How To Tell If You Need An X-Ray?

To Take Or Not To Take A Scan?

I am often asked, “Do I need a scan?” by my clients. There are many circumstances where a scan may be warranted, however, there are also other circumstances where it isn’t necessary. There are times when the results can be inaccurate, irrelevant, and often misleading.

5 Reasons Why Scans Can Be Misleading

1. The reliability of the imaging is dependent upon the quality of the image itself. If the image quality isn’t great, then it is difficult to extrapolate further findings.
   
   
2. Not all scans are sensitive or specific to the particular injury under question. Certain scans are relevant for certain injuries/conditions (for example, in regards to a shoulder joint injury an ultrasound is not always as reliable as an X-ray). Therefore, the type of scan is important to ensure the best image is detected for that particular injury type.
   
   
3. The scan report doesn’t finalise the injury as it doesn’t consider any clinical findings. The image is only a static image, and the body is a functioning moving system, so the image only captures a snippet of the big picture. Second to this, the image doesn’t look at the person as a whole. It’s important that your practitioner treats the person not the picture.
   
   
4. The results of the scan are dependent upon the efficiency of the scanner. It is important that certain images are taken from certain angles and positions, if this isn’t achieved, this directly affects the outcome of the scan. It is also important to consider that sonographers can often be misled according to the doctors reason for referral, leading them to look for a certain diagnosis, when in fact there could be another one lingering.
   
   
5. Just because the reports finding states a certain injury to be present, it doesn’t mean that this is the source of your pain.

The graphic above illustrates all of the different abnormalities that are present on scans with people who have no pain or issue with that body part. We see this time and time again with lower back pain. As can be seen, up to 87% of people who do not have neck pain will have some sort of disc bulge. Therefore, if you do have back pain, a scan may reveal a disc bulge that is totally irrelevant to the presenting pain. If it correlates with your pain, then it does become relevant.

The problem with scans, particularly the scan report, is that it labels an injury, but it can also lead to patients over emphasising the importance of the scan report.

For example, Bob will come into the clinic and introduce himself as “Bob, with a disc bulge”, just because his scan report concludes that he has a disc bulge. As seen from the statistics relating to undiagnosed disc bulges, just because a scan says that an injury is evident, it doesn’t mean it’s the source of their pain.

Despite the research, many people continue to place great significance on radiological findings, using them to incorrectly guide clinical treatment.  This can impact a patient psychologically as they often judge the severity of their diagnosis on the report finding alone.

Then the question is, does this finding on scan change your management in any way? In most cases, the answer is no. So why get the scan?

The Purpose Of A Scan

1. They’re a great way to rule out “nasties” which could be anything from fractures to more serious (and rare) conditions, such as cancer.
   
   
2. They’re great in supporting a treatment plan to help guide treatment options.
   
   
3. They are helpful to add another piece of information to the bigger picture, however, it shouldn’t be the guiding factor. The body is a complex system so it isn’t just to conclude the diagnosis from this one piece on information.

Imaging may confirm a suspected diagnosis, or rule out a cancerous tumor, but the costs must be weighed against the benefit if it will not change the course of treatment. This includes exposure to large amounts of radiation, time out, and expense for the patient and health care system.

At Pro-Form we view the body as a whole, and treat it holistically, so the scan is another piece to the puzzle, along with the subjective history, objective assessment, and clinical reasoning to diagnose the most relevant and accurate injury accordingly. We acknowledge all factors when diagnosing an injury, if you need help to navigate through an injury, book in an appointment today.

Written by:
Natasha Cauchi
M. Phty, B.App.Sc (Exercise & Sport)

References
Kjaer, P., Leboeuf-Yde, C., Korsholm, L.,Sorensen, J.S., Bendix, T. (2005) Magnetic Resonance Imaging and Low Back Pain in Adults: A Diagnostic Imaging Study of 40-Year-Old Men and Women. Spine.30(10):1173-1180

Image References
Back
(Jensen et al 1994) found that 64% of people without back pain had a disc abnormality on MRI, 38% at more than one level. More recent studies showed similar findings (Brinjikji et al 2015).

Neck
Disc bulges were observed in 88% of healthy patients, including those in their 20’s. radiology is similar (Nakashima et al 2015).

Hip
(Heerey et al 2018), found 54% of individuals without pain displayed a laberal tear on imaging.
(Ganderton et al 2017) found gluteal tendon injury in 88% of pain-free individuals.
(Han et al 2018), showed hip impingement deformity in 31% of patients without pain.

Knee
MRI’s showed 16% patients without pain were found to have meniscal tears (Boden et al 1992).

Shoulder
Rotator cuff tears were observed in 23% of patients after imaging their shoulders (Tempelhofet al 1999).