X-Ray Vs. MRI

I need a little help from either x-ray/mri technicians or doctors.

After taking anti-epileptic and anti-viral medications for many years, I have developed severe osteoporosis.

Recently I had a bi-lateral x-ray on my hips and the image produced a fracture on the ball joint (all the way across) on my left side. The good doctor sent me for an MRI and it came up negative for anything (except the osteo).

Well....I'm gimping along in pain and can not google a darn thing to explain this discrepancy.

Any answers? It's real important to prove my muskulo-skeletal issues as they preclude me from working in my previous line of work in construction. I've got bursitis, tendonitis and arthritis in most of my joints. I'm a skelatal nightmare. But this Hip MRI has to be wrong.

To add, I have a permanant and total disabilty from the V.A and am working on my social security case. I need an air tight defense to prove my many disabilities. To get SSDI you have to be nearly dead (many get approval after they've died). I'm probably a few years from that, but I can't work in pain any longer. Any answers would be greatly appreciated.

Any theories, conpiracies or otherwise? Thanx in advance.

I have a couple of suggestions since this is part of my profession, I am in MRI sales.

1) Have "another" radiologist look at the MRI films. Believe it or not, the films can be SUBJECTIVE in interpretation.

2) See if you have a positional MRI in your area and get another MRI done. This is a new type of MRI machine that can show images of people in positions of symtomatic pain. The google search is "FONAR upright MRI"

Best of luck.

Obviously, this isn't really a good place to give medical advice, and I won't offer any sort of diagnosis, as I haven't personally seen you or the films. I will say, however, that the few times I've seen a discrepancy between films like you're describing, it was due to either an artifact on the X-ray film (much more common than an artifact on an MRI reading) or a poor reading by the radiologist.

I would probably get a second opinion about why there is a discrepancy, preferably by a radiologist. They don't usually like seeing patients (at least the ones I know), so it might take a few calls to get one to go over the films with you quickly.

Thanx for the quick replys. I did an open MRI, don't know if this method is less effective or not. I've got anxiety issues.

I will re-address the results on my next visit to my othopedic doctor. They have done a great job in diagnosing my other ills. When I complain about something, I'm usually correct in my assumptions 90% of the time. Therfore, that is why I'm perplexed.

Originally posted by brilab45
I need a little help from either x-ray/mri technicians or doctors.

After taking anti-epileptic and anti-viral medications for many years, I have developed severe osteoporosis.

Recently I had a bi-lateral x-ray on my hips and the image produced a fracture on the ball joint (all the way across) on my left side. The good doctor sent me for an MRI and it came up negative for anything (except the osteo).

Well....I'm gimping along in pain and can not google a darn thing to explain this discrepancy.

Any answers? It's real important to prove my muskulo-skeletal issues as they preclude me from working in my previous line of work in construction. I've got bursitis, tendonitis and arthritis in most of my joints. I'm a skelatal nightmare. But this Hip MRI has to be wrong.

To add, I have a permanant and total disabilty from the V.A and am working on my social security case. I need an air tight defense to prove my many disabilities. To get SSDI you have to be nearly dead (many get approval after they've died). I'm probably a few years from that, but I can't work in pain any longer. Any answers would be greatly appreciated.

Any theories, conpiracies or otherwise? Thanx in advance.

I don't usually comment on medical diagnosis, but being an MD my self I feel in this case. I have to. Please understand my background is academic, not clinical medicine. The party who just made a comment is right. So much of this is really subjective. I would suggest you have your doctor test you for auto-immune problems. This covers areas like inflamatory problems. Have him draw blood and do an SGOT/SGPT, Sedrate, and WBC with differential. Those terms are a bit old fassioned, but he/she will know what I'm talking about. Please take care, and all my love; Bob

Originally posted by brilab45
I will re-address the results on my next visit to my othopedic doctor. They have done a great job in diagnosing my other ills. When I complain about something, I'm usually correct in my assumptions 90% of the time. Therfore, that is why I'm perplexed.

That's the absolute best thing you can do. If something makes you uneasy or otherwise uncomfortable, address it. Most of the time, I have no idea a patient is anxious about something unless they tell me, which then clues me in on other issues that may be occuring that I wasn't privy to. It makes it much, much more likely that the correct diagnosis will be pinned down.

Good luck with your next visit, and I sincerely hope you get this problem resolved quickly and easily.

Originally posted by brilab45
Thanx for the quick replys. I did an open MRI, don't know if this method is less effective or not. I've got anxiety issues.

There is a difference between "open" and "positional" MRI's.

Positional MRI's can image you in bending positions such as flexion and extension. If there is occult pathology, only this type of MRI machine will detect THE FULLEST EXTENT of the pathology. Do some more research....Lawyers love this technology.

Thanx again everyone. I'm going to run with some of your advice and do some critical layman style research. I'm sure this thread is useless to most, but you have already helped me!

Originally posted by brilab45
Thanx for the quick replys. I did an open MRI, don't know if this method is less effective or not. I've got anxiety issues.

Are you claustrophobic? Why the open MRI? It has a weaker magnetic read. The standard is 1.5 tesla, while most open MRI's are .8 or weaker. Usually, MRI focus on the tissue aspect of the scan, like if a break has inflicted upon the ligaments or tendons. You should be able to see the break either way, unless its a spiral fracture or a stress fracture. But I would inquire about the magnetic field of the open, or if it was meant to see tissue only.

I run a diagnostic imaging center in LA btw. Good luck.

AAC

Originally posted by AnAbsoluteCreation

Originally posted by brilab45
Thanx for the quick replys. I did an open MRI, don't know if this method is less effective or not. I've got anxiety issues.

Are you claustrophobic? Why the open MRI? It has a weaker magnetic read.

AAC

U are right and wrong. Most "open" MRI's are low and weaker...The technology of an Upright Fonar MRI is a .6 tesla but behaves like a 2.0 because of the dedicated coil technology. The images of an Upright FONAR just blow away any open MRI films and give the closed field MRI's a good run. We have neurosurgeons that are very impressed with the Upright Scanner. No I am not a FONAR rep either.

reply to post by AnAbsoluteCreation


Only in the last 6 months have I discovered all my issues. My choice of analgesic was alcohol, which in turn created a huge anxiety issue for me. Of course my doctors educated me quite clearly that alcohol contributes to bone loss and anxiety. Hind sight is 20/20.

At least I have a chance to regain some mobility back, but its going to be a rough ride. Alcohol is out. Slowly starting in the gym to help build bone density and taking calcium citrate wit vit d, magnesium, etc.

Don't want to take the bone building drugs like boniva or Foxamax. The science behind the drugs scare me. If they can kill off blood vessells in the jaw, it must do other damage. I must take in to consideration my heart health and feel these drugs will do me more harm.

reply to post by solarstorm


Not familiar with the FONAR. I do however know that insurances are now beginning to refuse the reimbursements for low-field scans. I wonder if the dedicated coils change that? I doubt it though considering medicare asks for type of scanner rather than type of coils.

Interesting. Good luck with the sales in this market. We have just ordered a Philips Achieva A series for a february install. Some of the new capabilities on this are quite fascinating.

To the OP, good luck, and would definitely look into your own diagnosis and treatment and see if it corroborates with what they tell you. Good luck.

AAC

[edit on 25-1-2010 by AnAbsoluteCreation]

reply to post by AnAbsoluteCreation


Thanx. I've decided to call the hospital billing dept. and letting them know why I'm not paying my bill. Guess I'll demand a reinterpretation to start with. Of course I will pay them in the end, but at least I have a bargaining chip.

Originally posted by AnAbsoluteCreation
reply to post by solarstorm

 

Not familiar with the FONAR. I do however know that insurances are now beginning to refuse the reimbursements for low-field scans. I wonder if the dedicated coils change that? I doubt it though considering medicare asks for type of scanner rather than type of coils.

[edit on 25-1-2010 by AnAbsoluteCreation]

Ahem...again you are right and wrong. We bill out to over 70 insurance companies and have all the major carriers including Medicare. This is because we are a site accredited by the American College of Radiology. In case you are not familiar with ACR accreditation which it sounds like you are not...you would know and appreciate the standards they put forth on an imaging facility, which includes high film quality standards of clinical value.

Sorry about your "ignorance".

Oh and 1 more thing...FONAR is owned by Dr. Raymond Damadian who happened to invent MRI's....Now you are not "as" ignorant, anymore.

[edit on 26-1-2010 by solarstorm]

That was an awfully acerbic post, Solarstorm. I don't think AAC was accusing you of anything or making a rude statement. I was actually wondering the same thing as to how it would be billed, either as low frequency or on a seperate scale altogether. I haven't had a chance to use the FONAR system myself, so I wouldn't have known.

Originally posted by solarstorm

Sorry about your "ignorance".

Do not apologize for my lack of a frame of reference on billing low-quality MRIs. However, I do know ACR, a man by the name of Robert Bell, who is on the board of ACR accredited my site personally.

I should however apologize about my stranglehold on the market share in Beverly Hills.

AAC

I have a degree in Radiographic Technology and worked as an x-ray tech about 15 years ago. My experience with MRI is very limited, and the technology has probably improved dramatically, but I do recall that x-ray is best for imaging bones while MRI is best for imaging soft tissue. An MRI typically manipulates the hydrogen atom to generate the signal that produces the image. Wherever in the body there is water, there are hydrogen atoms. Soft tissues contain lots of water, while bones have very little. You can tell where the bones are with an MRI, but there isn't much detail. MRIs of the hip are performed routinely, but probably not to image a hairline fracture. An x-ray ( radiograph ) on the other hand works by differential absorption. X-rays are passed through the body, and bones absorb or block many of them while soft tissues and air allow most to pass through to the film cassette. As bones vary in thickness and density, different techniques ( strength and amount/duration of x-rays as well as body part positioning ) are used depending on the bone to be imaged. The link below will confirm this difference between x-ray and MRI. The webpage is about CT versus MRI, but CT uses x-rays so it is relevant. The first paragraph is about MRI, and there is an error in the last sentence. Bones do not appear black on an MRI. There are pictures showing a lateral knee series and the bones are clearly not black. The femur is easily visible in the middle of the series, though as I mentioned there is little detail.

www.diffen.com...

An x-ray of a fracture does not require confirmation, it is confirmation. If the image quality was poor or artifact was suspected, then the x-ray should have been repeated - or possibly a CT scan could be performed. If you can get approved for outside services, a freestanding Radiology clinic would be the best place to have your hips x-rayed again. If not, make sure that the tech performs an actual bilateral hip series and produces quality images. Films of the unaffected hip are not necessary, but are useful for comparison. There should be four films total ( two for each hip ) each about the length and width of a hardback novel. A single x-ray of the entire pelvis showing both hips is not the best technique. The area of interest should be in the middle of the film to eliminate distortion from beam divergence, and the exposure area should only be of required size. As x-rays pass through soft tissue, scatter radiation is produced which can contribute to film exposure, diminishing contrast and therefore quality. Larger exposure areas will produce more scatter, so the exposure area should be kept to a minimum, which also minimizes your radiation dose. The link below shows some x-ray films of the hip. You can scroll through them to see different ones, but check out the first three shown. The one to the far left is a good example of a quality radiograph. The one on the right is a good example of poor technique, making hairline fracture detection more difficult.

www.livestrong.com...

Regardless of where you have your x-rays repeated, make sure that a Radiologist reads them and forwards a report to your physician. Primary care physicians are not qualified to properly analyze radiographs. I hope everything goes well for you. Good luck.

reply to post by nevermore


Thank you for your informative reply. I did obtain the MRI results on disk. Am seeing my doctor next month to resolve these issues. I can barely walk and their telling me the MRI says nothing is wrong, when the x-ray clearly shows a fracture.

Thanx again, I'm "printin" this one out for future reference when speaking with my doc. My doc is really a great caring doc., I just think he is overworked.