Today on the Doc on the Run podcast, we’re talking about why runners should always get the second MRI at the same imaging facility.
Today’s question actually comes from a call I just got from a runner, and this is someone who has an injury and has something kind of strange going on. And he now has pain that he actually had an abnormal finding on an MRI from a little more than three years ago. At the time that he had that previous MRI that thing that was a little weird on his MRI wasn’t really causing a problem, but now his pain is in exactly that same spot.
So we were going to get an MRI to take a better look at it and see if that has actually gotten worse over the course of the last three and a half years or so. So the best way to do that is to get another MRI and compare it. But MRIs are not the same at all facilities.
I was just doing a conference in Hawaii recently where I was given a lecture and I was talking about medical imaging, and I was explaining that a lot of times when I do telemedicine second opinions for runners, I get MRIs that are sent to me to review with the runner. The slices on the MRI may be three and a half or four millimeters apart.
Some of the doctors in the audience didn’t even seem to be aware that some MRIs at some facilities have such a huge gap between the slices where you actually get to visualize what’s going on in the foot. And in the foot, four millimeters is actually a pretty long way and you can miss lots of things, like little tears in the planter plate, little ostacles or little bone fragments, little cysts in the bone.
Some of these things can actually get missed, so can small stress fractures and so it’s really important that you get an apples to apples comparison if you’re going to the trouble to get a second MRI. The title of this podcast actually suggests that you should get two MRIs and that’s not what I’m talking about.
Most of the time you should not get a second MRI to assess whether or not it’s safe for you to run. Most of the time you should not get a second MRI just to check things. But if you have a condition that had something that was strange or weird and you needed an MRI to really assess it, and you have to get a second one later to see if it’s gotten worse because your symptoms have gotten worse, then you should definitely get the MRI at the same facility.
Now, in this case doing so wasn’t really convenient. This is somebody that used to live way down the peninsula near Mountain View, and he got an MRI previously in Mountain View. Well, San Francisco is maybe an hour away, a little bit less maybe when there’s no traffic, but there is lots of traffic in the San Francisco Bay Area. So if you schedule it at the wrong time, like early in the morning or late in the afternoon, it could literally take you three or four hours round trip just to get there, let alone have the study.
He wanted to see if he could get the study in San Francisco instead of down the peninsula at a different facility. I said, “I think that’s a really bad idea. Since you really need this study and it’s really going to help you assess whether or not you need to have some minimal intervention or some really serious intervention to get you back to running and training the way you want, it’s worth making the trip to get it at the exact same facility where first of all, the radiologist will have access to your old study and will compare it side by side.”
In addition, the study that they do now will be a side by side comparison on the exact same machine with the exact same protocol, giving you a very similar MRI to compare it to the prior MRI. And that is why you really need to make sure that if you’re going to get a second MRI to assess something again, you get it at the exact same facility.