Radiology is prescribed based on clinical judgement, chronology and severity of injury process

When to Consider X-Ray, MRI, CT and Bone Scans – Simplifying the Radiology Process!!

My athletic injury series is taking a small detour to address a prevalent diagnostic issue that patients and treating physicians deal with when negotiating through the diagnosis and management of injuries. Proper and accurate diagnosis of injuries requires a detailed history, thorough evaluation and clinical trouble shooting but frequently the actual pathology must be visualized so that the patient and physician can move forward with proper treatment and training modifications.

Types of Radiology :

X-Ray: an image obtained through high frequency electromagnetic radiation that highlights body structures such as bone or even organs to determine extent of injuries.
Why I prescribe X-Ray: athletes are kinetic motion machines and x-ray allows for structural and biomechanical assessment of the bony structures and how they interrelate and articulate.  They also “tell a story” about stress patterns in the body that may be influenced by the training patterns of the athlete.

MRI(Magnetic Resonance Imaging): the newest and most versatile imaging technology available utilizes strong magnets and pulses of radio waves that produces excellent images of organs and soft tissues. MRI is particularly effective for imaging brain, spine, bone interior and joint tissues. MRI poses few known health risks.

Why I prescribe MRI:  athletes are repetitive motion machines and consequently incur numerous soft tissue and bone stress injuries. MRI provides excellent clinical correlation when micro/macro-tears are suspected in the muscle, tendon, ligament and/or cartilage tissues. MRI also will show when stress fractures are “brewing” as the imaging highlights the bone matrix interior and reveals critical information if the bone tissue is exhibiting signs of a stress fracture when x-ray will miss it. Pinpoint management is allowed following MRI as the source of pathology is frequently identified. I love this technology!!

CT Scan(Computerized tomography): combines a series of x-ray views taken from many different angles and computer processing creates cross sectional images of bones and soft tissues of the body. CT imaging can now be combined to create 3D images and they are particularly effective for internal injuries, trauma and ruling out serious pathology. The downside is high radiation dosing.

Why I prescribe CT Scan:  when athletes experience trauma or for ruling out suspected bone or other visceral pathology, the 3D CT Scan is a very effective imaging tool. I tend to lean more to MRI technology but CT Scans produce better yield for specific pathological issues. This technology is also used cautiously due to the elevated radiation dosing.

Bone Scan(Bone Scintigraphy, Radionuclide Bone Scan): detect areas of increased or decreased bone activity that may indicate bone injury or disease process. Radioactive isotopes and tracer chemicals are used to highlight problem areas.

Why I prescribe Bone Scan: for advanced pathology and/or clinical correlation, this scanning method will confirm stress fractures, bone lesions or infections and even cancer that metastasized to bone tissue.

Final Thoughts:

Radiology is prescribed based on clinical judgement, chronology and severity of injury process and for directing patient care and management. Radiology remains as the benchmark for differential diagnosis in musculoskeletal medicine and provides patient and doctor definitive visuals for education, clinical confirmation and management direction and healing perspectives. Personally, I utilize radiology routinely in practice to solidify clinical findings, deepen my perspective in understanding the brevity of the pathology at hand and empower the patient to better understand the extent of injury and/or damage that has incurred. This enlightening process promotes the healing process and allows both doctor and patient to move forward together or to lead to a referral to a more qualified specialist.

Image: Aidan Jones 
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Dr. John Michie

About Dr. John Michie

John L. Michie, D.C., C.C.S.P., founder of Whole Health Chiropractic, embraces Edison's wisdom and incorporates a balance of nutrition, exercise, physiotherapy and chiropractic care to positively impact his patients’ health. Whole Health Chiropractic is a holistic, patient-centered practice. "It's our goal to uncover the causes of debilitating symptoms and follow with an action plan that addresses necessary steps for sustained healing."

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