The Importance of an Onsite MRI Radiologist for Diagnostic Accuracy

Following highly publicized reports of several missed diagnoses by a radiologist in Ontario, an article published late in 2013, entitled Can Quality be Assured for Diagnostic Imaging?, addressed the hot topic.

“There are no national quality assurance standards for diagnostic imaging in Canada,” the authors wrote. “Approaches to quality assurance vary based on factors like the practice setting, type of diagnostic imaging being used and number of radiologists in practice.”

Although steps are now being taken–Vancouver Coastal Health is currently piloting a new quality assurance program for diagnostic imaging–the fact remains that without a national standard, some responsibility falls upon patients to ensure that they receive the best diagnostic care available to them.

What is the simplest, most effective way to do this? Meet your radiologist.

Many patients have diagnostic imaging done in hospital and wait weeks for results of an MRI or CT scan reported by a locum radiologist whom they will never get to meet. At AIM, we have onsite radiologists who are intimately familiar with our MRI equipment and the technologists (specialists who run the MRI machine) who work here. Apart from being an internationally recognized authority on whole body diffusion MRI, AIM’s lead radiologist, Dr. Attariwala, has assembled our MRI machine himself and knows exactly how best to use the equipment. Furthermore, he has personally trained AIM’s other radiologists to do the same, so that imaging results are optimal, every time.

4 of 10+ filters which may be used to image liver

Above is an MRI scan of a liver seen through four different filters. The top left image is seen through an In Phase Imaging filter, the standard T1 style image which is great for visualizing anatomy: fluid is dark, fat is bright.

The top right image is seen through an Out of Phase Imaging filter, used for looking at the water interface between organs and the surrounding fat. Clinically, is it valuable for detecting fatty infiltration of the liver, which is a precursor to cirrhosis, hepatitis and HCC (hepato-cellular carcinoma).

The bottom left image is seen through a Fat Saturation filter, the preferable mode for detecting tumours within organs.

Finally, the the bottom right image, seen through a Water Saturation filter, makes fat appear bright; therefore, this technique is used to quantify fat, whether subcutaneous (under the skin) or visceral (around organs).

The images shown above are just 4 out of 10+ filters which may be used for imaging of the liver alone; there are many other filters and sequences which may be applied to scans of different areas of the body. Since filters are selected while an MRI scan is in progress, and since attaining precise MR images is a time-consuming process, you can begin to see why having the medical expertise of a certified radiologist onsite is imperative for imaging accuracy.

At AIM, our onsite radiologists play many other crucial roles, such as:

-Determining the appropriate scan for your specific needs

-Directing the MRI technologists to ensure scans of the highest quality

-Administering gadolinium contrast agent, when needed, to get a closer look at suspicious results

-Performing arthrograms

-Requesting previous imaging results for comparisons

-Reviewing results in real time

-Consulting with patients one-on-one, offering both a diagnosis and answers to their questions

-Immediately writing up a report for the patient and their doctor(s), as well as recommendations for future care