Mangle Your MR

November 14, 2014

Tips for sabotaging your MR studies.

MRI stands out as one of the most sophisticated, highest tech tools in our medical imaging arsenal. To the uninitiated, it can seem practically like magic, especially when compared with modalities like X-ray. It also (for now) remains a means by which a radiological practice can remain financially viable.

Unfortunately, to take full advantage of this, one needs to either learn how to use it, keeping current with new developments, or (horrors!) pay someone else to do it. Trying to skate by with subpar reads is asking for trouble; as with much of radiology, the evidence of what you missed is right there, in black and white, ready to be blown up to huge proportions for display in your very own medmal crucifixion. The higher quality the images you generated, the more unforgivable seems your failure to read them.

Some facilities seem to have found a loophole, however, by routinely producing lousy MR studies. Sufficient for dictation and billing purposes, the images they generate teeter on the brink between diagnostic quality and non-. A slush of barely decipherable pixels constitutes each imaging sequence, and with the resulting mess it is perhaps less noticeable when a barely competent reader renders a report rather than, say, a top flight subspecialist.

And since such craptacular studies are reimbursed exactly the same as the pristine ones, there’s virtually no downside to this approach…assuming one isn’t burdened by troublesome things like a conscience or professional pride. For those interested in downgrading the readability of their MR studies, these seem to be reliable methods:

Get lousy equipment. The field has come a long way, and manufacturers are working hard to outdo one another with gear that promises to make your studies better in every way. Fortunately, there is a robust market of secondhand and refurbished machinery out there. You can also cut other corners; such measures will not only give you crummy imaging studies, but will also reward you with lower overhead. An early post-training employer of mine was a shining example of this; one office contained a unit so old its alert noise was an old-fashioned ringing doorbell.[[{"type":"media","view_mode":"media_crop","fid":"29484","attributes":{"alt":"sabotage","class":"media-image media-image-right","id":"media_crop_9667366932637","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3051","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 301px; width: 150px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Inadequately staff. Some practices conduct careful recruitment campaigns to get capable, experienced technologists who have the knowhow and drive to get every last bit of quality out of their machines. Don’t be like that; instead, pay bottom dollar, ignore red flags that might pop up during interviews and background checks, or even force your current techs in other modalities to learn and cover MR whether they want to or not. And don’t waste valuable time or resources sending techs out for proper training - task your current demoralized, insufficiently trained staff to mentor one another.

Don’t communicate with the patients. Once you’ve made sure they don’t have pacemakers or other contraindications to getting scanned, have as little interaction with them as possible, and make sure your techs follow your lead. Any pertinent clinical history you might get from a patient might force you to add extra imaging sequences that could accidentally provide diagnostic answers to the clinical concern. Make sure nobody tells the patients that staying still while they’re being scanned will yield better images, and provide minimal instruction regarding breath-holding. Also, the less the patients understand how long the exam is likely to take, and the fewer of their anxieties are laid to rest beforehand, the greater the chance they will prematurely terminate the exam for you, gaining you extra magnet-time for other billable procedures while you dictate another “Limited” report.