Dear Readers, One of the most common questions I receive in person and online concerns radiology and medical imaging. In my experience as a radiologist, I have observed many gaps in patient care including:
The mammogram and colonoscopy industries have driven me wild over the years. Seems to me that the crunch-em-flat mammography would be injurious and even encourage metastasis. Risks of bowel prep in the elderly, perforation and bleeds are such an issue with colonoscopy. What do you think?
I once had to have an x-ray scan of my jaw. When I asked the lady in charge of the equipment what dose of radiation she gave me, she was completely clueless. Could not even give me a guesstimate.
Much as I'd enjoy complaining, I haven't had any problems with radiology. Dental X-rays are much easier now that they use digital "film". Once when I went to the ER for a problem that turned out to be a migraine symptom, the neurologist tried to upsell an MRI, but he didn't push the issue and allowed me to decline the offer.
I'm most interested in incidental findings. Say I have a chest CT scan - showing "bilateral ground glass pneumonia" - OK that's good to know but I already knew I had some type of pneumonia before they did the scan. Now, did they see a slightly enlarged heart? A kidney cyst? A scoliosis? All things that not only should be noted but in some cases should be followed up - but seldom are.
Just a heads up for you, and maybe our Dr Remnant can comment as well. You need to educate yourself on Oxalate damage.
So how does radiology respond to Oxalate damage, hard to see maybe be very pervasive everywhere in the modern diet. Like OldSysEng vividly describes, that ground glass is exactly what Oxalates do anywhere in the body. It affects kidneys big time because it’s the kidneys role to get rid of it.
So how can radiologists relay to people that it appears that you have a plant poison problem.
I’ve been on the low Oxalate diet (in my 4th year) because a family member was clearly Oxalate toxic, but got no help from the medical establishment. I’ve been gleaning information from Dr’s like Dr Remnant that lead me to Sally Norton and TLO group on Facebook.
Thank you for being you Dr Remnant and actually caring about people!
I've had two kidney stone attacks, although the stones were too small to find in the screen "catcher". First time I was expecting it to be muscle cramp but blood in urine and ultrasound showed the tiny kidney stones. I'm recently reducing oxalates - thanks!
OldSysEng when you said crushed glass in your lungs and cysts. I was ‘Oh my this person needs to have Oxalates on their food radar’. But kidney stones too! I started the low Oxalate diet thinking I didn’t have that problem (supporting a family member that is definitely oxalate toxic). I learned, I’m Oxalate toxic too!
So relieved to here you’re reducing Oxalates. The scientific data is full of the damage Oxalates do in the body, but the data has been largely ignored.
My personal issue is being told, with held breath, that I have ‘extremely dense breasts’ after a mammo. I’ve been hearing this since I got my first ob/gyn exam in my early 20s. They’ve never told me I have an actual issue, and it’s never changed. Is it because it makes it harder to tell if something is there? I really wish they would just stick to facts, like ‘no evidence of any abnormalities’ and be done with it.
I'd like to know what different medical imaging platforms pros and cons. What will ultrasound show vs Xray vs CT scan? If dense breasts, which platforms will best image health/disease? Microcalcifications monitoring? When is needle biopsy better? When getting contrast Xray or CT scan and they can't get a vein to get contrast in but they image anyway, when does a patient protest? When ultrasonographer can't find right kidney (and admits it) when does a patient call in another operator to get it done correctly? Maybe things patients can do to help get best images from various imaging platforms? I think medical imaging is awesome but I see so much sloppiness and lack of basic anatomy in the techs who are collecting the images. When is good enough OK?
I'm concerned about being overexposed to x-ray frequencies. My Dentist has taken multiple X-rays along with my GP Dr. Everybody using X-rays for diagnostics and nobody monitoring my total exposure to ionizing radiation by healthcare providers.
Why wasn’t my mother’s brain imaged before they took out her lung for lung cancer since brain cancer is often where lung cancer metastasis?
What can imaging diagnose?
A friend suffered intense hip pain for over seven years and X-rays of hip made doctors think she was crazy because X-ray showed nothing. An mri showed some spurs but not enough to get doctor to operate. Finally, after multiple ER visits a hip replacement was approved. Hip Surgeon commented how the spurs were very numerous and obviously painful and more than expected so surgery took longer than expected. Why did this happen?
There high dependency on labs and scans, and low use of physical examination techniques. There is fairly high error in lab results so it would be good if docs could evaluate physical signs and symptoms better.
A vast body of humor surrounds the mis or disuse of the stethoscope in western medicine. CAT scans are a real concern with respect to accumulated radiation exposure. X rays, not so much radiation as in the past.
Thank you. Attended FNP masters program, UCLA. Physical exam in 1991 always included exam of system below and above area of complaint plus listening to heart and lungs. Look, listen, palpate. Today, any type of physical exam, here in the Uk is nearly extinct. Most gps order a blood test and send you on your way. You will not get an X-ray for weeks, ct or mri will take months here. Sometimes that is good as the tincture of time continues to heal certain problems.
Absolute truth! that in the early 90s physical exams were still happening. By the early 2000s, it was a whole new world in the U.S.
And we get those delays too. Third party payment systems really engineer the denial of access even for people who would have been able to pay outright. Private pay is still allowed here, so it's weird to hear people who have actual $$$$ tell me that they have to wait for their insurance to allow a test. (I saved money and used a cheaper, high deductible plan in order to manage initial care.)
Those who are able should hide some cash to buy testing for anything that really scares them, or that they would act on. (People have gotten immediate scans here by flashing the cash.) Third party payment is used to delay diagnosis, because once the diagnosis happens, the excuse to delay/deny treatment is reduced.
All in here, Doc
https://twitter.com/TheMenta1ist/status/1689897511522369536
The mammogram and colonoscopy industries have driven me wild over the years. Seems to me that the crunch-em-flat mammography would be injurious and even encourage metastasis. Risks of bowel prep in the elderly, perforation and bleeds are such an issue with colonoscopy. What do you think?
I once had to have an x-ray scan of my jaw. When I asked the lady in charge of the equipment what dose of radiation she gave me, she was completely clueless. Could not even give me a guesstimate.
What percentage of Drs contact you to discuss/clarify results of your reports ? Maybe that’s not a thing. Maybe that’s a tv thing.
A lot more than you'd think.
A lot more than I had expected, going into the job.
Contrast dye (gladolinium?). Are you aware of any harms?
https://medicalxpress.com/news/2023-02-nanoparticles-rare-earth-metal-mri.html
Thank you. Gadolinium. 😲
Much as I'd enjoy complaining, I haven't had any problems with radiology. Dental X-rays are much easier now that they use digital "film". Once when I went to the ER for a problem that turned out to be a migraine symptom, the neurologist tried to upsell an MRI, but he didn't push the issue and allowed me to decline the offer.
I'm most interested in incidental findings. Say I have a chest CT scan - showing "bilateral ground glass pneumonia" - OK that's good to know but I already knew I had some type of pneumonia before they did the scan. Now, did they see a slightly enlarged heart? A kidney cyst? A scoliosis? All things that not only should be noted but in some cases should be followed up - but seldom are.
Just a heads up for you, and maybe our Dr Remnant can comment as well. You need to educate yourself on Oxalate damage.
So how does radiology respond to Oxalate damage, hard to see maybe be very pervasive everywhere in the modern diet. Like OldSysEng vividly describes, that ground glass is exactly what Oxalates do anywhere in the body. It affects kidneys big time because it’s the kidneys role to get rid of it.
So how can radiologists relay to people that it appears that you have a plant poison problem.
I’ve been on the low Oxalate diet (in my 4th year) because a family member was clearly Oxalate toxic, but got no help from the medical establishment. I’ve been gleaning information from Dr’s like Dr Remnant that lead me to Sally Norton and TLO group on Facebook.
Thank you for being you Dr Remnant and actually caring about people!
I've had two kidney stone attacks, although the stones were too small to find in the screen "catcher". First time I was expecting it to be muscle cramp but blood in urine and ultrasound showed the tiny kidney stones. I'm recently reducing oxalates - thanks!
OldSysEng when you said crushed glass in your lungs and cysts. I was ‘Oh my this person needs to have Oxalates on their food radar’. But kidney stones too! I started the low Oxalate diet thinking I didn’t have that problem (supporting a family member that is definitely oxalate toxic). I learned, I’m Oxalate toxic too!
So relieved to here you’re reducing Oxalates. The scientific data is full of the damage Oxalates do in the body, but the data has been largely ignored.
My personal issue is being told, with held breath, that I have ‘extremely dense breasts’ after a mammo. I’ve been hearing this since I got my first ob/gyn exam in my early 20s. They’ve never told me I have an actual issue, and it’s never changed. Is it because it makes it harder to tell if something is there? I really wish they would just stick to facts, like ‘no evidence of any abnormalities’ and be done with it.
Dense breasts limits the ability of the interpreting radiologist to discern a density from background normal breast tissue.
They prefer fattier breasts, so the densities pop out.
I'd like to know what different medical imaging platforms pros and cons. What will ultrasound show vs Xray vs CT scan? If dense breasts, which platforms will best image health/disease? Microcalcifications monitoring? When is needle biopsy better? When getting contrast Xray or CT scan and they can't get a vein to get contrast in but they image anyway, when does a patient protest? When ultrasonographer can't find right kidney (and admits it) when does a patient call in another operator to get it done correctly? Maybe things patients can do to help get best images from various imaging platforms? I think medical imaging is awesome but I see so much sloppiness and lack of basic anatomy in the techs who are collecting the images. When is good enough OK?
I'm concerned about being overexposed to x-ray frequencies. My Dentist has taken multiple X-rays along with my GP Dr. Everybody using X-rays for diagnostics and nobody monitoring my total exposure to ionizing radiation by healthcare providers.
What is the difference between an x-ray, MRI and Catscan, and when should those particular tests be ordered.
Why wasn’t my mother’s brain imaged before they took out her lung for lung cancer since brain cancer is often where lung cancer metastasis?
What can imaging diagnose?
A friend suffered intense hip pain for over seven years and X-rays of hip made doctors think she was crazy because X-ray showed nothing. An mri showed some spurs but not enough to get doctor to operate. Finally, after multiple ER visits a hip replacement was approved. Hip Surgeon commented how the spurs were very numerous and obviously painful and more than expected so surgery took longer than expected. Why did this happen?
Is medical imaging over used?
There high dependency on labs and scans, and low use of physical examination techniques. There is fairly high error in lab results so it would be good if docs could evaluate physical signs and symptoms better.
A vast body of humor surrounds the mis or disuse of the stethoscope in western medicine. CAT scans are a real concern with respect to accumulated radiation exposure. X rays, not so much radiation as in the past.
Thank you. Attended FNP masters program, UCLA. Physical exam in 1991 always included exam of system below and above area of complaint plus listening to heart and lungs. Look, listen, palpate. Today, any type of physical exam, here in the Uk is nearly extinct. Most gps order a blood test and send you on your way. You will not get an X-ray for weeks, ct or mri will take months here. Sometimes that is good as the tincture of time continues to heal certain problems.
Absolute truth! that in the early 90s physical exams were still happening. By the early 2000s, it was a whole new world in the U.S.
And we get those delays too. Third party payment systems really engineer the denial of access even for people who would have been able to pay outright. Private pay is still allowed here, so it's weird to hear people who have actual $$$$ tell me that they have to wait for their insurance to allow a test. (I saved money and used a cheaper, high deductible plan in order to manage initial care.)
Those who are able should hide some cash to buy testing for anything that really scares them, or that they would act on. (People have gotten immediate scans here by flashing the cash.) Third party payment is used to delay diagnosis, because once the diagnosis happens, the excuse to delay/deny treatment is reduced.