Out of State MRI

[lonelobo]

I like most of posters like to look at MRI studies vs. just report.
So what do you do when a new patient brings in fairly recent MRI report( maybe out of state) and you are not familar with reading radiologists.
There is no hard copy available( as request for records sometimes fall on deaf ears or maybe sent a month or two later)

Physical Exam is only somewhat consistent with MRI report.
Do you proceed with interventional tx with exisiting report info or do you order a new one?

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[SSdoc33]

ill do the shot. if no improvement then ill either demand the old mri imnages or get a new one

 

[101N]

I like most of posters like to look at MRI studies vs. just report.
So what do you do when a new patient brings in fairly recent MRI report( maybe out of state) and you are not familar with reading radiologists.
There is no hard copy available( as request for records sometimes fall on deaf ears or maybe sent a month or two later)

Physical Exam is only somewhat consistent with MRI report.
Do you proceed with interventional tx with exisiting report info or do you order a new one?

The risk is that there is rare but deadly zebra lurking in the patient's spine that was missed by the night-hawk service that read the out-of-state MRI. Then patient has the injection but is lost to follow up. 6mo later you hear from their attorney as you are sued for delay in diagnosis as the zebra has metastasized.

If you opt to perform the injection - as I probably would as well - I would document in your consent that the patient has agreed to proceed with the injection based upon the existing imaging that they provided, the history, and your thorough examination. They further agree that to follow up with you at 2wks & 12 weeks for re-evaluation by you. Finally, if their pain is not diminished by 50% or more at one or both time intervals they agree to obtain a new imaging.

 

[PMR 4 MSK]

You have to go with the information available to you, then make your call. I would only re-order if it would change my treatment plan.

I saw pt recently with shoulder pain. MRI shoulder read as tendinitis of the supraspinatus. Films not available to me. Clinically she presented as adhesive capsulitis, so I asked our MRI department to get the films and have them re-read by the rads we contract with. Without telling them my Dx, they read it as capsule thickening c/w capsulitis, as well as SS tendinitis. The first radiologist never mentioned the capsule as normal or not.

In that case, the re-read helped to determine my course of treatment. Without radiographic evidence of capsulitis, I would not have done IASI in a young pt.

 

[Tenesma]

i never do anything until i have the hard-copy - primarily because most reports now-a-days state each level has "broad based disc bulge, moderate central and foraminal stenosis with multi-level degenerative changes".... so new consults are told that we can't do anything until i have hard-copy and about 90% bring hard-copy on their first visit.