

 

References:

 

Getting an MRI if you have a pacemaker. Harvard Health Publishing. August 2015;Web. Available from: https://www.health.harvard.edu/heart-health/getting-an-mri-if-you-have-a-pacemaker

 

Nazarian S et. al. Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices. The New England Journal of Medicine. December 2017;377:2555-2564. doi:10.1056/NEJMoa1604267

 

Slachta A. MRIs proven safe for patients with with FDA-unapproved implantable devices. Cardiovascular Business. January 2018;Web. Available from: http://www.cardiovascularbusiness.com/topics/electrophysiology-arrhythmia/mris-proven-safe-patients-fda-unapproved-implantable-devices

 

TIA-MRI

MRI Scans and Transient Ischemic Attack (Mini-Strokes): Timeliness Makes a Difference

29 Jan 2018 Uncategorized

A transient ischemic attack (TIA) or commonly referred to as a mini-stroke has traditionally been regarded as a minor and temporary condition, but timely MRIs have proven that these events belong on the same spectrum as strokes. However, because TIAs, by definition, only last a short time, MR imaging must take place as quickly as possible for the fullest yield of useful information.

 

There is now a consensus that having a TIA increases a person’s risk of a stroke.

 

Approximately one in six people who survive a TIA suffer a stroke within 90 days. Undergoing an MRI as soon as possible after a TIA can detect crucial warning signs that computed tomography (CT) alone cannot see.

 

Previous consensus guidelines from the American Heart Association (AHA) do not recommend MRI for all TIA patients because of the higher cost. However, mounting evidence suggests that an MRI within 1 to 2 days of a TIA could spot evidence of a stroke that may disappear in time.

 

MRIs can detect tissue damage even when symptoms are temporary.

 

The sophisticated imaging technique can detect stroke lesions that may become less apparent quickly. A study from the journal Stroke followed 263 patients who had suffered a TIA or minor stroke and received a baseline MRI within 24 hours. After 90 days, a follow-up MRI was conducted.

 

The results of each patient’s two MRIs were assessed independently and the results confirm the importance of early scans. Thirty percent of patients with a negative scan at 90 days had a clearly identifiable stroke in the baseline image. Without the early scan, physicians would not know that a stroke had occurred in this large group of patients.

 

In spite of this evidence, some physicians settle for a less-precise CT scan. A recent study from Neurology found that just 40 percent of patients with TIA or minor stroke had an MRI performed within 48 hours.

 

New guidelines offer options for those at high-risk of stroke.

 

The AHA and American Stroke Association have published new consensus guidelines for preventing strokes in patients with a history of strokes or TIA. Reducing hypertension and statin therapy remain at the top of the list. Increasing physical activity, reducing sodium intake, and following a Mediterranean-style diet (as opposed to a low-fat diet) are recommended. Other practices, such as sleep assessments and anti-platelet therapy immediately following a TIA may be considered.

 

For patients with a history of stroke or TIA, the average annual rate of future stroke is at an all-time low. That’s great news, but a more nuanced understanding of TIAs and timely MRI of those who suffer them could yield even more impressive results.

 

References:

 

AHA and ASA Release Guideline for Prevention of Future Stroke in Patients with Stroke or TIA. American Family Physician. January 2015;91(2):136-137. Available from: https://www.aafp.org/afp/2015/0115/p136.html

 

Chaturvedi S et al. Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke? Neurology. January 2017;88(3):237-244. doi:10.1212/WNL.0000000000003503

 

Krieger D. Should patients with TIAs be hospitalized? Cleveland Clinic Journal of Medicine. August 2005;72(8):722-724. Available from: http://www.clevelandclinicmeded.com/medicalpubs/ccjm/august2005/krieger.htm

 

Moreau F et al. Early Magnetic Resonance Imaging in Transient Ischemic Attack and Minor Stroke: Do it or Lose it. Stroke. March 2013;44(3)671-674. doi:10.1161/STROKEAHA.111.680033

 

The MRI Procedure in 10 Steps: Managing Patient Anxiety Through Information

10 Jan 2018 Health Care, Medical, MRI

 

A first-time MRI procedure can make patients nervous, even to the point of ending the scan. That can lead to higher costs for imaging centers, and even affect patient outcomes if the anxiety interferes with the quality of the radiology report. Research shows one simple way to help nervous patients get through their scans without interruption: Communication.

 

A 2015 study in the journal Magnetic Resonance Imaging tested an intervention in which imaging staff explained the MRI process to one group of patients. They took blood samples during the scans, later testing them for the stress hormones prolactin and cortisol. Additionally, they took both the experimental and control groups through the 40-questions State-Trait Anxiety Inventory to measure patient nervousness.

 

The patients who had the intervention in which staff verbally shared information about the scan showed a 6-percent drop in cortisol after the scan. The control group’s cortisol levels increased by 18 percent. The authors of the study conclude that “MRI anxiety can be reduced by information and communication. This combined method is shown to be effective and should be used during daily radiology routine.”

 

So what can physicians do to prepare their patients for a first MRI scan in advance? It’s never too early to start educating patients about what they can expect during a health procedure. And the MRI process can be boiled down into 10, easy-to-grasp steps. Share these steps with patients to help limit anxiety during an MRI scan:

 

  1. First, radiology staff will walk the patient through a detailed screening process. Because of the strong magnetic field generated during an MRI, patients must report any medical implants or metal particles in their bodies. These may preclude the use of MRI imaging. 
  2. Once the patient clears the screening, staff will lead them into the MRI suite. Some imaging facilities offer hospital robes, to ensure there’s no metal in the patient’s clothing. Others allow patients to wear their own metal-free clothes, such as sweat pants and a T-shirt. The technologist will proceed to position the patient on the table; most commonly, patients lie on their backs. If the scan requires an additional radiofrequency coil, the technologist will place that on the patient’s body at this time.

  3. The patient enters the bore. Meanwhile, technologists cycle through a list of pre-programmed settings called “protocols.” They’ll choose the protocol that corresponds with the body part they are imaging; this will tell the MRI machine which angles, targets, and pulse sequences to use in this particular procedure.

  4. Before the scan proper begins, technologists run a “scout” or “localizer” scan. This is a low-quality image, and it won’t be used in reporting. However, localizer scans obtain visual and placement information that the computer will used to plan the angles of its imaging later in the process.

  5. Parallel imaging is a process designed to speed up scan time. It collects less raw data during the scan, and patches missing information using special algorithms to generate the final image. Parallel imaging requires specifically calibrated coils, and may call for a calibration scan at this point.

  6. One of the great strengths of MRI scans is that they create 3D images that can be viewed from any angle. The next step is to program in the angle of images for the radiologist. Technologists can change the “thickness” of the image at this point, as well.

  7. Before the scanner can begin collecting valuable images, it must calibrate all systems through the use of a prescan. This shouldn’t take much more than 10 or 20 seconds.

  8. It is only at this relatively late stage in the process that the technologist actually runs the scan. They will make necessary adjustments and continue scanning according to the chosen protocol. In the end, they’ll have clear, accurate images that radiologists will use in their reporting.

  9. Some types of images require extra work in post-production, but this can be done after the patient has left the MRI suite.

  10. Scanning complete, the technologist pulls the patient from the bore. Different types of scans take varying lengths of time, but most range between 20 and 60 minutes.      

 

When patients understand more about their medical procedures, and know what to expect, they’re less likely to experience significant anxiety. That’s both a value in itself — as patient-centered caregivers, staff at Precise Imaging works to keep patients comfortable, both physically and emotionally — and an element of better diagnoses, which lead to better patient outcomes.

 

To learn more about an MRI procedure from Precise Imaging, or to refer a patient, call us at 800-558-2223.  

 

References:

 

Deshmane A, Gulani V, Griswold MA, Seiberlich N. Parallel MR imaging. Journal of Magnetic Resonance Imaging: JMRI. 2012;36(1):55-72. doi:10.1002/jmri.23639

 

Elster AD. “Performing an MR Scan.” MRIQuestions.com. 2017. Web. Jan. 8 2018.

 

Tazegul G, Etcioglu E, Yildiz F, Tuney D. Can MRI related patient anxiety be prevented? Magnetic Resonance Imaging. 2015;33(1):180-3. doi:10.1016/j.mri.2014.08.024

 

Insurers Demand Independent Imaging Centers: What Physicians Should Tell Patients

Independent imaging centers are moving to the forefront of diagnostic care in the United States. Recently, at least one major health insurer dropped coverage for CT and MRI scans at hospital radiology facilities. The insurance company will only pay for these scans when patients visit providers who specialize in diagnostic imaging, and imaging alone.

 

How will this change the conversation between referring physicians and their patients? In order to explain the changes — why insurers would make a rule like this, and why it’s not at all a bad change for patient care — physicians need only look at two key metrics of today’s health care system: price and quality.

 

The Price Difference Between Hospitals and Independent Imaging Centers

 

When an insurance company makes a move like this, it’s a clear indication that there’s a wide price differential that’s not necessarily associated with a difference in quality of care. Research from the Healthcare Financial Management Association — a professional organization for people who work on the financial side of the health care industry — shows that prices at hospitals are, in fact, dramatically higher than those at the average free-standing imaging provider. Among other differences, the HFMA found:

 

  • MRI scans cost an average of 70 percent more at hospitals than at independent imaging centers.
  • When those MRI scans covered the head and/or neck, they were an average of 80 percent more expensive in hospital-owned facilities.
  • The differences were even more stark for CT scans. Imaging of the body using CT cost 135 percent more at hospitals.
  • For CT scans of the head and/or neck, patients paid an average of 149 percent more at hospitals than at free-standing imaging facilities.

 

This research was published in 2017, though most of its data came from 2014. Either way, price gaps remains.

 

Measuring the Quality of Diagnostic Imaging Providers

 

Patients are used to associating higher prices with better service. In health care, however, quality and cost are independent of one another. The United States has the most expensive health care in the world.

 

In 2014, U.S. health care spending per capita was $9,237. That year the United Kingdom spent $3,749 per person while Japan’s figure stood at $3,816. Still, among the 12 wealthiest industrialized nations — including Japan and the UK — the United States lands dead last in terms of life expectancy.

 

Clearly, spending more does not buy better care in this country. In fact, independent imaging centers offer measures of quality, in terms of better patient experience, that most hospitals cannot boast. At Precise Imaging, these include:

 

  • Evening and weekend hours to work around the patient’s schedule, not the other way around.
  • Excellent, board-certified radiologists and technicians, often the same ones hospitals use, at a drastically reduced cost.
  • Quick reporting with HIPAA-compliant online sharing with referring physicians. Most doctors are reading radiology reports within 24 hours of the scan.
  • Same-day scheduling.  
  • Transparent pricing.

 

There have been plenty of good reasons to refer patients to a free-standing imaging facility for years. Now that insurers are refusing to support the arbitrary and inflated costs that hospitals charge, more and more patients will be able to experience the care that Precise Imaging provides.

 

The Expanding Use of MRI in Personal Injury Law

 

Personal injury attorneys have relied on MRI scans to bolster their clients’ claims for years, but the role of this crucial technology may soon grow dramatically. As a diagnostic imaging modality, MRI is ideal for recording soft tissue injuries, including disc protrusions and herniations and muscle tears. But even perfect documentation of these injuries doesn’t necessarily prove a devastating type of affliction that’s all too common, and often difficult to demonstrate: chronic pain.

 

Pain is a subjective sensation. One person’s agony might be another’s slight discomfort, and defense attorneys have a history of leaning on this subjectivity to reduce damages. Meanwhile, though, patients’ lives can be destroyed; ravaged by pain, they might not be able to work, or even perform daily tasks of living. A fair settlement might be the only thing that stands between them and utter destitution.

 

But how can an MRI scan document pain? Neuroscientists say they’re right on the verge of an answer.

 

Using MRI Technology to Track Pain’s Pathways in the Brain

 

A specialized type of MRI scan, functional magnetic resonance imaging, or fMRI, measures blood flow within the brain. When a certain region of the brain activates, cerebral blood flow in that area increases. The fMRI tracks these changes.

 

Brain mapping allows neuroscientists to associated certain areas of the human brain with general functional experiences within the thinker — including, perhaps, the thinker’s experience of pain. If an attorney could demonstrate that a client’s brain activity is consistent with chronic pain, that could be enough to sway the judge. However, we’re not quite ready to break out the fMRI scans in tomorrow’s personal injury case.

 

Hurdles in the Use of fMRI Scans for Personal Injury Cases

 

Neuroscientists are still debating the reliability of fMRI to demonstrate chronic pain. Most of the studies involving pain and brain mapping have been conducted on acute pain, not the chronic variety. Some scientists argue that patients could “cheat” the scan, imagining a greater-than-baseline intensity of pain.  

 

The science behind demonstrating pain with fMRI scans isn’t quite up to courtroom standards yet, but it’s close, and it’s getting closer. With every new study on the subject, fMRI technology inches toward a future in which pain is as visible as a broken arm in an X-ray.

 

Meanwhile, standard MRI scans continue to be an important element in many personal injury cases. This technology has changed the way personal injury law functions, and it appears it will continue to do so in a broader range of cases soon.  

 

References:

 

Cherniak, Todd. “Litigation MRI: Why lawyers are asking for it and why your patients need it.BCMJ. British Columbia Medical Journal, Sept. 2005. Web. 20 Dec. 2017.

 

Davis, Kevin. “Personal injury lawyers turn to neuroscience to back claims of chronic pain.ABAJournal. American Bar Association, Mar. 2016. Web. 20 Dec. 2017.

 

Geddess, Linda. “Human brain mapped in unprecedented detail.Nature. Macmillan Publishers Limited, 20 July 2016. Web. 20 Dec. 2017.   

 

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