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MRI's

Posted by Pauline on 6/07/04 at 17:32 (152276)

Do doctors prefer MRI's for P.F. taken with and without contrast or only without? Which do you order?

Re: MRI's

Dr. Z on 6/07/04 at 19:50 (152290)

Pauline,

Since I have learned how to use Ultrasound I don't order that many MRI's. IF I do I order without contrast.

Re: MRI's

Ed Davis, DPM on 6/08/04 at 13:21 (152412)

Dr. Z:
I would agree that ultrasonography should be the 'gold standard' to look directly at the plantar fascia. Dr. Rompe sent me a paper from a Turkish researcher last summer to that effect -- I will really have to 'dig' to find that one. Ultrasonography is a lot less expensive than an MRI so that, hoepfully, should satisfy anyone who is focusing on the cost issue.
Ed

Re: MRI's

Pauline on 6/08/04 at 14:36 (152431)

Interesting Dr. Zingas was doing this while you were still ordering MRI's.

Re: MRI's

Dr. Z on 6/08/04 at 15:14 (152436)

Pauline,

You are correct. It was the dornier outline ultrsound that taught me the importance of ultrasound and the evaluation of plantar fasciitis. I look up to doctors like Dr. Zingas who took the time to help get FDA approval for the dornier epos ultra. It is a beautiful machine. We should also thank Dornier for having the smarts to have ultrasound built into the machine.

On another note it is your comments out of the clear blue that cause problems. Are your postings meant to set up debate, fights, etc. Why would you make a comment in your posting 'Posted by Pauline on 6/08/04 at 14:36 View Thread
Interesting Dr. Zingas was doing this while you were still ordering MRI's '

Is this meant to mean something??????????????

Re: MRI's

Pauline on 6/08/04 at 15:56 (152438)

No. Not unless you want to read something into it. I'm saying that Dr. Zingas was using Ultrasound at a time when I was reading posts to readers who were just diagnosed with P.F to have an MRI. I wondered why Ultrasound wasn't used more often.

In fact I recently read an article authored by one of the Podiatric Societies that suggested ultrasound be used because it was more cost effective than MRI. I don't know if authored is the correct term, maybe suggesting would be better.

That's it no hidden agenda so can we move on. I think that's what everyone wants.

Re: MRI's

Ed Davis, DPM on 6/08/04 at 18:58 (152458)

Pauline:
I think that the real significant issue is that there has been, in the last 4 years, a significant price reduction in portable ultrasound machines to the point where they have become cost effective for most offices to own. There is nothing like having a machine at your fingertips and showing patients an immediate picture of a tendon or fascia; no being sent to a hospital for MRI or waits. If a tendon is torn, we can look at it immediately. Technologically, we have hit a point where ultrasound machines should be a common site in offices. If Dr. Zingas was ahead of the curve, then kudos to him.
Ed

Re: MRI's

Pauline on 6/08/04 at 19:24 (152460)

Dr. Ed,
My Gyn has had her own for quite a while now. In fact she owns two different types. One that is used inside only and the other is used on the outside.

Many surgeons especially those that do only breast surgery also have them in their offices. As you say the test is done on site.

I say kudos to every doctor who has the latest technology on site. It certainly makes better use of the patients time, but here's the kicker some insurances will only cover the test if its done in a hospital or ASC.

Re: MRI's

Ed Davis, DPM on 6/09/04 at 09:20 (152512)

Pauline:

The machines tend to be fairly similar. It is the frequency of the sound heads that makes them different. An OB uses a 3 MHz frequency head for the dpth of penetration needed. In podiatry/orhtopedics a 8 MHz frequency head is used. Many machines allow one to change heads. A 12 MHz head actaully exists to examine the skin (look at the shape of ulcers); from England but has not caught on in the US yet.

You also make an interesting point about coverage. One would expect use of such equipment always to be less costly at the office, but for some reason, there is a certain bias among some insurers that hospitals somehow act as a 'legitimizer' of treatments which is why surgery coverage almost always has a green light and non-surgical treatments deserve greater scrutiny. ESWT is just one of many examples of this. Ossatron went for a hospital or ASC based model which made their treatment model significantly more expensive than their competitors; they tried to set the standard.
Ed

Re: MRI's

Dr. David S. Wander on 6/09/04 at 13:06 (152540)

Pauline,

There are a few points I'd like to make. Performing an MRI isn't necessarily a second choice and doesn't necessarily mean that a doctor isn't up to date on the latest technology. There are several important factors. Often I utilize MRI not only to assess the status of the soft tissue (plantar fascia), but also to assess for bone marrow edema, stress/occult fractures of the calcaneus, bone tumors, etc. If I am simply looking for a fascial tear or thickening, ultrasound is an excellent choice. Since some insurance plans only reimburse certain facilities, the test is only as good as the person performing the exam and the radiologist reading the exam. In certain areas and certain facilities that insurance mandates we utilize, these ultrasound reads can be inaccurate and sometimes horrible. There is a significant learning curve with ultrasound and many times I receive a better report with greater accuracy if I obtain an MRI. Additionally, with the ridiculous amount of insurance restrictions, and low reimbursements, unfortunately not all doctors can afford to purchase an ultrasound machine for their offices. So many patients have managed care plans that mandate that a patient goes to a specific facility, the cost of the ultrasound machine for an office can often not be recouped. This is unfortunate but is the sad truth.

The bottom line is that ultrasound is excellent for determining the status of the plantar fascia, but MRI continues to be useful when ruling out other conditions or when accurate ultrasound services are not readily available. Hope this helps.

Re: MRI's

Ed Davis, DPM on 6/09/04 at 21:48 (152614)

Dr. David:
Interesting to hear your comments. I have maintained largely an 'open door' policy accepting all patients and insurances but am starting to reconsider this. Some insurance companies are throwing up so many roadblocks that it has become difficult to give their patients adequate care. Many don't realize that their lack of a 'cure' is not because their doctor isn't skilled but because he/she just could not jump through enough insurance company hoops to obtain the necessary care.
Ed