Vertebral Augmentation

[PinchandBurn]

Hey guys-

I'm an Interventional Pain Physician. I work rather closely with IR guys. We have 'conferences' and hash through some imaging,etc.

I however wanted to finese my ability to read MRIs a bit. Namely to recognize facet hypertrophy, bulging discs,etc both in the cervical spine and the Lumbar. Is there a good book that you can recommend....maybe 'something for dummies'. Or does your societies have a 'MRI reading workshop" that I could attend?

Also...finally about reading MRs prior to vertebral Augmentation. One of our Radiologists is mroe of a 'cowboy' and the other guys is more conservative. For excample, one of the guys will call it a compression fx, the other a 'compression deformity'....Any suggstions on how I could start to read my own MRIs in regards to edema on T2s so that I could ask the right questions,etc. Thanks!

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[IRneuroIR]

This is really a forum for medical students and residents interested in interventional radiology.

And no offense, but why do you think it would be that easy for you to learn how to read lumbar MRIs if you are not a radiologist? Radiologists go through five years of residency and additional fellowship training to learn diagnostic imaging. But to answer your question, I am not aware of any "easy workshops" or "dummies" books to learn how to interpret MRIs. Perhaps your own society(s) would be a better resource to find shortcuts to looking at MRIs.

 

[davidjones]

I think it's totally fine for other specialties to come on here and ask questions.

There are numerous books on spinal imaging that you can go through to get a better grasp of imaging, just pick one, degenerative disease is not that complex that you would need any sort of special course. You could also sit down with a neurorad to have him/her teach you how to get a better idea of what you're looking for. It shouldn't take you too long to develop an eye for these things.

It might even be good to have a neuroradiologist present when you have you're conferences; you could probably develop it into something like a tumor-board model, i.e. "multi-disciplinary pain center" especially there are likely things you do that IR doesn't and vice versa, even partering with a spine surgeon, you'd be surprised how much your business would go up.

I do caution using your own "interpretation" to guide treatment, people who are not super-specialized, i.e. academic neurosurgeons, really shouldn't be doing interpretations, I have seen a lot of docs either act on their own interpretation or ignore what the radiologist said to the detrement of themselves (law-suit) and the patient (harm).

Even IR guys who only do IR should not really be putting in diagnostic interpretations in my opinion, and in academics they usually only do vascular imaging (which isn't that tough) . There is a well respected IR guy at my hospital who does a lot of liver oncology, in fact that's pretty much all he does, and he has probably seen thousands of liver CTs and MRIs and even he will come to consult with body imagers.

Note that I am not saying that that is what you're trying to do nor that you are necessarily looking for a short-cut, in fact I think it's admirable, the more people lay eyes on a film the more likely that nothing will be missed.

Also, "compression fracture" and "compression deformity" mean the same thing

 

[PinchandBurn]

I think it's totally fine for other specialties to come on here and ask questions.

There are numerous books on spinal imaging that you can go through to get a better grasp of imaging, just pick one, degenerative disease is not that complex that you would need any sort of special course. You could also sit down with a neurorad to have him/her teach you how to get a better idea of what you're looking for. It shouldn't take you too long to develop an eye for these things.

It might even be good to have a neuroradiologist present when you have you're conferences; you could probably develop it into something like a tumor-board model, i.e. "multi-disciplinary pain center" especially there are likely things you do that IR doesn't and vice versa, even partering with a spine surgeon, you'd be surprised how much your business would go up.

I do caution using your own "interpretation" to guide treatment, people who are not super-specialized, i.e. academic neurosurgeons, really shouldn't be doing interpretations, I have seen a lot of docs either act on their own interpretation or ignore what the radiologist said to the detrement of themselves (law-suit) and the patient (harm).

Even IR guys who only do IR should not really be putting in diagnostic interpretations in my opinion, and in academics they usually only do vascular imaging (which isn't that tough) . There is a well respected IR guy at my hospital who does a lot of liver oncology, in fact that's pretty much all he does, and he has probably seen thousands of liver CTs and MRIs and even he will come to consult with body imagers.

Note that I am not saying that that is what you're trying to do nor that you are necessarily looking for a short-cut, in fact I think it's admirable, the more people lay eyes on a film the more likely that nothing will be missed.

Also, "compression fracture" and "compression deformity" mean the same thing

Thanks

Trust me...I am NOT trying to avoid getting a read from a Radiologist by any means. However, there is always some variations between reads from different radiologists. I've even been told that some radiologists even alter their language such as saying something is 'mild or moderate' ,etc. So if anything I want to be able to also interpret some of what they are saying, so I as the interventionalist can determine whether I should pursue the injection or fracture....

Unfortunatley I havent seen any good workshops in our societys for this. On the flip side, there are always radiologists at our injection courses. I wish it was more two way.....

 

[shark2000]

It is not the radiologist mistake.

The association between MRI findings and patient's symptoms is horrible when it comes to spine.
There may be a severe facet arthropathy with minimal pain and vice versa.

There is practically not any standard scale for mild, moderate and severe in radiology literature. These two factors make reading the MRI very variable. There is also a great intra-observer variability.

I think the best report is to describe it level by level and then putting the worst or two worst locations in the impression. However, still the patient may have the worst pain in a relatively mild location.