How to improve spine MRI reads

[PainApp2021]

Hi all,

About to start my pain fellowship and one of my glaring deficiencies (among many) I've realized is independence in reading spine MRIs. Our residency had very good exposure to pain, but I feel like I didn't make as much of an effort to become proficient at this so I wouldn't have to rely on a radiologist's interpretation. A lot of the time my attending would point out abnormalities that I either could or could not appreciate, and then I didn't necessarily think about it again. Does anyone have a good source for methodically going through scans?

Thank you for any help!

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[geauxg8rs]

Hi all,

About to start my pain fellowship and one of my glaring deficiencies (among many) I've realized is independence in reading spine MRIs. Our residency had very good exposure to pain, but I feel like I didn't make as much of an effort to become proficient at this so I wouldn't have to rely on a radiologist's interpretation. A lot of the time my attending would point out abnormalities that I either could or could not appreciate, and then I didn't necessarily think about it again. Does anyone have a good source for methodically going through scans?

Thank you for any help!

One thing we did in fellowship was have radiology rounds. We would compile some scans with interesting findings and we would then have a friendly radiology attending go over them with the us every few weeks. It helped to have an expert go over scans, they could answer normal stuff and show the odd stuff. Great resource

 

[swamprat]

Check out this book - I read it over several times over the years as I reviewed my own imaging

"MRI Essentials for the Spine Specialist" by A Jay Khanna

 

[JFS]

Here are a few resources I've found over time. For background I'm a pain fellow but wanted to get really good at reading imaging and was also really interested in spinal cord injury.

Video lectures
Free:
A fast primer on L-spine MRI:
A little more detail on L-spine:

Paid: I found the SIS lecture series "Core Curriculum: Imaging Anatomy for the Spine Interventionalist" to be expensive but worth it if you really want to understand spine imaging.

Books
I second MRI Essentials for the Spine Specialist.
If your library has ebook access then anytime you find something weird I'd recommend looking it up in Diagnostic Imaging: Spine by Ross and Moore. It is in bulleted format and to the point. The website radiopaedia is always a good choice too.

The most important thing is to be intentional about learning imaging and get lots of reps. Look over imaging for all your patients. If you have radiology rounds that's ideal but not available everywhere. If your attending points out an abnormality and you are not sure you see it then take the opportunity and have them explain what they see.

 

[RoloTomassi]

Not uncommon to see radiology reports that miss things (lateral and foraminal herniations, disc fragments, facet cysts and effusions) and under or over-read the severity of stenosis, so make sure you don't use the reports as your answer key, and ask your attendings lots of questions.

Also if pt has a transitional level, rad can read this as L5-S1 or S1-2, and you may be surprised which one they go with, so if you aren't on the same page and not correlating MRI with XR/fluoro, you may be injecting a level off.

 

[Ducttape]

as a fellow, you should have a rotation with neuroradiologists to review MRIs and other images.

 

[Agast]

You know what’s fun? Discovering there are “chiropractor radiologists” and reading their MRI interpretations. Like Stranger Things-level “squelching wetly” descriptions.

 

[MitchLevi]

SIS case series is great.

 

[DubVille]

You know what’s fun? Discovering there are “chiropractor radiologists” and reading their MRI interpretations. Like Stranger Things-level “squelching wetly” descriptions.

My wife is a neuroradiologist. Boils her blood.

I love to send her the reports with "1 mm disc bulge" at every level.

Even worse is she has called some regular chiros who are ordering brain MRIs (for some reason). She has about one a year with a critical finding. Recently was a massive subdural with midline shift. Chiro apparently said "send them home."

EMS was called to get them from outpatient imaging center. Almost universally the chiropractors seem to completely blow off critical findings.

 

[callmeanesthesia]

My wife is a neuroradiologist. Boils her blood.

Well that’s one way to improve your spine MRI reads.

 

[buddababa]

You know what’s fun? Discovering there are “chiropractor radiologists” and reading their MRI interpretations. Like Stranger Things-level “squelching wetly” descriptions.

Yeah there's one in my town, works side by side by radiologists - ive been meaning to call the radiologist and say why you letting this guy do this, but $$$$$$$$$$$$$$ prolly dont care since they make money

 

[PainApp2021]

Thanks everyone! You are all a very valuable resource that I am grateful for.

 

[MitchLevi]

You know what’s fun? Discovering there are “chiropractor radiologists” and reading their MRI interpretations. Like Stranger Things-level “squelching wetly” descriptions.

I've mentioned this before, but I once had a pt receive an occipital to coccyx ultrasound.

The guy dictated every single level and said there was a "subluxation" at each level.

LMAO

 

[drrosenrosen]

Not uncommon to see radiology reports that miss things (lateral and foraminal herniations, disc fragments, facet cysts and effusions) and under or over-read the severity of stenosis, so make sure you don't use the reports as your answer key, and ask your attendings lots of questions.

Also if pt has a transitional level, rad can read this as L5-S1 or S1-2, and you may be surprised which one they go with, so if you aren't on the same page and not correlating MRI with XR/fluoro, you may be injecting a level off.

Definitely recommend reading the images before reading the report. I still do this. Make your own assessment, and see if it squares with what the radiologist said. If there's something that really seems off - something large they didn't catch for example, try calling and see if you can speak to the reading radiologist. This repetition will also help to build your skill in reading films.

 

[Doctodd]

dont stop at spine MRI's......get to know the shoulder, knee, hip, etc

 

[MitchLevi]

dont stop at spine MRI's......get to know the shoulder, knee, hip, etc

Shoulder MRIs can be hard.

 

[Doctodd]

Shoulder MRIs can be hard.

i was just going to add that....now i cant lol

 

[RoloTomassi]

Yeah I always feel inadequate when a patient brings shoulder MRI disc before the report is in

 

[Doctodd]

here ya go.....simple layman explanations.....then graduate to something more detailed

 

[Clean7795]

I've mentioned this before, but I once had a pt receive an occipital to coccyx ultrasound.

The guy dictated every single level and said there was a "subluxation" at each level.

LMAO

Brings me back to my ER rotation in medical school where one of my patients told me she had current multilevel rib subluxations dx by her chiro.