Medical advancement in imaging

When a man came into the emergency trauma center at University Medical Center  of Southern Nevada at Las Vegas having broken multiple bones in the pelvic area after an 80-foot fall, the risk was too high to cut into him for surgery for fear that his severe injury could cause him to bleed out. Instead, doctors inserted a catheter to seal his wounds and arteries from the inside without having to make a deep incision.  Decades ago, the risk was high for this type of patient to bleed to death during surgery, but now thanks to advances in medical imaging doctors can use MRI (magnetic resonance imaging) to perform surgery with minimal invasion by viewing the images as they operate using a small catheter.

“Technology is so great. More lives are being saved because it provides ways of having minimally invasive surgery,” said Dr. Joseph Urban, who specializes in diagnostic radiology for Desert Radiologists and often works at UMC.

Medical imaging is the technique and process to view images of the human body or parts of the human body for clinical purposes. Medical imaging has been an essential key to health care since the late 1800s when X-rays were first discovered by the German scientist Wilhelm Conrad Roentgen according to the Mayo Foundation for Medical Education and Research. Since then, technology has come a long way from providing a way to view fractures in bones to viewing a fetus, studying cells, soft tissues and organs and even providing three-dimensional images from inside the human body.

The average person who will undergo some type of medical imaging procedure does it for back pain and knee pain, scans of the brain or to have an ultrasound of a fetus. It is easy to forget that this technology doesn’t just help identify pain but also saves thousands of lives on a daily basis.

Dr. Urban notes how important CAT scans are for patients who go into cardiac arrest or suffer a stroke. At one time there was no way to treat a stroke, but now medical imaging allows doctors to put a catheter through the patient's brain and dissolve the blood clot, limiting the terrible damage a stroke can inflict.

“And if they come within six hours they can suffer very little or no permanent damage to their brain and be fine,” said Dr. Urban.

Medical imaging can also be used for cancer of the liver using regional chemotherapy by using a catheter to provide chemotherapy at the site of the tumor without having to perform invasive surgery and avoid going into the liver with a scalpel, which can be a dangerous procedure.

Medical imaging has assisted in treating kidney stones, detecting breast cancer, studying Alzheimer’s diesease, multiple sclerosis and seizures and in performing a coronary angiogram to see the inside of the heart’s blood vessels. The alternative to a coronary angiogram is inserting a narrow tube through the leg or arm and threading it up the body to the coronary arteries, a much more invasive, dangerous and painful procedure.

“There is so much we can do now and it’s amazing how much less you actually touch people to save their lives and all it takes is 40 seconds to four minutes to perform these procedures,” said Dr. Urban. 

As Dr. Urban checks out a patient who suffered a motor vehicle accident, he images her skull and the base of her spine and notices a small fracture that has to be treated. Had they not had the technology to take such a close look, the patient would have had a lifetime of pain in her neck with a small chance of it ever getting diagnosed or treated.

But if anyone has ever had an imaging procedure done, it was probably not in an ER setting.

Dr. Vinay Bararia, a physician who practices internal medicine and works with Centennial Medical Imaging, deals mostly with screenings of brain, spine, joints and the pancreas. A lot of his patients are there to treat ongoing pain or get checked after a vehicle accident and this treatment can substantially improve a person’s quality of life. Centennial Medical Imaging boasts some of the best and most modern imaging systems in the Las Vegas Valley, a difference that Dr. Bararia says has proven to be essential.

“We had a woman who was going blind and we did three MRIs. Then she got tested with a 3-tesla (the newest available version of an MRI machine) and it was then that they found a small stroke blood clot in the back of the brain which was impairing her vision,” said Dr. Bararia. But although Centennial Medical Imaging invested in a powerful 3-tesla, the Tesla five and seven models are already being tested to go out into the market.

“That’s the way medical advancement is. It’s like a computer — you buy the newest one and the next thing you know they came up with a better and faster version,” said Dr. Bararia.

Dr. Urban said he doesn’t feel being up-to-date with the newest machine or equipment is that vital. Some of the newer machines just work faster and although the quality is better there is so much that can already be done with the current models.

So what are these procedures and what do they do?

An MRI uses powerful magnets to polarize and excite hydrogen nuclei using strong magnets to line up the cells and provide two-dimensional or “sliced” images of the body or areas that are studied. It can provide such quality contrast images that doctors can look inside a spinal disc to look for tears or inflammation or find clots in the smallest arteries of the body as well as look for signal changes in the brain to study neurological diseases. An MRI does not involve the use of ionization radiation and so far there is no evidence of long-term effects of exposure, but because the magnets used are so powerful, people with metal plates in their bodies would not be able to undergo this procedure. An MRI is ideal for looking at soft-tissue injuries. It is also recommended for women who have breast implants and want to do a breast exam; some doctors have claimed that it will be the new way of performing breast exams. Many of the new machines now come without an enclosure and instead looks like a donut-hole to accommodate claustrophobic anxiety. MRIs are also best for looking at the brain, spine, joint and pancreas.

X-ray computed tomography (also known as a CT or “cat” scan) uses radiation, unlike the MRI, and is not recommended for women who are pregnant; however, because there are no magnets it is better used for patients who have metal plates implanted in their bodies. To acquire images a “contrast agent” or dye is administered with an IV in order to provide a better quality image to highlight structures such as blood vessels and to highlight tissues. Cat scans are good for viewing a soft tissue and are recommended when gathering images of the chest or abdomen area. 

An X-ray, or x-radiation, is the most common medical imaging used and usually the first step taken before having an MRI or CT scan. The X-ray is a form of electromagnetic radiation; it penetrate solid objects to view and identify bony structures. X-rays can be used to determine fractures in the bones or event to identify lung diseases or chest problems or kidney stones and even scans of the brain or muscle. While the X-ray is ideal for looking at and identifying fractures, a simple X-ray can miss images of a pinched nerve or a blocked arteries in some cases, which is why if there is a bigger problem than a fracture suspected it is recommended to have a higher- quality scan such as an MRI or CT scan.

Ultrasound is another common form of imaging most often used in pregnant women to view the progress of the fetus. Ultrasounds can now offer 3-D images of the fetus and can capture images in real time, meaning that they can see objects move. It is quick to perform, uses no radiation and is safe to use. The real time moving image can also be used to guide drainage and biopsy procedures.

The following are some of the most common forms of imaging but technology advancement have allowed for other techniques and models such as a brain helmet that images brain energy in real time to be used for stroke patients or patients with Alzheimer’s or seizures.

Controversies

Although everyone can agree that technology has saved many lives, others wonder whether technology works too well or is used too often. The high costs related to some of these scans can cause skeptics to wonder about the neceessity of scanning.

While some doctors says that MRIs will be the golden standard for breast exams, others argue they are too costly and the images are so clear and precise that it will detect many masses and areas that would cause unnecessary concern.

A big problem is the cost of these images. Dr. Bararia says an MRI can cost between $300 and $600. A CT scan can cost from $250 to $400 while an X-ray can cost from $20 to $45.

But the problems can lie in what an insurance company covers. Dr. Bararia makes it clear that doctors do not get reimbursed for ordering scans but ask for them to get the best picture of their patient’s health. However, working with the insurance companies can sometimes be a hassle.

“Sometimes I’ll get a patient that I know needs an MRI, but the insurance makes them get an X-ray first. It’s a waste of money, because according to their injury I already know that patient needs an MRI, but they end up paying for both,” said Dr. Bararia.

Some insurance companies don’t cover certain scanning procedures but Dr. Urban says there is always a way around it.

“Most insurance companies are pretty good. If doctors are suspicious they will contact the insurance company over and over again until the procedure is authorized if the doctor is concerned about their patient,” said Dr. Urban.

Getting through the red tape can be mind-boggling but Dr. Urban hopes that there will be more leniency in the future regarding images.

“The guidelines are just that — guidelines. That’s why medicine is both a science and an art and sometimes someone has to use judgment and they should get the leeway to make those decisions,” said Dr. Urban.

Doctors want patients to understand that they run these exams as a form of preventative medicine and to provide the best results.

“We always want a better picture to diagnose and to cure. If you don’t get certain images then you proceed with continuous pain and we can never diagnose. It just depends on the systems and insurance,” said Dr. Bararia.