Physicians have long prescribed the use of MRI's, or magnetic resonance imaging, to assist them in accurately diagnosing and treating patients. MRI's provide valuable information-without the use of radiation-that physical examinations may not always reveal. However, negative publicity has recently surfaced alleging that MRI's are overprescribed and potentially causing more harm to patients than good.

Consider: approximately fifty percent of all middle-aged people show evidence of a partially torn rotator cuff on imaging, but never knew they had it. Why? Because the tear does not cause them pain or affect their activities of daily living. A similar study shows that ten percent of participants, who claimed to have no pain or disability, had disc degeneration or a condition known as a “spondylo” appear in images of their spine (What's even more ironic is that people with “normal” images typically have a higher likelihood of injury than people whose images appear “abnormal.”). Doctors see these “abnormal” findings in the image report and are ready to pounce on them, whether they're the source of the patient's problem or not. Are imperfect MRI finding causing doctors to treat patients for injuries that are not the cause of their disability or pain?

There are over 28 million MRI's performed every year in the US, and they are expensive. A simple MRI of the knee can cost up to $ 2,000. It makes sense that an MRI scan costs so much when you figure that the price of owning an MRI machine is anywhere from $ 300,000 to $ 1 million. That's a lot of overhead. Are doctors, who own MRI machines, unnecessarily prescribing MRI's to recoup their costs? Are doctors, who do not own MRI machines, unnecessarily prescribing MRI's because they receive kickbacks from the owners? Who knows? I sure do not know, but this is something else to consider.

There is no denying that MRI's and other imaging are critical to the health of a patient and the efficiency of the physician. I have personally prescribed multiple MRI's during my clinical days and do not regret a single prescription. However, every MRI I've prescribed fell within two categories: the patient suffered recent trauma or injury, or the patient did not show improvement after two-three weeks of conservative care. I recommend that you receive an MRI or other imaging if you fall within these two categories, as well.

MRI's are critical to the health care industry. They provide valuable information that is often hidden to the naked eye and ambiguous upon physical examination. However, make sure your doctor is justified in prescribing one. I recommend the following tips to help you decide when you need an MRI:

-Get a second opinion. Whenever your doctor tells you anything you are not 100% comfortable with, get a second opinion. This rule applies to imaging, too. If you do not think you need an MRI, get a second opinion. If your second opinion tells you to get an MRI, get it.

-If you have not had recent trauma or injury, try conservative care first before you schedule an MRI or other imaging. Try the conservative care for 2-3 weeks. If you do not have improvement after 2-3 weeks, get imaging.