Imaging tests including MRI, CT scan, and X-rays

Magnetic resonance imaging (MRI) is a test that produces very clear pictures, or images, of the human body without the use of x-rays. MRI uses a large magnet, radio waves and a computer to produce these images as described here.

64-slice CT scanner. Beta blockers are usually given in conjunction with this type of scan, and an IV contrast material is used. Evidently the contrast dose is lower but the radiation exposure is higher, compared to the older 16-slice CT scans.

A patient undergoing an abdominal CT scan receives over 50 times more radiation than in a standard X-ray.

Xrays are very subjective in interpretation. It is best to get the original radiographer's reports (usually available from the lab who took the Xray films)

http://xkcd.com/radiation/

Risk is not only from radiation exposure, but may arise from dyes used, depending on individual sensitivity, so it is prudent to ask what contrast agents are in use for the proposed scan.

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MRI and CT (filelink)

MRI

Question: “I would really appreciate your thoughts on another MRI. The neurologist asked me to have another MRI so he could check the development (or lack) of a lesion I had. My GP has advised me to proceed with this scan. saying the specialists need to know about my progress on MP as they are treating many people with diseases that could be helped by MP.”

Reply: The question to ask, may be “What will the MRI achieve?”

As you have reported symptoms improvements - that is a good sign for the Dr.. Remember that symptoms are expected to get worse before they get better.

If the MRI is to be used as research it is difficult to say what they may deduce from it. If it is worse, indicating ImmunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed., will the Drs understand this and not want to stop or change your treatment?

If it is better, will they expect other or similar tests on yourself or others to also show improvement at this early stage?

My suggestion would be that you agree to undergo the MRI if it is satisfactory to you in every aspect to do so, and to suggest to your Dr/s that you will review and report any improvement or otherwise in symptoms. At this stage you (and your Dr) may wish to rely on your assessment of Immunopathology and symptoms to evaluate your progress.

I believe that a frank evaluation of your progress along these lines will reassure both you and your physician. This is the point where your physician will really need to listen to your assessment of your symptoms because it is possible an improvement to the MRI may not manifest for some time.

Dr Marshall wrote: “Please understand that there is little or no correlation between symptoms such as headaches, and lesions on MRI. Don't fall into the trap of supposing “there must be,” because the studies (often) show otherwise.

If you are having an MRI with contrast they will be using an I.V. form of the element gadolinium, that is usually largely eliminated with no problem in most people. There may be a problem in those with kidney problems, and the FDA has issued a black box warning recently about this. It mostly involve MRA's, but could be relevant to MRI's. See: http://kidneydiseases.about.com/b/a/007094.htm

The gadolinium would be fine for most people on the MP, but everyone should be aware of the black box warning. In those with kidney involvement I would always see if an MRI without contrast would be good enough to visualize what needs to be examined.

Some of the gadolinium can remain in the body even with good kidneys, and it remains an unknown as to all of its possible long term health effects. In some the cost/benefit analysis might be that using the gadolinium is worth it. ~P.B. RN

In patients with impaired renal function, use of iodinated contrast agents can lead to further damage to the kidneys. ~Belinda.

MRI with contrast

The dye used for radiology purposes is not contraindicated on the MP, however there are some considerations I'd recommend.

Be sure your test is absolutely necessary as you will have a fairly high degree of Xray exposure and ask Dr. what he will do with the results.

A few things to consider:

1. Are you allergic to iodine? Be sure to tell radiology if you are.

2. Request the non inonic low osmolar contrast dye if you must have dye for this test. It is much better tolerated and easier on the kidneys; one type goes by the acronym LOCA

3. If you have concern about your kidneys related to recent lab work, do communicate that to your Dr. ~ VEZ

CT scan

Dr Marshall: “Doc doesn't have the patience you have, because he is not experiencing what you are experiencing, and he is therefore puzzled as to what is actually happening. So Doc is trying to evaluate things based on his own perceptions ('models') of the world.

There is a finite risk to every procedure, even CT scans (which usually require an infusion of contrast medium) not to mention the cost, which for CT scans is quite high.

You made exactly the correct choice. Doc really would not be able to interpret what he can see, in any case. Except for obvious things, like lymph-node swelling. But he can often pulpate the key nodes and sense that without the need for any high-tech procedures” <

Here is some information about the 64-slice CT scanner. Beta blockers are usually given in conjunction with this type of scan, and an IV contrast material is used. Evidently the contrast dose is lower but the radiation exposure is higher, compared to the older 16-slice CT scans.

See also What is the best way to assess lung function?

This is a horrible source, but it might be worth following up on these studies: http://www.cracked.com/article_18840_5-common-medical-procedures-that-secretly-arent-worth-it_p1.html

Radiation exposure

“Your concern about radiation is valid. I am currently in contact with a group of nuclear power station workers who have a very high incidence of sarcoidosis. Given that energy is a key ingredient in changing 7-dehydrocholesterolA cholesterol precursor manufactured by humans. When exposed to ultraviolet light converted into vitamin D3. Also known as previtamin-D3. to pre-Vitamin-D I would be very wary giving any sarcoidosis patients even the amount of ionizing radiation normally acceptable to the healthy population.

In this case it would seem that the CT scan results would not change Doc's therapeutic decisions, and therefore am puzzled why Doc would insist on them. ..Trevor..

The New England Journal of Medicine (Nov.29, 2007) reported the average American's radiation exposure has doubled since 1980, largely because of the booming use of CT scans. A patient undergoing an abdominal CT scan receives over 50 times more radiation than in a standard X-ray. A person who receives two scans is bathed in as much radiation as if he stood two miles from ground zero at Hiroshima.

For a more readable synopsis and comment, see http://www.msnbc.msn.com/id/22010076/\Msnbc

Part of the research report says:

Although most of the quantitative estimates of the radiation-induced cancer risk are derived from analyses of atomic-bomb survivors, there are other supporting studies, including a recent large-scale study of 400,000 radiation workers in the nuclear industry who were exposed to an average dose of approximately 20 mSv (a typical organ dose from a single CT scan for an adult). A significant association was reported between the radiation dose and mortality from cancer in this cohort (with a significant increase in the risk of cancer among workers who received doses between 5 and 150 mSv); the risks were quantitatively consistent with those reported for atomic-bomb survivors.

Errors in imaging interpretation are common

Ehsan Samei of the Advanced Imaging Laboratories at Duke University Medical Center recently summarized results from a variety of radiological procedures: “Currently, the average diagnostic error in interpreting medical images is in the twenty percent to thirty percent range. These errors, being either of the false-negative of false-positive type, have significant impact on patient care.” How Doctors Think by Jerome Groopman, MD.

Micromanaging the healing process

” …. the biggest issue, IMO, is trying to micromanage the healing process. If you are typical of the folks who come looking to the MP for relief, then you have a body which is very ill. It is systemically ill, there will be no part of it that has totally escaped damage. That's the problem with micromanaging - when you get too much data it becomes not easy to analyse what is happening. Healing takes place on a yearly scale, and testing should follow it in the same timeframe, IMO.” ..Trevor..

See Diagnostic imaging

Chest Xrays are very subjective in interpretation. They are an excellent vehicle for a pulmonologist to use if he/she is trying to persuade you your condition is getting worse, or getting better. Often both interpretations might be made from the same films by different readers.

Best to get the original radiographer's reports (usually available from the lab who took the Xray films), and check to see if it is the same person reporting both, post them here, so the moderators can help you understand what they say, and then try to get that knowledge to line up with your pulmonologist's summary.

Dr Marc Judson, one of the sarcoidosis experts, has written that xrays are not useful for staging, or tracking disease progression, and in this I fully agree with him.