MD's, Radiologists, Medical industry folks

[MBAtarga]

When a patient gets an MRI or an Xray - how is the radiologist chosen? Is there a reason for a different radiologist to require the MRI/Xray be taken again?

I had a lumbar MRI and 7 xrays done at a 3rd party location rather than the hospital that the Pain Clinic Dr is affiliated. I've got the MRI images on 1 CD, and the xrays on another.

My pain clinic doctor says the radiologist reports they were provided from that 3rd party are worthless. I can understand their perspective as I was given hard copies of the reports. I'm just an engineer - but when an MRI of the lumber is taken - and I've had an L4/L5 fusion - yet nothing is stated about that fusion - I have my doubts too!

I asked is it possible to get a different radiologist to review the images - and the PA at the pain clinic said that it's unlikely to find another radiologist that wouldn't require the MRI to be taken again. The MRI was just taken 3 weeks ago - is there something about accepted practices that prevents a radiologist from looking at the MRI images off a CD?

I really don't want to go through the time and expense of the MRI and more xrays at a different location just to get a different radiologist to review the images.

My first call Monday is to the 3rd party practice and ask about the radiologist reports and to request something more substantial be provided. Pending that conversation, my next call is to Aetna to see what if anything they can suggest.

[ramonesfreak]

I’m not a doctor but I read MRI reports all day long and have been doing so for almost 30 years. If you had fusion at that level and it is not noted in the report of a lumbar spine MRI something is very wrong since the condition of the hardware should be noted in the impression

Do you have the report? Nevermind, I see you have it

[ramonesfreak]

Personally, I would take the MRI results to the surgeon who should be able to read the MRI to make sure the fusion is ok

[MBAtarga]

To clarify - I'm seeing this Dr at the Pain Clinic because the L4/L5 fusion 2 years ago didn't relieve any of my low back pain. I've since had a TPI as well with little pain relief.

I'm not going back to the lying surgeon that did the fusion.

Do you have any input on the PA stating I've got to get another MRI done in able for a different radiologist to review the images to get a worthwhile report?

[Shifter]

Not a medical professional, just a professional patient.

I would suspect liability is why they don't want to read an older scan. If something changed in the time since your last scan and they base your treatment on the old scan, bad things can happen.

I believe most medical professionals don't want to contradict each other, as that can open the door for lawsuits.

[ramonesfreak]

Nope. Not without reading the report in order to try to understand why the PA said that

If the report does not note the fusion hardware and comment on whether there is a solid union etc, I am wondering if the radiologist mixed you up with someone else? I would think that even a poor MRI image would show the fusion hardware

If you don’t want to go back to the original surgeon the I would try to get a consultation with a different surgeon to review your case

Why do you call the surgeon a lier? Because he promised relief and you have had no relief?

Did you have an MRI done post surgery….maybe 90 days out or 6 months out…to confirm the fusion was a success before being released for work etc…?

Originally Posted by MBAtarga

To clarify - I'm seeing this Dr at the Pain Clinic because the L4/L5 fusion 2 years ago didn't relieve any of my low back pain. I've since had a TPI as well with little pain relief.

I'm not going back to the lying surgeon that did the fusion.

Do you have any input on the PA stating I've got to get another MRI done in able for a different radiologist to review the images to get a worthwhile report?

[Noah930]

I don't know exactly how the billing shakes out (that's the crux of the 'need' for a 2nd study), but there are times when a doctor will have a trusted radiologist re-read a study. I don't know the ins and outs of how the 2nd radiologist bills for the reading, but tertiary care centers (like at a university) will have patients bring in their completed studies so that the university radiologists (who are specialists on that particular sub-field) can re-read them.

[ramonesfreak]

He said the MRI was done 3 weeks ago…that’s not an older scan

And the new MRI should be compared to the prior MRI that would have been done post surgery

Originally Posted by Shifter

Not a medical professional, just a professional patient.

I would suspect liability is why they don't want to read an older scan. If something changed in the time since your last scan and they base your treatment on the old scan, bad things can happen.

I believe most medical professionals don't want to contradict each other, as that can open the door for lawsuits.

[Tobra]

I always want to look at the pictures, not a description of the pictures

3 week old MRI images not good enough, really?

[ramonesfreak]

He said the fusion isn’t mentioned on the report…that’s the first mystery that needs to be solved.

A pain management doctor could likely interpret the films but I would want an ortho or neuro surgeon looking at the films

MBA Can you redact your private info and post the report ?

[Arizona_928]

I had a ct in Phoenix that was beyond worthless… radiologist simply stated for each level “may indicate injury to xyz”. I needed it due to a neurosurgeon i saw couldn’t see the broken pedicle screws in the mri and x ray, and wanted the ct. What’s worse, they didn’t like tricare’s reimbursement rates and tried to come after me for 500 bucks. Called the number on the bill and it was for some foreigners in Vegas… wankers

[pavulon]

That's a big miss. A few things could explain it but that omission is so glaring that it makes all of it questionable. Scans can have incorrect names on them and reports can have wrong names on them. Consider calling the facility where the scan was performed, explain your concern and ask them for reasonable recommendations you find acceptable.

[Dixie]

Originally Posted by MBAtarga

My pain clinic doctor says the radiologist reports they were provided from that 3rd party are worthless.

Could you elaborate on why your doctor said they're worthless? Was he expressing there's no new data he can use, or starting the scan/reading is flawed? If it's the later, surely he ordered new scans?

(It seems to me that radiologists would eschew re-reading scans. Their goal is to provide quality healthcare, not risk becoming embroiled in legal kerfuffles.)

[greglepore]

I'm in the same position as Ramonesfreak, read a gazillion MRI reports doing personal injury law, and agree its worthless. Its entirely possible that the dictation got messed up at the 3rd party practice, or that someone isn't competent. I'd call and ask to speak to the practice manager or show up there and insist on speaking to them. The reports should be reread. While they shouldn't be compensated until this is done, I doubt Aetna will get involved.

As far as no other radiologist reading them, bunk. Litigation atty's routinely have ortho's or radiologists provide independent reports of images based on review of images on cd's, often more than a year old. Granted, we had resources of groups of physicians that were willing to do that, but its hardly impossible. They do expect to be compensated.

[ramonesfreak]

FYI I was a medical malpractice defense attorney and have always worked in personal injury. Spine injuries have been the most common cases, followed by knees and then shoulders. A fusion not noted on an MRI report is not something I have ever seen in the hundreds, maybe a thousand or so Ive reviewed leading me to believe the report has the wrong patient name on it but without reading I am not sure but would love to read this report

[ramonesfreak]

And assuming there is something wrong with the actual report rather than the report saying the MRI was poor and a new scan is recommended, the pain management doctor should call up the radiologist and say you knew the history was positive for fusion, there is no way the fusion disappeared, yet your report fails to mention what would be the most obvious defect on this spine so what gives? Dictation right? Correct patient? Any radiologist would quickly take another look at all this on his lunch break. Shouldn’t turn into some huge drama involving carriers if the doctors give a damn. Usually they do give a damn. And if a new MRI is needed because of some distortion on the image or something, the carrier will likely approve a new one

[GH85Carrera]

One of my friends is a radiologist. He said that he receives a lot of things to read from Medicare patients. Medicare just knocks down the payment to $40. And that has to pay for the actual x-ray tech and the machine, then his fee, and his fee is split with the billing company. And he has to pay malpractice insurance out of that. In the end, he is often left with almost no income. And if he misses something he is on the hook to be sued by the patient, for a X-ray he read for a dollar of income.

[ramonesfreak]

Yea but the vast majority of his patients are not on Medicare they are via private health insurance and Workers’ Comp carriers which typically pay per a fee schedule but it’s a hell of a lot more than $40….unless he is specializing in elderly patients and SSD. It’s a high volume business just like my own PCP’s office. Just like my business.

I had an ortho doctor testify recently when I asked him if he had referred the patient to the imaging provider for an MRI and he say he did and probably keeps them in business because of how many patients he referred to them every week. Point is, most radiologist will return a call to another doctor who has a concern about something if they care about their reputation and behave like a professional. It takes the radiologist about 5 minutes to look at the images and report on his computer at which point he says OMG what have I done and the goes to work correcting the error.

[gchappel]

I am a radiologist- almost retired.
I retired as a partner from a large group- 50+ rads. I still work a little part time.
When possible, we assigned exams to rads by their subspecialty. Spine MRI would be assigned, when possible, to a radiologist with subspecialty neuro training. Not all groups have that capability.
If they actually missed something large like a fusion, you can ask for it to be reviewed. It is usually easiest if your doctor asks. At least with us, those would be assigned to both the original reader and if a review was requested by your doctor- would also be assigned to a different second rad. An addendum would be produced.
It may really be difficult to find a different group to reread your exam. Believe it or not, many groups use different protocols- so images look different. It is a legal nightmare- if we disagree on anything. Plus, no one will pay for it. Your insurance will not pay- they already paid once. Our group would not do it.
Tough situation- but you, or preferably your doctor, could call and ask for a review as significant findings were missed.
Good luck
gary

[PorscheGAL]

Couple things:

Continuing to have pain after a fusion is very common. Failed Back Surgery Syndrome can occur in something like 60-70% of the time.

In some smaller hospitals in my area, the radiologist rotate schedules so they may not necessarily have subspecialties as Gary stated above when reading MRIs and CT. Not sure if you are in that type of situation.

Your pain doctor could ask for more specifics on the fusion and the radiologist will amend the report. I do this regularly when I spot something specific in a previous image report and it is not mentioned in the current report.

Most pain doctors in this area will ask for a disk of the images and look at it themselves.