Five Essential Questions To Ask The Doctor Before Having A Medical Scan

Direct to consumer marketing of diagnostic imaging is creating increased awareness, but few consumers are aware of the risks associated with these procedures. MedSolutions, specializing in radiology management services for nearly 25 million individuals nationwide, recommends that all patients ask five basic questions before having a medical scan.

“These essential questions promote patient safety and emphasize the importance of performing the correct imaging test the first time,” explains Pamela Dehmlow, M.D., vice president and senior medical director for MedSolutions and a board-certified family practice physician. “Individuals need to be aware that one CT scan can be as much as 300 times the radiation exposure of one chest x-ray, further emphasizing the importance of appropriate imaging procedures. These essential questions can specifically avoid unnecessary testing and promote safety for themselves and their families.”

1.      Why is this test needed? When a doctor says a scan is needed, do not hesitate to ask why and what added information it will provide. Ask how the scan will help make a diagnosis and how the results of the scan will affect your treatment.

Advanced medical imaging scans such as MRI (Magnetic Resonance Imaging), CT (Computerized Tomography) and PET (Positron Emission Tomography) are excellent tools in diagnosing and treating illness, but they should not replace a physical exam. The physician’s training and experience are often all that are needed to take care of the majority of health problems, without the need for expensive scans.

Also, just because a friend or neighbor got the latest high tech scan or there was an ad for it, does not mean that a scan should be done. Sometimes the doctor will tell say that a particular scan is not needed. Again, take the time to discuss the pros and cons of any scan with the doctor.

2.      What are the risks and side effects?

A. Exposure to energy source. Producing medical images involves an energy source that transmits pictures to film or computer. Radiation exposure (in CT studies), magnetic fields (in MRIs) and nuclear sources (in PET) must be considered:

• MRI. Done with a magnetic field and is considered safe for most patients. In general, it should not be done if someone has a pacemaker or an automatic defibrillator, has had recent surgery with metallic articles put into place, has known metal fragments in the eyes or tattoos that contain metallic dyes.
• CT. Done with ionizing radiation at higher levels than plain x-rays and is relatively safe if used when needed. Medical experts differ about how much radiation exposure leads to problems. This test should be avoided in pregnancy unless no other imaging would provide the needed information.
• PET. Done with a nuclear source and is considered safe for most patients. There is also a newer machine called a PET/CT scan that adds some radiation.

B. Allergic reactions. All of these scans might call for contrast, a sterile dye-like substance usually injected into a vein. In rare cases, contrast can cause allergic reactions that require immediate medical attention. Be sure to let the doctor know prior to a test if a reaction has happened in the past, or if there is a history of diabetes or kidney problems.

C. Other testing. Advanced imaging techniques frequently expose abnormalities that are not necessarily a health problem. However, the physician is obligated to do further testing to ensure there is not a problem. For example, while viewing a CT for someone with stomach pain, the radiologist sees something in liver or in the gland above the kidney that would never have caused a problem, but now the doctor has to do follow up studies to make sure. This causes inconvenience and extra tests – sometimes even a biopsy – and increases the cost of health care.

3.      How much will it cost? Is there a more cost effective alternative? The price of imaging studies varies, but CT is generally less expensive than MRI, which is less expensive than PET. There are many cases where less expensive imaging studies, such as an x-ray or ultrasound study, may provide the information the physician needs. Often, waiting for the results of blood tests or other tests such as biopsies will offset the need for imaging. Ultimately, it is a decision that should be discussed completely with your doctor.

4.      Where should the test be done?
Just as quality may vary at different stores, quality at medical imaging facilities also varies. Centers may differ in the age of their equipment and quality of the images. Target points of interest/concern may include:

• Are the technicians and technologists certified/licensed?
• Are the films read by board certified radiologists?
• Is the equipment up to date?
• Are proper safety measures in place for radiation and magnetic fields?
• Are you treated courteously and with consideration?
• Is it convenient?
• Ask the doctor if the recommended imaging center provides quality results.

5.  How soon should the test be done? Most advanced imaging studies do not have to be performed immediately. The patient should consider how long the health problem or condition has been present and whether it is improving or not. Take MRI of the lower back for sciatica, as an example. Most orthopedists and physicians who treat this problem agree that, unless there are complications, this problem should be treated for six to eight weeks before considering an MRI. Of course, if the imaging is needed urgently, the physician will send the patient to the appropriate setting at the right time.

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