MRI or magnetic resonance imaging is an advanced test that uses a strong magnetic field and radio waves to create pictures of organs inside the body. It is among one of the most sophisticated diagnosis tool available to the physicians. An MRI scan is often quite helpful in analyzing following type of conditions or injuries.
- Sports injuries involving soft tissues such as cartilage, ligament
- Spinal conditions and injuries
- Other musculoskeletal problems
- Brain ailments including tumor, dementia
- Few gastrointestinal tract conditions
- Vascular conditions i.e. issues related to blood supply
- Prostate problems
- Pelvic area problems
- ENT-related conditions
With regards to muscle or bone related issues, physicians may sometimes suggest a person to undergo an MRI scan. Given that an MRI scan is a costly diagnostic procedure, expert physicians would not advise patients to undergo an MRI scan as the very first test to diagnose their illness. Patients too should be aware when MRI may be overkill, or when it can be most useful. If required, getting a second opinion from another expert may be more cost-effective.
Is MRI getting overused?
A study carried out in the United States found that of all the patient visits to their primary care physician, nearly 17% reported having a primary complaint of knee pain.  Primary care physicians in the United States are the first line of doctors, whom patient visits for almost any health related issue. Only when the primary doctor ascertains that a specialist service is needed, a referral is provided for the same. Without such a referral, an insurance company would refuse to entertain a patient’s request to see a specialist such as an orthopedist or orthopedic surgeon.
Above study found that in comparison to the specialists, primary care providers were more likely to recommend an MRI scan. It was found that nearly 40% of patients first evaluated by primary care physicians underwent an MRI scan, which was four times higher compared to when a specialist first saw the patient. Similar studies like the above have also demonstrated that a specialist would have ordered only 12% of the MRI scans suggested by the primary care physicians. 
A specialist was much more likely to assess the illness by giving more attention to the clinical history, a preliminary knee examination and by relying on diagnosis using the knee x-ray, before deciding to suggest an MRI scan.
Several possibilities are cited to the reason for a higher percentage of MRI’s suggested by primary care physicians. Subspecialist or generalist doctors require this advanced imaging before giving a referral. At times, patients may also demand the procedure. It is also possible that since the primary physician lacks the orthopedics specific clinical history taking skills, he or she feels more comfortable receiving results from an MRI scan.
MRI is a costly procedure to carry out. According to latest estimates, it can cost an average of $2800 with a low to high range of $1000 – $5000, depending on the type of MRI, such as brain MRI, spinal MRI to name a few. This includes the cost of procedure, radiologist fee, and consumables such as contrast dyes.
In a country like India, the same cost could vary from Rs 3000 – Rs 10,000 based on the type of MRI, type of hospital (private/public) and insurance coverage. Many people in India pay such expenses out of their pocket and can sometimes not afford to have such diagnostic tests carried out unless necessary and when other primary tests have failed to provide clarity on the underlying cause of the pain.
An X-ray is much cheaper compared to the MRI and should constitute the first line of diagnosis. Combined with a clinical history examination, a specialist is highly capable of narrowing down the possible causes and suggesting a suitable line of treatment.
When should MRI not be done?
Since MRI involves the use of an extremely strong magnetic field, MRI is not conducted when a patient has any artificial components in their body such as a cardiac pacemaker, clips in the head such as aneurysm
clips, a cochlear ear implant, a metallic foreign body, had a recent surgery or if the person is pregnant. As much as it is doctor’s responsibility to ask the patient about such possibilities given their medical history, an aware patient should also clearly convey this information to their physician.
Key Take Away
As a patient, one would always want that his or her diagnosis is complete and accurate. However, one should be aware that MRI being a costly diagnostic procedure should not be advised until other options for diagnosis and treatment have been exhausted. An experienced specialist would not normally jump the gun and suggest an MRI scan as the first line of test. Instead, more emphasis would be given to taking a clinical history and understanding your pain pattern. Questions such as how long the pain has been around, what activities aggravate it, which time of the day do you feel it most intense and many others may be asked. An X-ray test may also be suggested. Conservative treatment therapies including physical therapy may also be recommended before suggesting any further diagnosis or advanced treatment. MRI scan makes good sense when the expert feels that clinical history and available X-ray is failing to provide any evidence of the underlying cause of the pain symptom.
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- After the Bone and Joint Decade: It Is Still Time to Educate on the Musculoskeletal System; Kenter, Keith; Journal of Bone and Joint Surgery, Volume 97 (1) – Jan 7, 2015
- Bone and Joint Decade. The burden of musculoskeletal diseases in the United States: prevalence, societal and economic cost. Rosemont, IL: American Academy of Orthopedic Surgeons; 2011
- Use of knee magnetic resonance imaging by primary care physicians in patients aged 40 years and older; Petron DJ, Greis PE, Aoki SK, Black S, Krete D, Sohagia KB, Burks R; Sports Health, 2010 Sep, 2(5):385-90
- Photo Credit: https://www.cedars-sinai.edu
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