Are Diagnostic Imaging Centers Superior to Hospital Imaging Departments?

[MsWobbles]

Hi, MSers and Limbolanders,

I finally paid to have my last brain MRI CD (done two years ago on a 1.5 Tesla at a local hospital) printed out into radiology films that I can actually read for the first time.  Five years previously I had had a brain MRI done at an imaging center that had given me complimentary old-fashioned, readable films.  

In my unprofessional opinion, the films from the imaging center appear superior to those from the local hospital radiology department.  They are clearer and better illuminated in general.  Many of the frames from the hospital MRI seem alright, but a few are really looking like wasted money - dark or overexposed.  

Also, in some of the frames from the hospital MRI done two years ago I am seeing quite a few bright white spots in areas that I don't believe involve bone.  What gives?  Are there supposed to be bright white spots that jump out at you in normal MRIs?  They mostly are in the shots taken after contrast was administered but a few are in the pictures before the contrast.  Yet my films are considered "negative."  Do the rest of you have bright white spots in your negative MRI films?

I recently found out that a local hospital here has a 3 Tesla MRI machine.  Yet, my experience with the last hospital-done MRI makes me wonder if I should hold out for a diagnostic imaging facility with a 3-Tesla instead of using the hospital 3-Tesla.

Seeking opinions:  What do you think?

WAF

[MsWobbles]

Thanks so much for the clarification about what the software does - that it actually translates numbers into images (I thought the software only interpreted the images!).  So if that isn't done well, even getting a second opinion might not help much!  

I just read the questions you posed to Dr. Kantor about MS diagnosis - they were great questions - so helpful to many of us!!

I can't imagine cancelling out an MS diagnosis just because an MRI remained static for some time.  Some MS episodes are years apart!!  

You add so much to this site -  I love reading your posts!!  Thanks!

WAF

[MsWobbles]

Interesting point!  If only I knew how to view an MRI CD myself at home.  But the neuro I have an appointment with insists on old-fashioned film images.

PastorDan, thank you for answering.

WAF

[PastorDan]

One possible issue is that you're looking at hospital films that are second generation images, printed onto film from the CD, which was generated by the hospital's computer.  The imaging center's films were likely first generation back in those days, meaning that the computer prints the film; there is one less layer of copying between the scan and your viewing of the image (no CD in between).  From my study of photographic processes, I recall that the degradation of an image increased with each successive generation.  In digital imaging, this is supposed to be an essentially nonexistent problem, but when film is involved, it could be a factor.

[Quixotic1]

Reminds me of a GW Bush joke.  He was being briefed on an uprising somewhere.  The advisor told him that at the end of all the shooting a Brazilian had been wounded.  Bush, said, "Remind me again.  How many are there in a brazillion?"

[Lulu54]

just a quick question Quix - how many zeroes are in a kazillion?

[Quixotic1]

Without the software there is no image at all, just a computer full of numerical data.

The software is what turns magnetic signals into a picture.  I remember in the 1970's when the CT was being developed by EMI ((the same EMI, (Electronic Music, Inc) of the Beatles)).  They told us that the computer needed to analyze 27,000 simultaneous equations per second in order to make the (essentially) 3D images.  That was mind-boggling at the time.  Now the software analyzes many kazillions of simultaneous equations per second to create the images.  Some analysis can and must be done by computer (like the computations of atrophy), but the whole image must then be read by the neuroradiologists - a difficult subspecialty of radiology.

I always think having a second opinion on a questionable or debated MRI interpretation is a good idea.

The "radiology assistant" is a great site.  I spend time looking there, too, but still don't try to read MRIs - at least not that I will admite to anyone, lol.  I don't want that responsibility, knowing that I would not be doing a good job.

Have fun!

Quix  :))

[MsWobbles]

Wow!  I got a lot of valuable info from you both - thanks so much for responding!

I'm going to go to that link you suggested Lulu.  I love playing amateur radiologist with my films (even though I know it's a somewhat useless game).  I have to feel like I'm doing something myself toward a diagnosis!!

And Quixotic - wow - I didn't realize that they used software to analyze the images.  I remember how, in apparently ancient times, radiologists used to just flip those images up on the illuminated screen and read them themselves!!  When they use the software, do they still review the films themselves too?  I hope so.  

I know that now hospitals are using long-distance radiologists, such as a service called "Night Hawk," to read x-rays on the night shift - so assessments about our MRIs could be coming from countries far, far away.

Anyway, I guess if I don't feel comfortable with the interpretation, I can always send the films to a "name" institution and have them read there.  That is what my son's orthodontist's husband did - because he continued to have symptoms, he sent his images (originally read as "negative") to another institution and found out he had pancreatic cancer.   But you have to have good quality films to begin with, so I think finding a place with a good 3Tesla machine and experienced MRI techs is very important!!

Thanks so much for your help!!

WAF

[Quixotic1]

Well, I disagree with Lu a little here.  There are many "white spots" that are seen on one slice that can be carefully traced through subsequent slices to normal structures.  Most of the things you can point out with be demonstrated to be normal.  I know, I have been there with the radiologists pointing them out.  Common structures that show brightly on MRIs are larger blood vessels seen "on end."   Another source of mistake is the appearance of the cortex as it follows a brain fold deep into the brain.  On one slice the cortex may appear to be disjoined from the rest, but as your creep through all the slices you see it join up again.

Although it is fun and hard to keep from doing, trying to read your own MRIs is folly, unless you have a pretty great understanding of neuroanatomy.  And Lu is right.  I won't look at people's MRIs because I know that I am not skilled, despite my experience.

On the issue of who has the better machines.  It depends COMPLETELY on who has most recently spent the millions of $$ to uprgrade the machine AND the software.  I had quite a discussion with my neuro about this.   The software that is used to analyze the images is of critical importance.   He stated that with poor software a 3T machine can be worse in resolution than a 1.5T with really great software.

There are hospitals with dynamite MRIs and fly-by-night stand alone centers with old crappy machines.  So there is no rule that says where you are going to get the best pictures.

Sorry not to be able to give anyone a good rule-of-thumb.  I do think that many of the really fancy larger centers do keep their machines updated better than many hospitals can.  That is the case where I go by request of my neurologist.  He actually knows what software is better and who has what.  That's pretty impressive.

Quix

[Lulu54]

No, our brains should not show bright white spots on MRI films.  I just copied this link for someone else -
http://www.radiologyassistant.nl/en/4556dea65db62#p4594f74ccbf19

check out the pictures and see if it helps you to see lesions.

Reading films is such an artform, even Q won't do it here.  

be well,
Lulu