How Why When Doctors use Xrays,MRI, and CT's in healhcare - Research Paper Example

? How, When, Why do Doctors Use MRIs, X-Rays, and CT Scans This paper will go into depth about the reasoning as to why, when, and how doctors use MRI, X-Rays, and CT scans to help with their diagnosis and treatment of their patients. Furthermore, this paper will also look at the pros and cons of why one should be used over another and if they are really relevant to the treatment of patients in today’s society. Keywords: MRI, CT, X-Rays, doctor, patient Table of Contents Abstract 2 Table of Contents 3 Introduction 4 Literature Review 5 Cervical Spine Fracture 5 MRI, CT, PET Scans… 5 MRI Shows What? 5 Computed Tomography 6 Thermography 6 Why Doctors Order Too Many Tests 7 Carpal Tunnel Syndrome 7 Discussion 8 X-Rays 8 CT Scan 9 MRI 11 Combination 12 Summary Recommendations References Introduction Fairly common things for doctor’s to order to help diagnose patients are located in the radiology department. Most hospitals have an outpatient radiology department or imaging center as some hospitals call them. Some hospital chains, even branch out their outpatient imaging departments from the hospitals into more neighborhoods so they can be closer to their affiliated doctors. Located within these imaging centers are the most common imaging tests: CT scans, MRIs, and X-Rays. Occasionally, the imaging centers may include mammograms and PET scans, but those are usually not located in those imaging center. This paper will show the reader how, when, why a CT scan, an MRI, or an X-Ray is ordered for a patient. This paper will also go on to explain the benefits of each type of test and whether or not it is the right test for the person involved. Also, this paper will show in the recommendations area what possible alternatives to the CT, MRI, and X-Ray are located out there and whether or not they might be good enough to replace the other test. Literature Review Clinical Examination & its Reliability in Identifying Cervical Spine Fracture.  To sum up this work by Therese M Duane, MD, Tracey Dechert, MD, Luke .G Wolfe, MS, Micahel B Aboutanos, MD, MPH, Ajai K. Malhotra, MD, and Rao R. Ivatury, MD, they determined that in this article that clinical examinations cannot be depended upon to rule c-spine damage. Furthermore, it was also noted by Dr. Duane that the study was efficacious since together they did not handle the study very well with the use of the CT scanner. Especially since, they did not set it sensitive enough to get the results that they were looking for. In the end they realized that they needed to put forth more effort when examining the patient to know exactly how to better results when treating the patient. MRI, CT, & PET Scans… This article by Kim Fowler, from WQMag.com, tells the reader the differences between a CT scan, a PET scan, and an MRI. Furthermore, it goes on to discuss why doctors would possibly order some of the scans to be done and what would work best with either a CT, PET, or MRI. What Does An Mri Show? This article from Dr. Henley’s website tells the reader what MRI stands for. Then it goes on to explain how an MRI is able to scan the body and what it really shows the doctors. Furthermore, this article goes on to explain the difference between an MRI and an X-Ray. The next topic discussed in this article is why a doctor may order an MRI. The article, then, goes on to give some highpoints about MRIs. From there, the article continues on to whether or not a patient needs an MRI. Next, comes a discussion about claustrophobia and MRIs. And, lastly, finishes with a note letting patients know that every MRI scanner is different. Computed Tomography The International Atomic Energy Agency (IAEA) gives the reader a pretty good break down of a CT scan. From what it is to how much radiation that it gives off to whether or not it is unsafe to whether or not a pregnant woman should be able to have one performed (not all radiology departments will perform CT scans on pregnant or potentially pregnant women) and whether or not a parent should have any concerns when their child is prescribed a CT scan by their doctors. Thermography This article talks about a new alternative to the usually scanning techniques of mammograms, CT scans, MRIs, PET scans, and X-Rays. It shows us that the radiation can be harmful to our body, but Thermography machines use an infrared thermal scanning system which allows imaging of the damaged areas of the body from arthritis to back pain to toothaches to nerve damage, etc. to show up on the thermal scan as either red or white spots. Thus, it can give the doctors a better idea without irradiating a person where the patient should be treated and how to go about that treatment. It’s relatively new, so it is not in many place right now. Why Doctors Order Too Many Tests This article shows the reader that a lot of doctors truly believe that they are trying to stay away from the lawsuit which is why they are ordering the test that will help their patients out. They are using the old adage: ‘Better safe than sorry.’ And that sorry for them, is money coming out of their pocketbooks and into their patients’ wallets. But, it does also give an insight into the future generation of doctors who believe that they are not ordering the tests to make money or to be careful, but they are ordering the tests as a way to collect all the pertinent information they can to help in the diagnosis of the patient. Carpal Tunnel Syndrome- Diagnosis This article is rather simplistic. It breaks down what carpal tunnel syndrome is, what the symptoms are, ruling out of other underlying medical conditions, similar conditions to carpal tunnel syndrome, and different imaging techniques used to diagnose carpal tunnel syndrome. Discussion Imaging Centers are big business for the hospitals and hospital systems which they represent. The imaging centers which bring in the higher amount of dollars into their hospital or hospital system are usually outpatient. These outpatient imaging centers usually have four main types of radiological tests located within: X-Rays, CT Scans, MRIs, and Ultrasounds. Each of these tests have their own particular uses and are such ordered by the doctors to help in the diagnosis of their patient. X-Rays, CTs, and MRIs will be looked at in length in this paper. These tests will be shown as to what they are ordered to help diagnose and what the strengths and weaknesses of each particular test are. X-Rays It’s pretty obvious that most of the imaging centers would not be inexistence without the advent of the X-Ray back in the early 1900s during the First World War by Pierre and Marie Curie, both of whom later died of radiation poisoning. This test sprays the patient with a small dose of radiation to get a picture of the inside of the person. Of all the imaging tests, this is the most well known to everyone. X-Rays are not ordered as much as they used to be by doctors. Multiple pictures at multiple angles must be taken by the techs to gather the information for the doctors to look at. A patient usually will have to four or more X-Rays pictures taken in order for the entire area needing to be scanned can be appropriately looked at. And an X-Ray only takes a few second to be scanned. Furthermore, if an are of the body doesn’t contain any bone or something which contains calcium, it will not show up very well upon an x-ray. Thus, soft tissue parts like muscle and skin show up as gray shadows upon a plain x-ray. This allows for a harder or more calcified object to show up better and, therefore, x-rays are very useful for looking at shapes and positions of the bones within the human body. (Henley) X-rays, for the most part, are ordered to see if there is something wrong with bones or tendons within the human body. It allows, quickly and easily, for a doctor to determine whether or not a person has a fracture of any sort upon their body. However, with medical technology increasing, the X-Ray is being used less and less. Other, more efficient ways of scanning the body are being used by doctors, almost eliminating the need for the X-Ray machine anymore. With the increase of medical technology, who knows how much longer the X-Ray machine will be in use. But once, it is gone, will there be something better that will replace it or improve upon the basic use of the X-Ray machine. Only time will tell whether or not medical technology will bring about these changes. X-Rays still provide a quick look for doctors to check out their patient and the tests are relatively inexpensive compared to the other imaging tests available to the doctors to order. One test that seems to be a takeoff of the X-Ray, or rather a vast improvement upon the X-Ray is the CT Scan. CT Scan CT is short for Computed Tomography. At one time the CT scan was known as the CAT, or Computed Axial Tomography. The CT scan is an improvement upon the X-Ray. Instead of having to turn your body in various directions for the x-ray to scan a person, the scanner, instead, shoots beams of radiation around the body of the entire person. Thus, this allows for the scan to be taken without the patient ever having to move. But, the amount of radiation going into the patient’s body is higher than that of the X-ray. Where the X-ray uses a minimal dose of radiation of provide the scans needed for the doctor, the CT scan uses a higher dose to provide a more detailed and accurate scan of the patient for the doctor in order to help diagnose the patient. Also, CTs are useful for “diagnosing bone disorders such as tumors and fractures, cancer or heart disease, and internal injuries.” (Fowler 2009) Although, some people say that using a CT scan on a pregnant woman may not harm the unborn child, most imaging centers are very reluctant to even take the chance of a pregnant woman having a miscarriage due to the radiation produced by the CT scan. Most imaging centers would recommend that the patient return after the child is born for the CT scan to complete the CT scan. One of the benefits that have arisen from CT scans being available is the lowered amount of exploratory surgeries due to being able to see what is going on in the patient’s body before ever putting a scalpel to the skin to cut it open. Thus, the CT scan has almost become mandatory by surgeons to allow them to know where they will be cutting into the patient without making any mistakes. Without the surgeons making as many mistakes, they may still make a few every now and then, it will be a quicker recovery for the patient and a less likelihood for a malpractice suit befalling the surgeon. Even with all of these benefits that the CT scans provide the doctors, it is still possible that the doctors who look over the CT scans may have to order other imaging tests to gather more detailed information since the CT scan was unable to provide everything that were looking for. Thus, the next option, or test which seems to be an upgrade upon the CT scan is the MRI. MRI The MRI, short for Magnetic Resonating Image, is readily available for the doctors at outpatient imaging centers. This test does take longer than the X-Ray scan or the CT scan. Usually, an MRI averages about two hours per test from start to finish. The MRI does not produce any radiation that is shot into the body. However, before an MRI can be performed upon a patient, that patient must disclose whether or not that there is any metal within their body, whether or not that it is in a tattoo, an implant, body piercings, or shrapnel. Once the pre-test screening is over with and it is decided that everything is okay to proceed, the patient is place on a table that will slide into a huge tube that surrounds the patient. All around the patient, in the MRI are huge magnets which will be used to pull information from the body to be digitized into a scan that will detail the body parts separately from one another. An MRI shows a clearer contrast amongst different kinds of tissue where an x-ray shows the difference between bone and tissue. (Fowler 2009) Some of the reasons a doctor will order an MRI is to determine the exact damage to areas of the body that are made of different types of tissue, such as cartilage, tendons, muscle, fat, and nerves. (Henley) One of the more common injuries of this day and age of the technological revolution is also leading to more and more MRIs being ordered. Carpal Tunnel Syndrome and other repetitive injury disorders, such as De Quervain's Tenosynovitis (an injury of the tendon at the thumb), are leading to the rise of MRI usage by doctors if it gets too bad for the patient. (Simon 2009) This will allow for the doctor to determine whether or not surgery is actually required or just how they will go about the surgery as to allow for the patient to have the quickest recovery possible. Combination And in the event that one test cannot provide enough information, there is always the possibility that the doctor will order a combination of these tests to get all of the information that they can to provide the best possible diagnosis to their patient’s situation. A combination of these test can be very expensive and time consuming for the patient and their relatives. Some of the tests may require that the patient not have anything to eat or drink for a specified period of time so that they may get the most accurate reading possible. For example, a patient goes into the doctor complaining of his arm hurting around the shoulder, and after a short physical the doctor comes up baffled. The doctor, then, decides to order a round of tests to determine whether or not that it is the joint hurting the patient, or possibly a fracture, or it could be something worse like a tear of the tendon or muscle and it may need surgery. So the doctor orders both a CT scan and an MRI. The CT scan comes back inconclusive as to what is exactly bother the patient, but the MRI shows the doctor that there is a tear in the muscle. The doctor, then, notifies the patient that surgery will be required so he preps the patient as to what the patient will need to expect in the ways of rehabilitation after the surgery. With the combination of these two particular tests, the doctor was able to help his patient get the treatment that eventually helped him gain pain free use back into his arm months later. As one can see, whether a test is a CT scan, an MRI, or an x-ray, one is not really better than the other. Each has their uses in providing information to the doctor. Summary Whether a doctor orders an x-ray, a CT, or an MRI, they have a reason and are looking for something very specific. Each test has its benefits and its detractions. Although an MRI can differentiate amongst different groups of tissues, it does go below the tissue membrane to the bone. You will not see any bones show up on an MRI. However, bones show up quite clearly upon CTs and X-rays. CTs, in all actuality, are just really an improvement upon X-rays. As time goes on, what one test was used for is now being tested for through another way. For example, CTs in the past were used to scan for seizures of the brain. Nowadays, scan of the brain for seizures have moved over to the MRI test. Also, doctors are using the imaging centers as a way of gaining information on their patient for better diagnosis before even being a full treatment panel. Some of the older doctors are calling this the “better safe than sorry” policy, while the new generation of doctors are calling this a tool for implementation that will better serve my patient in a way that will improve their health and help them to live a longer more productive life. Recommendations There are many recommendations that I can see from reading over this information. Too many doctors are relying on scans of their patients that may not be necessary to obtain the same information. It seems that a lot of doctors are in the fast food medicine style of treating patients. The fast food method refers to bringing the patient into the office and getting them out of the office with a prescription to either get medicine or to get an outpatient imaging scan performed. However, it is very possible that the patient may not need any of the above to be treated properly. But what most doctors really need to do is sit down with their patients, go over their symptoms and discuss what type of treatment they think is best for the patient and allow for the patient to make the overall decision on whether or not to agree with the doctor’s assessment of the patient’s situation. But, will this change anytime soon? That is not a very likely outcome. Doctors are being trained in a fast food style of medicine. However, there are some doctors in private practice who this style works and they are able to provide proper care for their patients because they have the information in their recollection and experience that allows them to quickly assess their patient’s situation and give them a solution to their problem. Furthermore, there are even new tests out there that could replace CT scans and x-rays by not even using radiation. There is a new technology called Themography, which could possibly replace CTs and x-rays in the future. Basically, what is being done, is a person is have a thermal scan of their entire body and any part of the body which is inflamed or causing pain will show up as either a red or white spot on the infrared spectrum. Will this test be fiscally feasible, right now that is not very possible with the technology being so new. In the future, however, it is possible. Thermography could eventually be something that will improve the treatment of patients in the future. But what the future of medical technology is not certain. There will eventually be something out there which will replace x-rays an CTs without pouring radiation into the human body. References Duane, MD, T. M., Dechert, MD, T., Wolfe, MS, L. G., Aboutanos, MD, MPH, M. B., Malhotra, MD, A. K., & Ivatury, MD, R. R. (2007). Clinical Examination & its Reliability in Identifying Cervical Spine Fracture. Journal of Trauma, 62(6), 1405-1410. DOI: 10.1097/TA.0b013e31804798d Fowler, K. (2009, September 20). MRI, CT, & PET Scans.. [Web log message]. Retrieved from http://www.wqmagonline.com/forum/topic/show?id=2298959:Topic:57184 Henley, MD, C. N. (n.d.) What Does An Mri Show? [Web log message]. Retrieved from http://www.noelhenley.com/447/what-does-an-mri-show/ IAEA.org. (n.d.). Computed Tomography. Retrieved from https://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/Patients/patient-information-computed-tomography/index.htm Mercola, MD, J. (n.d.)."Revolutionary and Safe Diagnostic Tool Detects Hidden Inflammation: Thermography". Retrieved from http://naturalhealthcenter.mercola.com/services/thermography.aspx Pines, MD, J. M. & Meisel, MD, Z. F. (2011, February 25). Why doctors order too many tests (it's not just to avoid lawsuits) Retrieved from http://www.time.com/time/health/article/0,8599,2053354,00.html Simon, MD, H. (2009). Carpal tunnel syndrome- diagnosis. Informally published manuscript, Medical Center, University of Maryland Medical Center, Baltimore, Maryland. Retrieved from http://www.umm.edu/patiented/articles/how_carpal_tunnel_syndrome_diagnosed_000034_7.htm Read More