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Hey, I want to talk to you a little bit this morning about MRI. And more importantly, and more specifically, the MRI slices. When you’re taking MRI, you’re performing an MRI the tech will make slices of the MRI. Here’s how I explain it to patients. So I basically say to them, have you been to the meat market and watched them slice meat?
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Yeah, same thing here. As the MRI. Slices off pieces. It takes off that piece and then takes a picture of what’s left. So it keeps going until you get into the middle. That’s the slice. Now, the question then becomes, what’s the importance of a slice thickness? What difference does it make?
So if you’re having the tech take an MRI, how thick that slice is makes a difference. Let me show it to you this way. So I’ve got a loaf of bread here. We’re going to take four, we’ll call these four millimeter slices. So here’s the MRI, here’s the body. So I come in here,
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Take a picture. Taking a picture of what’s left. This is taken away. So then we come in four millimeters, and I take another slice.
Nothing there. Here’s my four millimeter slice. Now, what if I were to say, let’s, instead of doing a four millimeter slice, let’s do a, 2 millimeter slice. We’re going to break that down even further. Here we go.
See the difference? Suddenly, I’ve found the middle part of the disc, right in the annulus and the nucleus. And if that is bulged out like that, it’s going to show up. That’s the importance of the slice.
Today, and I just want to take a second here and thank ChiroSecure for allowing us to talk a couple of minutes. Listen, the whole purpose behind me being here today is to help you become better at what you do. For so many years, I would all my pre chiropractic stuff that I had to do, and all my the All the classes that I had to take for license renewal.
Wow. I took activator so many times, I couldn’t tell you how many times I took it for a license renewal, and that’s basically about what I did. And then I got into realizing that if I wanted to be the best of the best, I had to study and become the best of the best. And so I spent a lot of time studying MRI and trauma.
Became the first chiropractor in the nation. To become a fellow in primary, not primary spine care through the State University of New York Jacobs School of Medicine. So in doing that I studied a lot of MRI, had two mini fellowships in MRI and just finished up another mini fellowship in MRI.
So I love, for those of you who are old. I graduated in 81 from Palmer College. I had taken classes with Dr. Russell Earhart, I don’t know if you remember him. And I loved X ray and got to be really good at reading X ray. I didn’t want to be a DAC bar, but because I wanted to practice chiropractic, but I got to be really good at X ray.
And then when I got into the to the fellowship program of the Academy of Chiropractic, I just fell in love with MRI. And have become good at it. I love it. And so there are three things that I want to talk to you today about MRI and the importance of certain things and you just saw the video I’d put together about the slices of MRI.
Listen, the importance of those is that if your slice is too big, you’re going to miss a lot of stuff. I’m just telling you. So I want to give you the slices and I got my little cheat sheet here that I’m going from the slices from the the big people in radiology who tell us what we should be doing.
And the slice thicknesses here, let me pull this up,
like in a lumbar spine, their slice thickness is four millimeters. That’s pretty thick. I have had it where there is a slice here, And a slice here and I completely miss the disc. That’s the whole purpose of what we’re doing. We’re looking at what is the disc doing. The they’re, they say maybe or 3.
In the cervical. You’re gonna miss so much stuff. You’re gonna, here’s the problem, you’re gonna order MRIs, And you’re going to have nothing show up and you say, Oh, there’s nothing wrong with this person. Remember the video that you just saw the egg in the middle of it. You’re going to miss all the eggs.
So if you’re taking notes, let me give you what Dr. Peister and Dr. Student and myself are saying. As far as a slice thickness, you ready for this? Cervical, 2 millimeters. Now, Dr. Peister and Dr. Students say if you have to do a 2. 5 millimeter, but I just ordered a 2 millimeter of the cervical.
Thoracic, about 2. 5 to 3. And a lumbar, a three millimeter slice. That way you’re going to make sure that you’re going through the disc. It’s going to be nice and clean. You also want them to follow the disc angle. Listen, these techs can get lazy and here’s the reason they don’t want a smaller slice thickness.
Because it takes them longer. So if it takes them a couple minutes longer, those minutes add up, and instead of seeing 12 patients, they’re only going to be able to see 10 or 11. That’s not your problem. Your problem is the ability to see what you need to see. When I order it on the MRI order form, I’m actually writing on there, I actually put a rubber stamp on there now that says, here’s what I want, two millimeter slice in the cervical, three millimeter slice in the lumbar, and follow the disc angle, cause they’ll just start at the spine and not change angle and it’ll go boom.
And part of it’s through the front of the disc and coming out the back of the vertebra And you’re missing the disc. You’ve got to follow the disc angle. So make sure that you tell them that. Listen, I had an MRI a couple of weeks ago. I did the cervical spine and I ordered two millimeter slice. They gave me three millimeter slice and completely missed the disc.
And I didn’t say, Oh, that’s geez, I hate that. Maybe next time they’ll do it better. No, I called them up and I said, do it over again. You’ve got it’s, you’re the doctor. You got to take control over that because if you miss it. That’s going on you. All right. So the question, the number two thing is when do I order an MRI?
Okay, here we go. If if there’s trauma and there are some immediate things that are showing up, um, then you need to order right away. Let me get, give you the things that can show up. Any myelopathic findings. Any myelopathic finding. Now what is myelopathy? Has nothing to do with muscle. Let me give you the definition of what myelopathy is.
Compression of the cord. with neurological deficit distal to the level of the lesion. If you’ve got numbness and tingling down to the fingers, don’t look to the thoracics. The thoracics are, everything just goes down. If you’re looking for numbness and tingling down the arms and fingers, you better look in the cervical spine.
Let me give you the, what we’re looking at, radicular pain. Is there pain down the arms and to the fingers? Or is there pain down the arms or the legs, or the flank into the chest? You can get cervical disc that’s going to go right past the between the spine and the scapula. That goes right down there to the tip of the scapula.
That can be a cervical disc. Okay? Intermittent electric burning type pains or sensations. Ridiculopathy. Motor weakness. So if you do a muscle test and there’s weakness in one area that’s the ability to take an MRI, have an MRI. Sensory. Weakness, paresthesia, changes like that, diminished reflexes, so if you’re doing a reflex test, and by the way, if you’re not, please, you’ve got to get into it.
You’ve got to do these great exams that are pointing you in the direction you need to go. It worsens with axial loading and relief by moving or lying down, so that’s when you can order an MRI. Now, If I have a trauma and there’s an immediate, these things are showing up, immediately order the MRI. Don’t wait.
Don’t, the insurance company wants you to wait six weeks. You gotta do it right away. Now here’s another question. If I have an MRI that was done let’s pick an arbitrary date here, May 2nd. This person had been having some problems, so the MD or whoever ordered the MRI, and you, you got the results of that on May 4th, they’re in an automobile accident, and now they’re having numbness, tingling, and all that kind of stuff.
And people will say you, you already have an MRI. You have an MRI of May 2nd. You have it prior to a trauma. So I don’t care if there was an MRI May 2nd and they were in an accident May 3rd, I’m going to get an MRI if there are neurological findings that we need to go after. Does that make sense?
So don’t let the insurance company tell you what to do. I’m telling you, this is your patient, it’s your responsibility, you got to do it. All right. Does that make sense? Now, let’s say you, you are treating the patient, there are no neurological symptoms, there’s no neurological stuff going on when can you order an MRI?
I recommend a doctor’s student recommends six weeks of conservative care. If you’re doing their treatments six weeks later, they are still having pain. Order an MRI. Just get it. You’re going to find stuff on there that nobody else is finding. Now, here’s the third one. So the first one, what is it?
Slice thickness. Number two is when do I order it? You got to know this stuff. And number three is who should order or who should read the MRI. So let me give you this. This is for the average radiologist, not a neuroradiologist. The average radiologist reads an MRI of the spine. According to the Spine Journal, this was an article written, There is an error rate of 43.
6 percent of reads by a regular radiologist when they’re reading spine. Oh my god. Dr. Peister, State University of New York School of Medicine says it’s a 95 percent error rate. Dr. Student says an 85%. I tend to probably go with Dr. Student. And, uh, what’s the lesson that you need to learn with that?
Don’t let a breast radiologist read your spine films. You have to have a neuroradiologist who knows spine backward and forward. They’re going to pick up on stuff that the average radiologist is not going to. You’ve got to have a neuroradiologist read it. The second person that needs to be able to read this is you.
You’ve got to be able to look at an MRI and figure out what it is. You got to know the terminology. You have to know how to age, date. Is this from this accident or is this from something else? You’ve got to know that. You’ve got to know the difference between a herniation, a protrusion, a bulge. You got to know all those things.
Yeah. Not only are you that’s important for you. It’s important for your attorneys. It’s important for your MDs that you deal with. You need to know what is myomalacia. What is that? And listen, if you don’t know this stuff, You’re not going to catch the attention of those people that you’re working with.
You’ve got to be able to know stuff that is going to set you apart, going to make you better than Joe blow down the street from you. And it, it takes you from being a average provider into someone who knows what they’re doing. So let’s go back and just recap. You got to know. and order the correct thickness of that slice.
It is so vital. Number two, you got to know when you can order it. Do not delay. I’m telling you, if they’ve got stuff you, you can’t delay. You’ve got to get it right away. And number three is the people that need to know how to read the MRI are the neuroradiologists. And listen, You remember I was telling you about the stamp I’ve got.
It’s actually a rubber stamp. I put it on the form that I send off my prescription for the MRI. It lists my slice, thicknesses follow the disc angle, and on the bottom it says, must be read by a neuro radiologist. Now I’m going to tell you at the beginning when you do that, you’re a pain in the rear end, but after a while.
You gain incredible respect with these people because they realize that that’s what I want. I don’t want to be the average chiropractor who just treats people snap, crackle, pop, next, trap, back, pop, next, trap. I want to know what I know the way that I know. And When I’m doing MRI, I’m very careful.
And if you need help learning how to do this and listen, this is not a weekend seminar. I have spent hundreds of hours learning how to do MRI. And I’ll tell you, there are so many times. When I read an MRI that I’ve got a question, I can either go back to Dr. Student, Dr. Peister, they will certainly answer those questions for me, or I can call the radiologist.
I’m telling you, I had, in fact, I had a radiologist a couple weeks ago. It’s been probably a month and a half ago. I had a patient came in, And, um, she had been to the ER, CT scan, by the way, CT scans are great for broken bones, but they’re horrible for everything else. Had a CT scan, no broken bones, or she had literally hit the steering wheel with her chest.
No broken bones, no problems, nothing there that you need to worry about, CAT scan. So I took. My x ray at the office and saw this sternum from the lateral view and instead of being like this, it was like this. So I called up the radiologist at the hospital. And said, listen, I just took an x ray of the sternum, and to me it looks fractured.
Would you do me a favor and just pull that up real quick and just take a quick look at it?
Here’s what I heard. Oh crap. Had missed it. Had missed it. And I said, listen, as long as we’re looking, would you do me another favor? Would you look at the ribs on the right side? She’s got a lot of complaints there. Would you look? Yeah, I’ll take the time to do that. I’d found a fracture he’d missed. Nine fractures in the ribs.
So if somebody comes in and says, I was at the hospital they took a couple of x rays and did a CT scan you don’t need to do anything. I take my own x rays. I want to find out stuff. My x rays are better. I know where to look. I know what to look for. And and people usually say I had x rays, a lot of x rays taken at the hospital.
I get them from the hospital and it’s, an AP and lateral skull or something stupid. So be sure that you take what you need. Don’t go in blind. Don’t treat until you know that you know what you’re treating. Does that make sense? So you learn how to read your own stuff. Real doctors do that, if you’ve got some questions about that, go back to where the video was, Dr. Student’s number is on there. He can give you lots of information about what to do. But I want you to become the best of the best at what you do. Your practice will soar. You’ll never have an issue with new patients because people gonna know you know what you’re talking about.
And attorneys will love you. Family practitioners will love you. I get referrals from the ER. I get referrals from urgent cares. because they know that I know what I know. All right. Listen, want to thank again ChiroSecure. What an incredible thing that they’re doing to help you become the best of the best.
Any questions or anything, please feel free to drop me an email or drop Dr. Student an email or give him a call. Love to talk to you. Okay. Thanks so much for being here and listening.
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