09/19/2012 05:54 pm ET Updated Nov 19, 2012

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What Your Radiologist Needs to Know Before an Imaging Study

You've been feeling under the weather lately, or you have aches and pains or swelling that just will not go away, or you just don't feel like yourself. You are hoping these signs, symptoms, and feelings are nothing serious, but you call your doctor to set up an appointment, just to make sure.

During the doctor's visit, you state your symptoms and consciously or unconsciously decide what to include. Maybe you have "white coat syndrome" and are reluctant to speak. Maybe you don't want to bother the doctor with all your symptoms because maybe you believe that they are not that important. You may not know what is important, or you may be afraid to say what you are thinking because it may indicate something "frightening." Perhaps, because you want to control the situation, you feel that if you reveal too much, the doctor will tell you what you do not want to hear. Maybe you feel, "The doctor knows best and should know what is important, so it is up to the doctor to ask!"

Signs and symptoms can be subtle. Since you know your body better than anyone else, typically you may be aware of early and mild changes before they are easily detected and before they become serious. The thought of some diagnoses and/or recommendations can be scary, but it is in your interest and of utmost importance that your doctor know everything there is to know about your signs and symptoms, so that an accurate diagnosis can be made.

You may wonder if it is important to reveal every aspect of your medical history. In many cases the answer is yes, and for a very good reason. Some conditions can cause signs and symptoms that may seem unrelated. For example, you may know that you have psoriasis because of skin or scalp lesions, and yet not realize that your recent foot or hand pain may be related. Your doctor may not see the skin plaques, and if you do not relay that information, the prescribed treatment may not be appropriate. Treatment plans may vary and may be dependent on the undisclosed information. Another example, for instance, is if you are having chest pains and your family has a history of heart disease. This information is critical for your doctor to determine how to manage your symptoms and advise appropriately.

In trying to decide on the appropriate treatment, your doctor may recommend that you have an imaging examination -- for example, an X-ray, MRI, CT, nuclear medicine or ultrasound -- to confirm or exclude a suspected diagnosis. Although imaging procedures are performed with your safety in mind, your medical history and information can be very helpful for determining which imaging examination is most appropriate, and how the examination is obtained -- for example, how you are positioned or the protocol used. Typically, the radiologist is only provided the information passed on from the referring physician or their office staff. You can never be 100 percent certain that everything you have told your doctor will be revealed to the radiologist. The intake form you are given prior to your imaging examination is critical. So when you fill out that form, the more specific you can be, the better, such as: Where does it hurt? Is it general or focused pain? How long have there been symptoms? Is the condition getting better or worse? Was there a fall or car accident? If so, when? Etc. This form may be the only way for you to communicate with the radiologist.

In addition to your symptoms, there are other things that the radiologist needs to know. Do you have any allergies? Have you had contrast agents previously; did you have any reaction to the contrast? Do you have any kidney issues? Do you have diabetes?

There are also safety concerns which differ by modality, e.g., for CT and for MR. For instance, for most patients, a pacemaker precludes having an MR examination. However, a Johns Hopkins study found that with appropriate precautions, patients with pacemakers and defibrillators can have MRI scans with very low risks of the device malfunctioning. This is not the case for every device, so it is important for the radiologist and technologist to know this information so an informed decision can be made regarding your examination.

Similarly, there is a need for disclosure of metal implants, hardware or vascular clips. If you have had a hip or knee replacement, or metal plates, screws or rods used in an old fracture, vascular clips for an aneurysm, or even cavity fillings, there is the potential that the metal may distort the CT or an MR image, even if you believe the metal is compatible with the imaging study. If the radiologist or technologist is informed about the device or metal, they can take necessary steps to protocol the examination appropriately and ensure that neither the exam nor your safety will be adversely affected.

Another example of information to disclose to your radiologist and technologist is whether you are pregnant. Radiology imaging examinations such as X-rays, nuclear medicine examinations, and CT studies expose you to varying levels of radiation. While shielding can usually protect the fetus, there may be an alternative imaging examination that can be diagnostic so you can avoid exposure to ionizing radiation altogether. Consultation with your referring physician and/or the radiologist is critical so that appropriate safety measures are used and your examination can be optimally performed the first time.

The moral of the story is simple... Tell your referring physician and your radiologist -- and any other health care provider you see -- about pre-existing conditions and your symptoms. The more you reveal from the get-go, the better off you will be. Even if the information they tell you regarding your condition is not what you want to hear, the chances for an accurate diagnosis will be improved. You will be in a much better position to focus on the situation and make an informed decision with professional advice as to the appropriate next step.


For more by Helene Pavlov, M.D., click here.

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