Technology changes in the past two decades have completely reshaped society.  In the healthcare space this has brought an ever-evolving kaleidoscope of diagnostic and treatment options at our fingertips.  One of these technologies – medical imaging has been a game changer.  There has however been a rise and then balancing out (rather than fall) in how imaging is used.

If we rewind to 1895; Wilhelm Roentgen stumbled on his discovery of the x-ray which was quickly used to diagnose fractures, kidney stones, shrapnel injuries and more.  This novel technology, the seeming holy grail of being able to “see inside the body” was what ultimately won him the Nobel Prize shortly thereafter.  Xrays were used for almost anything, even a shoe shop trying to show the bones of the foot to sell their latest footwear!

As time went on there was the invention of ultrasound imaging, magnetic resonance imaging (MRI), computerized tomography imaging (CT scans), arthrograms and more recently even functional (live) MRI scans.  Many of these advanced imaging techniques were able to detect the smallest abnormality or oddity in the human body.  In turn, diagnostics became more reliant on this technology (as well as blood tests and more), to the point where it was often assumed that whatever was seen on a scan must be the cause of the problem.  Many people were treated, even surgically – following these investigations…only to find that they were no better.

Research started to problem solve why this might be, and the presence of “asymptomatic findings” is now a known phenomenon that clinicians are aware of.  In short – just because something is there on a scan, doesn’t mean it is the cause of the pain.  There are false positives and false negatives.  Here are some interesting statistics about findings on imaging discovered in people with no pain*:

  • Knee osteoarthritis: present in 19 – 43% of people aged over 40 years old
  • Lumbar disc bulge: present in 87% of people aged 20-70yrs old
  • Lumbar disc degeneration: present in 37% of people 20yrs old and present in 96% of people 80yrs old.
  • Partial rotator cuff tear (shoulder): 22% of men aged 40-70yrs old
  • Labral injury (hip): seen in 68% people when surveying 2114 asymptomatic people

It has been said that diagnostics in the health care sector are up to 70% subjective…in other words we base a diagnosis on what you tell us.  It is the  ‘story’ you tell, and then the answers to the questions that we ask.   There are also better understood risks of inappropriate imaging, such as radiation exposure. As I commonly tell people in the clinic, we treat people…not pictures.  So next time you are seeking the advice of a health professional and they do not immediately send you for any imaging it may well be that the diagnosis can be made just as accurately without it.

Nb. This is not intended to replace the advice of your healthcare professional.

* References can be provided on request.

Nb. Written as Health columnist for the Hibiscus Matters.