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MRI benefits to rheumatology care offset by cost, access issues
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ORLANDO — Although magnetic resonance imaging has played a limited role in arthritis care, the emphasis on reducing patient radiation exposure, combined with improved MRI techniques, may bring this modality to the forefront, according to a presentation at the Rheumatology Nurses Society Annual Conference.
“MRI is very important in rheumatology and orthopedics today, particularly for musculoskeletal imaging,” Edward J. Mathes, PA-C, DFAAPA, from the Physician Assistant Program at the University of Rochester Medical Center, told attendees. “It is safe and painless, with no radiation exposure and no known biological hazards. The pictures created by MRI technology are precise, and the use of MRI may decrease the number of procedures patients go through.”
Though MRI provides a very sensitive examination for inflammation of the soft tissue and bone, Mathes noted that it does bear some drawbacks when compared to conventional radiography.
“MRI is expensive – costing up to $3,000 if you don’t have insurance,” Mathes said. “Certain patients are excluded from its use due to the magnetic fields, including those with pacemakers, insulin pumps and artificial joints. And if you’re claustrophobic, forget it. Additionally, you have to be able to lay still for about 45-60 minutes. I myself had both my shoulders imaged and I was in the scanner for one hour and twenty-five minutes.”
According to Mathes, the imaging of rheumatologic diseases still relies heavily on plain radiography. He later quipped, “Rule of thumb: When all else fails, order an MRI.”
Another issue to consider is that more frequent use of advanced imaging increases the need for communication between radiology and rheumatology. Specifically, an uptick in imaging use often fosters confusion about how to code for these procedures. Mathes noted that one of many common issues that arise when physicians attempt to order MRIs from a diagnostic center is whether to order gadolinium-based contrast agents with the MRI.
“You really don’t have to order with or without gadolinium unless you are looking for something specific and you know what you are looking for,” Mathes said. “Just ask your radiologist. We have protocols that we follow for imaging; if someone is coming in and they have a request to ‘rule out osteoarthritis of the knee,’ then we know what sequences we are going to pick and whether we are going to use contrast. Similarly, if they come in with a request to ‘rule out arteritis,’ we know the areas that need to be scanned, what sequences to use and whether to use contrast.”
“There is an [American College of Radiology] Appropriateness Criteria available, in which you can actually go to the ACR website, punch in what you think the patient has, and they will tell you what to order,” he said.
Despite the continued growth of advanced imaging such as ultrasound and MRI, appropriate care of patients often necessitates the use of imaging procedures with ionizing radiation. If ordered prudently, however, the benefits of these imaging procedures should supersede the risks imposed by radiation exposures.
“The only thing you have to know is that radiation exposure is not a good thing,” Mathes said. “Please remember as you are ordering studies to keep that radiation exposure in mind.”– by Robert Stott
Reference:
Mathes EJ. Fundamentals of radiology and imaging in rheumatology. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 7-10, 2019; Orlando.
Disclosure : Mathes reports no relevant financial disclosures.