Medical imaging (x-ray, CT, MRI, ultrasound) is one of the key problem solving tools used by doctors. Many times, the quality of medical images in combination with the skill of the interpreting radiologist can be the difference between a correct or incorrect diagnosis. Patients who receive poor quality imaging are, in the best of cases, forced to waste time scheduling appointments for repeat imaging, and in the worst of cases, left confused, without a diagnosis, and with a substantial medical bill.
In This Article
We will discuss five factors radiologists (physicians specialized in the interpretation of medical images) say patients should look for when selecting an imaging center.
- Is the imaging center using high quality equipment?
- Are medical images interpreted by specialty radiologists?
- Is repeat imaging free-of-charge?
- Is the imaging center ACR certified?
- Does the imaging center guarantee time to results?
1. Is the imaging center using high quality equipment?
Do you see the cerebral white matter abnormality indicated by the arrow in the brain to the left? The images above are from the same patient and are virtually identical in every way except one image was acquired on a 3T MRI while the other image was acquired on a 1.5T MRI. The magnetic field strength of an MRI system is indicated by the tesla (T). 3T MRI systems are 100% stronger than 1.5T MRI systems and are ideal for imaging fine structures throughout the musculoskeletal system such as intervertebral discs, mensici, and ligaments/tendons.
As the images above illustrates, the magnetic strength (T) of an MRI system can significantly impact image quality. Often, radiologists are looking for subtle findings that, if missed, can lead to misdiagnosis.
1.5T MRI is sufficient for imaging most body parts; however, when imaging small structures such as the wrist, ankle, elbow, or spine, 3T magnets are superior. If an imaging center uses below 1.5T magnets (1T, 0.2T), consider choosing a different imaging center as their is a high likelihood for poor image quality.
How to assess quality of equipment at an imaging center
Here are two questions you can ask the front desk personnel prior to scheduling:
- Will magnet strength (3.0T vs 1.5T) impact the quality of my examination?
- How frequently do patients require repeat exams due to poor image quality?
2. Are images interpreted by specialty radiologists?
As mentioned above, a radiologist is a doctor who interprets imaging studies. After a radiologist interprets an imaging study, the results are then relayed to the ordering doctor (orthopedic surgeon, family practitioner, neurosurgeon, etc) who can explain the radiologist’s findings to the patient.
After medical school and radiology residency, many radiologists then specialize within a particular field of radiology (subspecialty) such as:
1. Neuroradiolgy (specialization in diseases of the brain and spinal cord)
2. Mammography (specialization in diseases of the breasts), or
3. Musculoskeletal radiology (specialization in diseases of bones and joints)
Each specialty field of radiology corresponds to a specific body system (brain, gut, bones, breasts, etc). Specialty trained radiologists spend one to two years after residency, termed fellowship, learning solely about their body system of interest. Additional years of training generally make specialty radiologists better at diagnosing imaging findings on scans that are related to their field of expertise.
In an ideal world, every imaging study evaluating the spine would be interpreted by a musculoskeletal radiologist, and every study evaluating the breasts would be interpreted by a mammographer (breast imaging radiologist). Unfortunately, this is not the case in the real world. Due to an overall shortage of radiologists, many imaging centers contract with radiologists who will interpret studies outside of their body system of expertise, i.e., a mammographer reading an MRI of the lumbar spine. In some cases, this can lead to misinterpretation of findings and incorrect diagnosis.
How to assess if a clinic is using specialty radiologists
You can ask the following question to determine if your imaging study will be interpreted by a specialty radiologist:
- Will my imaging study be interpreted by a radiologist with fellowship training in the same body system as my study?
3. Is repeat imaging free-of-charge?
Sometimes, no matter the quality of the imaging equipment or the skill of the interpreting radiologist, studies just don’t turn out appropriately. Poor quality images are often due to artifacts, or features appearing in the final image that aren’t really there. Imaging artifacts can be caused by patient motion during the exam or metallic distortion from implanted medical devices (hip replacements, pacemakers, etc).
When artifacts lead to poor image quality, radiologists will note in their report that the images “are not of diagnostic quality.” This phrase means that no conclusion can be drawn from the imaging study due to poor image quality. In these cases, imaging centers should offer patients free-of-charge repeat imaging. Unfortunately for patients, this practice is not standard for all imaging facilities.
How to assess if a clinic offers free-of-charge repeat imaging
- The best way to assess if an imaging center accommodates patients who receive non-diagnostic images is to simply ask. Before scheduling, ask the front desk, “If my images are not of diagnostic quality, will I be offered repeat medical imaging at no charge?”
4. Is the imaging center ACR accredited?
The American College of Radiology (ACR) is the premier professional society for radiologists and imaging centers with over 38,000 active physician members. The core purpose of the ACR is to ensure high quality medical imaging to patients and society.
The ACR offers an accreditation process where medical imaging centers voluntarily undergo a rigorous review process. Patients can usually be assured that an ACR accredited imaging center will provide high quality medical imaging.
How to verify that an imaging center is ACR accredited
- ACR accredited imaging centers will usually display their gold seals of accreditation (image above) on their website and at their facility. Prior to scheduling, make sure the imaging center you choose has the gold seal documenting ACR accreditation.
5. Is time to imaging results guaranteed?
Test result anxiety, i.e., anxiety induced by waiting for medical results, is a known phenomenon. Often, patients will describe the uncertainty associated with waiting for medical results to be more distressing than the actual results, even in cases of bad news. A 2018 study showed that patients expect their outpatient imaging results within 1 to 3 days of an exam. Radiologists agree patients deserve quick imaging results so treatment can be initiated when necessary and to reduce test result anxiety.
How to assess the time it will take to get your results
Here are two strategies to assess turn around time:
- Many imaging centers will publicly display their turn around time on their website. A quick web search can help patients get a sense for turn around time.
- Front desk personnel usually know the average time to results for an imaging study. Call the imaging center and ask a scheduler how long it usually takes patients to receive their results.