https://www.painscience.com/bibliography.php?herzog16

[Michael McMurray]

Have a read of the blog post and article.

Post your thoughts are how you can use this study to help discuss imaging findings with patients without disparaging the radiologists too much.

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[August Winter]

Well the blog post was sufficiently snarky, but the article itself was very interesting. Maybe the blog post’s cynicism is rubbing off on me, but I’m almost surprised that this would get published in Spine given its less than stellar reflection on imaging of the spine.

I think the information in this article would be most relevant to bring up with patients when their clinical examination and imgaging results are at complete odds with each other. The best way to discuss the imaging results might be to layout the basics of the article, highlighting the fact that this was done in a complete different state and only on one patient. I might say something like this: ” A study this past year by a group of doctors had a patient get 10 MRIs in 10 different locations, and they found that overall there was poor agreement on the findings and that 1/3 of the total findings were only on one report. I would likely avoid mentioning the false negative rate, as this might inspire more fear in the patient and focus on the “unknown” surrounding the low back.

I think if you wanted to be mindful of not coming off as disparaging the radiologist I would highlight the fact that some of these errors may have to do with nomenclature, schooling/different definitions, and variation in the equipment.

[Erik Lineberry]

I agree with you August, I think the article is really interesting and was a good read. I’m not sure how much of it I would attempt to explain to patients due to inducing fear. The first paragraph of the results section is eye opening. I knew that imaging was variable, but I would not have guessed the results would be this varied.

“There was marked variability in the reported findings across
the 10 study examinations. Across all 10 examinations, there
were 49 distinct findings reported (in either the Body or the
Impression section of the MRI reports) related to the presence
of a distinct pathology at a specific motion segment. The
findings included vertebral alignment, disc bulge, disc degeneration
and desiccation or spondylosis, disc height, disc
herniation, stenosis of the central canal, lateral recess and
neural foramina, nerve root involvement, end plate degeneration,
and facet degeneration. Among the noteworthy aspects
of this aggregated set of findings is that none of the 49 reported
findings were unanimously reported in all 10 study
examinations, and only one of the findings, the anterior spondylolisthesis
present at L5–S1, was reported in 9 out of 10
examinations. Of the interpretive findings, 32.7% only appeared
once across all 10 reports.”

It would be interesting to see this study expanded upon with different patient presentations and areas of the country. It would be interesting to see if imaging results shares a pattern with the prevalence and cost of surgeries in different locales across the states.

[Scott Resetar]

I agree with your sentiment, August. I think this study is most useful when imaging and clinical presentation do not match. Also, it might be useful for patients who start bringing up surgery even with relatively normal findings on MRI. Showing them this study might put them at ease a bit that their findings 1. may not be truly significant and 2. may not be the source of their pain.

This is a great addition to my current “Imaging Sucks” folder on my google drive.

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