BY Dr Jack Gerbodach
We all know about MRI scanners – wonderful gadgets that can look inside you and are especially good at looking at soft tissues. They use no radiation so, like ultrasound, MRI scans are harmless and can be repeated frequently without any known patient harm. We see the value of the MRI scanner on the television series about the orthopaedic vet in the UK. The veterinary hospital in Dublin has an MRI service twice monthly for its patients. We hear about sportspersons having MRI scans of their injured joints and sports journalists talk about MRI with everyday familiarity so that MRIs are no longer something rare and exotic. Our own patients request them of us.
There are a few disadvantages of MRI scanners. They are expensive, need specialised technicians and they need someone to interpret the scans. They are much slower than CT scans – on average 30 minutes compared to three minutes, and patients who can’t lie perfectly still for all that time may need anaesthesia.
MRI scanners have multiple diagnostic uses in hospitals, although they are rarely needed in emergencies – X-rays and CT scans are good enough in most emergency cases. In a major head injury an MRI is not needed in the initial management of the injury but is invaluable in assessing brain injury afterwards. MRI for screening in breast and prostate cancer is increasingly being talked about. It is an area where we will see a lot of progress over the next few years. Screening however is not a justification for having an MRI immediately available onsite.
An indication for emergency MRI is the possibility of spinal compression by a haematoma or abscess. MRI is the scan of choice if these diagnoses are suspected. A hospital that does lumbar punctures should have optimal diagnostic facilities for a spinal haematoma and the question arises whether it should therefore have immediate access to MRI scans if a patient demonstrates signs of cord compression after a spinal tap.
MRI is also essential in ICU where doctors might suspect lumps or fluid collections in body cavities. MRI can give ICU doctors the information needed to save a life by identifying intrathoracic or intraabdominal abscesses that need interventional drainage. These patients are almost always on life-support and septic so it is difficult and dangerous to transfer them by ICU ambulance to an offsite MRI scanner, have the scan and then bring them back. For this reason a hospital with an ICU should always have an MRI scanner available onsite.
However I understand that many acute Irish hospitals, even those with an ICU, have no MRI scanner, relying instead on MRI scanners an hour or more away. Most of these hospitals do lumbar punctures and epidural injections so is the diagnosis and treatment of spinal cord compression delayed in these hospitals?
One wonders whether there is any HSE written policy about the rational distribution of MRI nationally. Most intriguing is the question of which HSE committee or officer decides which hospitals will be given expensive equipment and which will not. If we could FOI the meetings of this group then we could see how the HSE thinks.
Dr Jack Gerbodach is a pseudonym for a retired Irish consultant who spent year working abroad in the UK and Canada.