dear kamary

yes - CT and MRI are overused

In many cases you may get the diagnosis with ultrasound alone

regards

ferdinand

Yes. In middle east unfortunately so many repeated CT. Referees have lack of knowledge of radiation overexposure 

yes thats a problem 

the radiation from ct scans is relatively high

is a big problem 

regards

ferdinand 

Absolutely agree with Dr. Frauscher. But in some cases (knees injury) MRI is more preferable.

Absolutely agree with Dr. Frauscher. But in some cases (knees injury) MRI is more preferable.

dear boris

for joints and head MRI is the best

regards

ferdinand

While there is no hazards from using MRI the CT scans should be strongly restricted.

Thank you for all your answers.

Dr. Nasser Ballani, I have read about the inconsistency in radiation levels when using MRI and CT scans. Do you agree that would be a hazard? 

what would be your main reasons to request an advanced imaging test in pediatric patients?

I already understand that there is a preference for head trauma. But it was mentioned knee or joints in general. What conditions would make you say that MRI and CT scan is the invaluable? In your opinion, where x-ray is not enough?

Thanks

Dear Jasna,

Thank you very much for your amazing clarification. This brings me to understand much better how some decision are made. 

Kamary

Dear Jasna,

This true and therefore we are considering to work diligently to understand what are the most common diagnosis in ortho, investigated with advanced imaging in pediatric patients. Initially it may be a retrospective study, but we will have a second phase which will involve the physicians and imaging technologists to promote education.    

I am a radiologist and I refer here that our Scientific Society (SIRM: www.sirm.org)end SNR have stated that MRI is overused and that Italy is the place all over the world where the highest number od exames has been done.

I am a radiologist and I refer here that our Scientific Society (SIRM: www.sirm.org)end SNR have stated that MRI is overused and that Italy is the place all over the world where the highest number od exames has been done.

Dear Ferdinand,

I would not be so optimistic about ultrasound in contrast to CT and MRI.

Please take into consideration that ultrasound is much more sujective examination that CT and MRI.  There is not much space in ultrasound for consultation in contrast to CT and MRI. And there are objective advantages of CT over ultrasound eg hounsfield units of adrenal masses in contrast to very little differentiatial information in ultrasound. What can you say about bowel gases in ultrasound that make imposible to see the pancreas and aorta with serious patologies.

However would you comment that only 50% prostate cancers are visible on B-mode TRUS? However I strongly belive that, in prostate, ultrasound could give us in the future more valuable information however the phisicists and engineers have to work harder on new developements.

And last 

Please kindly compare the number of fruitful technical advances and developments in MRI and ultrasound in last 20 years. There is also huge predomination of research papers in the field of MRI over ultrasound.

I am telling all this from the position of a MD practicising 22 years in ultrasound up to nowdays but doing my PhD in MRI at the begining of my medical career.

Regards

Rafal

Dear Colleague

Determination of the need for such modalities is a physcian role by justifying the real need with considering the cost, patient safety and the expected outcome. I think more training specially for junior physcians will eliminate the overuse without justification

this is so easy to answer in hindsight with the retrospectoscope. Or even better on a desk running analysis on a population based retrospective study....however in real life where physicians must decide, in broad day light or night alike; some times under time pressure, some times biased by a recent case, sometimes afraid of medicolegal implications ....it becomes harder to only order the best exam

off course there will be overuse, how else can one be sure that all necessary examinations have been carried out... 

and yes it is frustrating that we have examinations and time and effort spend when in hindsight it could have been done without... however ...better safe than sorry and first don't harm are still relevant 

 I completely agree with Johan.

Real life is unpredictable and surprasing. 

We do not know who MD will be caring the patient. How seriously he will act according to our ultrasound report. What is the knowledge of the MD. What kind of personel he is? Thoughtful in regard of patient? Etc.

As an example I may give the example when Family phisician takes the results of emergency ultrasound as final, because ot was performance by experienced ultrasonologist (MD). He thinks what is the reason to spend extra money for aditional ultrasound. However he does not know that in many cases

hello

I agree that for ultrasound you have to be well trained.

but when you look on data of the incease of CT scan within the last 10 years (NEJM) - there is definitively an overuse!!

regards

ferdinand

dear rafal

concerning TRUS

depends on the system resolution

MRI t2 is similar

the mpMRI is better - but for routine too expensive

we will test a new system with TRUS 29 MHZ!!

this will be a new era in TRUS

regards

ferdinand

Dear Ferdinand,

That is great that you will perform such interesting research. We have just published on application of 50MHz ultrasound for vulvar skin examination in gynecological patients. The images look as histology. I hope that you will also see histology with your 29 MHz probe😊 I wish you it is a breakthrough in prostate cancer diagnosis. I keep my fingers crossed. Because it is very important issue for men.

Regards

Rafal 

don't agree

cost and availability in resource constrained settings of Africa limit their usage

I believe they are both over and under used. For example MRI has been overdone in chronic back pain to look for small intervertebral disc bulges even though diagnosis and decision to surgically intervene is based on clinical criteria. On the other hand there is too much dependence on Ultrasound for abdominal cases to rule out abdominal pathology which can easily miss the findings. I believe CT should be used when patient is symptomatic and Ultrasound fails to reveal anything. Recent COVID 19 pandemic has highlighted the usefulness of CT, even when RT PCR and X ray is negative.

I agree that we having and overuse of all imaging modalities - US, CT and MRI.

US is harmless, even the results depending very much on the experience of the ultrasonographers.

CT is the problem with ionizing radiation.

I would say that there are some areas where US is very limited - lungs.

I believe the US centers - with very well trained ultrasonographers may increase the value of US.

Do you agree? thanks