197- The Fundamentals of MRI Review

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor.

I AM your host, Dr. Jeff Langmaid.

This week we have a super important clinical episode. We are diving into the four fundamentals of MRI review. I know a lot of docs out there that just don't feel as comfortable as they would like reviewing MRIs and popping in that disc in front of the patient. Too many chiropractors out there are rely too much on the reports or they maybe only look at the lateral or sagittals and ignore those axial cuts. And that just needs to change. We're gonna start that change on today's episode. Additionally, I have released the pre order for my MRI essentials course. It is 50% off until September 30th. That is the pre order. It comes out September 30th. You can pick it up for less than 50 bucks. That's 50% off the price. MRI essentials for the practicing Chiropractor. You can get it at the evidence basedchiropractor.com on pre order and it is coming out at the end of this month. This episode is a little bit of teaser but all of the deep dive material to make you feel comfortable and confident reviewing MRIs with your patients. There's going to be an online portion of it. There will also be PDFs that showcase common conditions, common terms and examples. Course is awesome. Check it out. Pick it up for 50% off before September 30th at the evidencebasedchiropractor.com as always, today's episode is sponsored by Rock Tape. Check out Rock Blades Mohawk if you haven't done so yet. I just was out at Rock Stock 2019. Awesome time out there. So check out our YouTube channel and Facebook page to see all the behind the scenes. But if you have not checked out Mohawk and you do soft tissue work, please do so. It's 175 bucks. You get the Mohawk itself, the tool.

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Headed over to the evidence based Chiropractor and picked up MRI essentials for the practicing chiropractor, I would encourage you to do so. Get your 50% off check it out at the evidencebasedchiropractor.com and enjoy today's episode where we dive into the four fundamentals of MRI review.

The goal is to work through the four fundamentals so that you have a better understanding of where to go the next time somebody gives you that disc.

Also, special shout out on the Evidence.

Based Chiropractor Facebook page. We are now doing a future feature called the Big Picture. It's all about radiology. So at least once a week you are going to see me live reading.

An MRI and or some case studies.

That you can comment on. We can jam on them and make sure that you are headed in the right direction. So check out the Big Picture, which is a radiology series on the Evidence Based Chiropractor Facebook page and you can check it out on the evidence based chiropractor YouTube channel. But we are going to break down four fundamentals. We're going to talk viewer, we're going to talk tools, we're going to talk process, and we're going to talk double checking for success. So let's start that right at the top with viewer. I absolutely dislike any time that I have to rely on the viewer that comes on the disc. If you are somebody that does not have a viewer on your computer, your own viewer, and you're probably thinking yourself, oh man, I might be one of those people, you want to change that immediately. If you are reliant upon the viewer that comes with each individual MRI, reading MRIs is going to be a nightmare for you. All the viewers are dramatically different. I've had some MRIs I popped in, there's like 32 pictures. I can't tell, you know, try to bring it down to 16 and it goes to 64 pictures. The viewers that come on these MRI discs are a mess and a disaster. So what I typically recommend, what I always recommend, is to have your own viewer. Now there's a very simple way to go about this. If you use a PC, if you are a PC person, there is a viewer called Radiant Viewer. Radiant Viewer, you can download it. There's probably a free version of some sort. Radiant Viewer. If you are a PC person, if you are a Mac person, I recommend Osiris. That's like O S I R I X I believe. Oh, Sirix. That is what I use personally. And there is a free version for Mac. Having your own viewer. What having your own viewer enables you to do is a couple of different things. Number one is enables you to, as we're going to talk about later, have.

A system and a process.

Every time you open up that viewer, you know exactly where your tools are, you know exactly how it opens. It saves you a ton of time. And you don't have to, like, start sweating it out. You pop the disc in in front of a patient, you can't even figure out how to get the right pictures on the screen. And that's not comfortable for anybody. So if you download your own viewer, it's going to be the same, right? Standardizing, which builds efficiency. So I highly recommend picking up Radiant or Ocarix, depending upon whether or not you are a PC or a Mac person. That is number one. Number two fundamental, your tools. There's a couple tools. When you open up a viewer, you're going to see a massive amount of tools. Those tools are because for everything from neuroradiologists, DAC bars, you name it, there's a million different tools you can utilize. Almost like photo. If you open up a picture program, right, there's a million different tools, but the 8020 rule applies. That's the good news, right? You're not going to need to use a million tools. There's really just a few tools that are going to be super imperative for you. They're going to be the measure tool, the contrast tool, the zoom tool, and the scout lines tool. We'll go through those one by one. Now, typically is the good news, those are clustered in the middle top of nearly every MRI program because they are, as you can imagine, the most commonly used tools. So if you check out, if you open up your system, your program, you look at the top, in the middle, you should see a toolbar like little icons. In nearly every single radiology software is going to have a measure tool, which is pretty obvious, right? It allows you to measure things. You get to. You'll click on an area, let's say the edge of sacrum, you drag a line to the edge of L5, and you can get to see if there's a spondy, right? How much distance is there between those two points? So the measure tool is great to measure, like quick estimations on disc heights. I used it most predominantly to measure spondies. And probably, number one reason I'd use it to measure the central canal. So if I'm evaluating spinal stenosis, I love to know how much of the central canal is being taken up. 60%, 50%. Are they 10 millimeters or more A to B dimension as they should be, or are we looking at 6? Are we looking at 5? Are we looking at 8? So I used it a lot in the central canal as well as for measuring Spondy's measurement tool. Absolutely. Clutch secondarily is your contrast tool. Thank goodness. The days of, like, mri, excuse me, X rays with chemicals and manually turning big, you know, mass knobs and all this. Thank gosh, that's over. By the way, I never shot an X ray that didn't come out either completely black or completely white. So thank God for digital systems because it makes it so much easier. Including with your MRIs, the contrast tool allows you to simply typically either drag your mouse up or down with a click, and it either increases the contrast or decreases the contrast. It kind of looks like either it's getting brighter or dimmer. So regardless of, you know, whether the person might be a little bit thicker, maybe they're a little bit thinner, that's going to affect, you know, how the MRI comes out in terms of quality and in terms of how much light passes through, so to speak, or what's perceived as light when you view it. And the contrast tool enables you to make it so you can see everything, right? So if the image is a little bit dark, you're not. Not dark. You're not just stuck with that. You can brighten it up using the contrast tool. The third tool is the zoom tool. Zoom tool is crucial because if you are starting to see, is there a little bone spur there? Is there a little cyst forming? The zoom tool allows you to, as you can imagine, zoom directly in, get a really, really good view of whatever it is that you're looking for. So zoom is clutch and then scout lines. You need to know where you're at, right? So if you're looking at something on your sagittal or your lateral and you're saying, gosh, I'd love to see the cross section of that. The scout line makes it easy to rectify your sagittal or your laterals against your axial pictures.

So get your tools set up.

Number one was viewer. Number two. Get those tools set up, and the four big tools are gonna be your measurement tool, your contrast tool, your zoom tool, and your scout lines. Make sure you know where those are. If you know where those are, then you're gonna be great, like 80 to 90% of the time. Step number three, fundamentals. Number three is have a process. So I don't recommend also just like, throwing in the image and being like, okay, well, I just kind of go for it each time. Not a good way to read, right? So all when I say have a process, I mean, make sure that you're bringing up. Lets for me, I bring up my T2 weighted images. So I pop in a disk, I make sure on the left hand side, I bring up two windows. On the left hand side, I always put my sagittal or my lateral. On the right hand side of the screen, I always put my axial. I do it the same way every time with T2 weighted images every time to start because it gives me the foundation by which I can do good reads. So I'd say stay consistent and have a process. And then once you do that, make sure that you're reading pretty linearly, so to speak. So I always do on my sagittal or my laterals, I take a quick look at the vertebral bodies, what's going on there? Then I move what's going on with the discs? Then I say, okay, what's going on with the canal and. And what's going on in the foraminal canals? So I read in a systematic fashion. Then I look to my axials, right? So now I got a good idea. Now I'm gonna say, oh, okay, I got a good idea. On my sagittals, Let me look over onto my axials and rectify this and make sure what I'm seeing is true. So that's just process and procedure. I highly. Yours might be a little bit different, and that's a. Okay. But I recommend having a little bit of a process. Doesn't need to be super firm, but just kind of know where you're going, know where you're starting, know where you're trying to get it. Enables you to read quicker with better quality and less misses, so to speak. The worst thing to ever do on an MRI is to miss something. It's okay to, as I always say, I don't know necessarily the difference between a schwannoma and a neurofibroma. That's why we have great DAC bars. That's why we have great neuroradiologists. I want them to be able to read those what I'll call hard organic complaints. But there's no question that I should be able to identify spinal stenosis, foraminal stenosis, degenerative discs, and not only have to rely on the report or popping in the disc, even worse, popping in the disc and only looking at the laterals because it looks closest to an X ray, which I'm used to reading. Right. I've just seen that so many times where docs shy away from those axial views because it just looks a lot more Complicated. And they haven't got those reps in. So these fundamentals are enabling you to get those reps in to understand where you're going and where you're headed. And that makes things so much easier. Remember, on your axials as well, left and right are typically reversed, so it looks up, not down, so to speak. So keep that in mind with your axials. And number four is double check. So fundamental number four is double check. So this is where those reports are super valuable. I'm not diminishing the necessity to having a high quality neuroradiologist or radiologist report, but you should be using that as a cross reference, as a double check for success, not as your only look at what's going on. If it's your only look at what's going on, you might notice this degenerative discs and disc bulges and or herniations at multiple levels. And without you taking a look yourself, you have no clue necessarily which one is worse, which one. You know, I've seen so many reports where it just lists, you know, disc bulges, degenerative changes, all level after level after level. And then I put in the disc and look at it, and one is mild, one severe, and there's just wild differentiation once I'm looking at the pictures, even though the report was a little bit boilerplate. So it's why it's so, so important to review those MRIs with your, get a great understanding of what's going on with your patient. And unlike the radiologist, you have the, you're in the fortunate position. You get to literally physically examine the patient, you get to take a case history, so you are the person to be able to put it all together. But I would encourage you to make sure that you're putting it all together. Not just your history, not just your physical exam. But if somebody has advanced imaging, don't hesitate to get in there, take a look at that imaging, be able to have those great discussions with your patients, be able to help them make the best decisions for their health. That's ultimately what it's all about. But I'd encourage you to use these four fundamentals so you can make sure you have a system. Get your viewers set up, number one. Number two, identify those four key tools, make sure you know where they're at. Number three, make sure that you're working through a process. It can be very simple. And number four, use your rad reports as a double check and a cross reference to what you're seeing. That's a great way to go about it. If you have any questions about this, feel free to shoot me an email. Jeff the evidence basedchiropractor.com Also, I love to see the ratings and reviews on itunes. So if you've been listening getting value out of this, leave us a rating, feedback or review on itunes. That is awesome. It helps more and more docs find the podcast and as always, keep an eye out for the big picture, which is the new radiology series we're gonna be having across the Evidence Based Chiropractor Facebook page as well as the evidence based chiropractor YouTube channel. I hope you have a great week in practice and I'll talk to you soon.

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