Note: This post first appeared at e-patients.net
Gina Kolata’s must-read article in last week’s Science Times points out vast differences in the quality of MRI’s as well as vast differences in the expertise of the radiologists who interpret them.
Patients need to understand this, because physicians sure as Hades aren’t going to tell you.
Kolata uses sports injuries as example. With suspected cancers, the stakes are life and death. A poor MRI was part of the reason my daughter nearly failed to get a proper diagnosis of a malignant sarcoma in her arm, and then nearly failed to get the proper treatment.
The initial MRI was the only baseline image which her oncology team
had to grade the tumor before it had been cut open. Besides tissue
analysis, grade of tumor is determined by size, depth and firmness of
the mass. A physician at a university medical center finally explained
that the films were junk. Useless due to poor quality.
As Kolata points out, there is a vast difference in the quality of
MRI’s as well as vast differences in expertise of the radiologists who
Second, there is no substitute for research and patient
pro-activity. None. Nor, given the fractured state of health care in
the United States and the flailing economy, is there any substitute for
e-medicine for cancer cases in terms of speed, research capability and
Third, organizations like the American Cancer Society and the Lance
Armstrong Fund need to take the lead in getting the word out about
clutzy MRI’s. This is unconscionable.
As a further insight, the wife of my daughter’s high school biology
tutor, head pharmacist at a local hospital, informed us that in decades
past that my daughter’s case would have automatically been referred to
a major university medical center like UCSF. Now, given local oncology
facilities, insurance companies force the patient to beat his or her
way through the local medical scene, making referrals to true centers
of expertise extremely difficult if no t near impossible for the
The locals may be fine for diagnosis and treatment of the Big Four
cancers, but they ain’t fine for pediatric cancers and/or rare cancers
which present as suspicious lumps and bumps. For this, they can be
It would be different if physicians were to openly admit the limits
of their expertise, but I have yet to encounter that particular