Medical Imaging: What Does the Research Say?
Happy 2025!
Let’s start the new year by being better informed medical consumers.
I originally shared this in my December 2024 newsletter but thought that it’s important enough to share more broadly here on my blog.
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[From the Dec 2024 newsletter’s “Sound Off” section]
I thought we’d end the year with bang and discuss somewhat of a “spicy” topic - medical imaging. By medical imaging I’m referring to X-rays, CT scans, and MRIs.
Reminder - I’m not a doctor or pretending to be one…however I’d like to give you all some information to make you more informed health consumers. With that said, this section isn’t to be used as a replacement for diagnosing or treating any conditions and you should consult with your primary care provider, physician, or other medical professional to determine the appropriate course of action for you. (Now that the lawyers are happy, let’s go!)
Quick context - I was reading some research (which we’ll discuss in a future newsletter) about “A modern way to teach and practice manual therapy” which referred to another study from 2013 - Worsening Trends in the Management and Treatment of Back Pain
I’ve provided the links above if you want to read either or both research papers, but I’m going to pull out some interesting nuggets below.
I’ll provide the direct quotes and add some commentary, as necessary. Also, I’ve “jazzed up” the text sometimes (adding bold, italics, or underlining) to emphasize the main points.
“…the value of imaging for many [musculoskeletal] pain conditions (particularly spinal pain) has reduced drastically with clinical guidelines across the globe recommending against routine imaging for [musculoskeletal] pain of non-traumatic origin. Even so, the practice of routine imaging continues.”
In other words - the value of imaging for soft tissue issues has gotten lower and, despite clinical recommendations against it, is still a routine practice.
“For patients with non-specific low back pain, for example, imaging does not improve outcomes and risks overdiagnosis and overtreatment”
If you have back pain that wasn’t related to a specific traumatic event like a sports injury or car accident, for example, imaging doesn’t seem to improve your outcome and might even result in “extra” diagnoses and treatments.
The next 3 quotes are self-explanatory:
“the rates of unnecessary treatments, including surgery, are known to increase when imaging is used routinely”
“Six randomized-controlled trials have shown that imaging in the acute setting provides neither clinical nor psychological benefit to patients with routine back pain”
“In addition to being low value, the overuse of diagnostic imaging leads to more exposure to ionizing radiation. In 2007, a projected 1,200 additional future cancers were created by the 2.2 million lumbar CT scans performed in the U.S.”
The last 2 quotes below are related and I’ll break them down afterwards:
“the dramatic rise in spine surgeries seen over the last decade is almost certainly related to the overuse of imaging.”
“One study revealed that early MRI for acute back pain was associated with an eight-fold increased risk of surgery, while another found that regions with more MRIs do more surgeries, with 22% of the variability in spine surgery rates explained by rates of spine MRI use—more than twice the predictive power of patient characteristics”
Commentary: The more imaging that is done, the more surgery that is recommended. Also, from the second quote above - surgery rates seemed to relate more to MRI usage than the actual characteristics (symptoms) of the patients.
Based on another study in 2015, approximately 20-30% of 20-year-olds have “findings” in their CT scans or MRIs but are not experiencing pain and that number grows to 84-96% of 80-year-olds. Again, “findings” in their imaging are conditions like disk degeneration or bulging that are present without any pain or pain-like symptoms. In other words, imaging will likely always find something “wrong” - because as we age, most of us will have something “going on” whether or not we have pain!
Are these studies perfect and cover every situation? No.
Did they have complete data about symptom duration and every individual’s treatment? No.
Is there value in the conclusions they made based on their analysis of the data? Absolutely!
Bottom line - if you have a traumatic event - it makes sense to have medical imaging to see if something’s broken/torn/etc., but if you only have “non-specific” pain…you might want to reconsider imaging!
