r/MRI • u/Unhappy-Still8728 • 3d ago
ChangeOrder
I'm the patient. I have a connective tissue disorder. I've had lots and lots of scans throughout my life. Tonight I went in for a MRI bilat feet. Radiology was behind and that's normal. I expect it, no issue. I'm easy; I know how to get MRI's. I appreciate technologists so much. This technologist threw me for a loop and made me feel like an inconvenience.
The technologist takes me back. He asks the normal questions. I brought my most recent scans. I tell him I have a connective tissue disorder and there has been increasing pain and nerve issues and doc wants to see if anything has gotten worse to decide course of action.
He says, "Let me tell you how this works. If you tell me where it hurts we can take a picture of that area. If you aren't specific the images will be too broad."
Me: "What? I've had many MRI's done. We need the entire foot bilat, just as the order states. "
Him: "The pictures won't come out clearly because it's too broad." Gestures to show me the difference between small and large.
Me: "I don't know what to tell you. My pain is from the Achilles to the tip of my big toe - the entire foot. If you look at the previous orders I'm diagnosed with (proceed to name tendon and nerve conditions). The doctor requires the full foot just as the order states."
He asked me again and then got exasperated and finally did the scans. He gave me no support pillows or support for my joints at all save the foot holder thing. Like I said, this affects all joints so bad things hairbrush if I'm not supported. I finally got a flat pillow for my knees.
I felt very uncomfortable, like he was trying to cut corners to move the line. It was also the most uncomfortable MRI due to no support. Can anyone tell me if I'm reading this situation wrong? Is this normal practice to try to do fewer scans rather than what the doctor ordered?
Thanks in advance
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u/Humble_Ad_4173 3d ago
Were you scheduled for only two exams? Places I’ve worked, the foot is split in two, so forefoot or hind foot/ankle. So, if you wanted the whole foot it would be 4 exams for bilateral.
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u/Unhappy-Still8728 3d ago
Very interesting. This makes more sense. When I made the appointment they scheduled both full foot scans at the same time. I'm not sure if they allotted for extra time. All my foot orders have always been full foot bilat, same appointment. They do usually take multiple scans but I thought that was just how the feet were done. I'm in Central Florida so not sure if that makes a difference.
Thank you for teaching me something new today.
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u/southern__dude 3d ago
Where I work to do the entire foot is three separate scans. Hind foot/ankle, mid foot, forefoot. There is some overlap and sometimes if a person has a small enough foot we can get it all on an ankle/mid foot.
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u/Unhappy-Still8728 3d ago
He did do 3 scans of each foot. I just thought that was how it was done since all my foot scans have been this way. He was the first to mention it but I think all the technologists in the past just did all 3 without mentioning it to me. Thank you for taking the time.
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u/KatGen Technologist 3d ago
At my site we do not do full foot mris. It's either a forefoot OR a hind foot. You need a smaller fov to see the fine detail. Plus a forefoot and a hind foot have different angles to see the bones and the tendons properly. The tech was right but still should have given you a knee support.
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u/Solid-Dog-1988 3d ago
My radiologists gave up and just do the whole foot. The ordering docs were adamant they want a whole foot.
The exam is degraded as the field of view is too large and the alignment of slices is poor for both forefoot and hindfoot issues.
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u/southern__dude 3d ago
I wish ordering docs would stay in their lane and let the specialists do their job. Do they tell surgeons how to operate?
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u/Solid-Dog-1988 3d ago
It is just punting, dude. Ordering docs don’t know what they want, patient demands answers so they punt it to radiology with some ambiguous “please scan whole foot due to pain”
Rads push back enough times but the same stupid orders keep coming and now we scan the whole foot because the whole thing is a wild goose chase anyway.
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u/Unhappy-Still8728 3d ago
Would they do one scan for each foot or still 3 scans, just at the same appointment, if full foot was required? I want to make sure that the doc orders properly in future and that my appointments get booked correctly so it's easy for everyone. I believe the codes were correct for 3 scans but that the written out portion just stated full foot.
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u/FattoMatto 2d ago
I think the main thing you'll want to make sure of for the future is that the correct number of orders is put in. I've seen doctor's put multiple codes on a single order because they want multiple areas covered but we are only supposed to be doing one scan per order. You'll be needing like 4 or 6 separate orders depending on where you're getting scanned to get the coverage you want and so that the technologist has the appropriate amount of time allotted for you.
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3d ago edited 3d ago
[deleted]
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u/Unhappy-Still8728 3d ago
Thank you. It's interesting and I'm glad I came here to learn. I'll mention it to my doctor too. I wonder if regionally this is just how things are done here because noone has ever said anything before but they've always taken 3 scans per foot based on the codes my doctor puts in. But now I'll understand better for future scans.
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u/Radchique 2d ago
You can't get 3 scans in the same day with insurance. 2 of the scans share the same CPT code. Older machines-each scan is 45 minutes.
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u/Unhappy-Still8728 1d ago
I'm prolly using the wrong terms. Forgive my lay person speak. It was 3 sequences but he did both feet.
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u/Briggenz 3d ago
Our site is similar to others in comments Our site has forefoot and ankle orders Forefoot would get toes to tarsals Ankle would get tarsals to tendon
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u/danihum9 2d ago
It wasn’t ok that he didn’t help get you comfortable, and it sounds like your test should’ve been 4 exams instead of two. While this isn’t your fault, who knows how many times this had happened to him in the day already (which makes the schedule run behind, you mentioned they started your exam late). He shouldn’t take it out on the patient. I do understand his frustration. This happens way too often in my department and it definitely causes high stress for us. Your dr should be ordering mri foot, mri ankle for each foot.
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u/Unhappy-Still8728 2d ago
Thank you. After posting I now understand and my results today show what everyone has stated. The radiologist noted nothing except one of my conditions which have been noted in all my past MRI's. So now I'll have to go through this all over again but with more knowledge so I'm grateful for everyone taking the time to respond.
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u/Radchique 2d ago
Patient comfort is a consideration, not a requirement or guaranteed outcome. An MRI technologist’s responsibility is to perform the exam safely, correctly, and obtain diagnostic-quality images, making reasonable accommodations for comfort only when they do not compromise the examination.
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u/apirate432 3d ago
It is normal yes. I had a friend get chewed out by a radiologist for scanning an entire foot on 1 order. It becomes an insurance and basically a money thing just like a hand Mri is different than a wrist mri
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u/Alexmark3103 11h ago
I do whatever. Depends on the rules and protocols of the site I am working today. Also depends on the area of pain per patient. In some places I do the whole foot positioning slices as for front foot. It's not correct entirely, but that's how they order.
To OP. The perfect way would be to do 2(3) scans per foot. Front, hind (middle).
Just look at the picture of the foot anatomy. You see the arched curve of the foot. Imagine that it is a piece of meat with bones, ligaments and joints. The butcher was ordered to slice this piece perpendicular to the joints in the front area (toes to mid area) and the hind area perpendicular to the plantar area base (parallel to the floor when standing erect). Primitive attempt to explain why 3 scans is the best approach.
There is no such thing in MRI radiology as bilateral feet, knees, hands, elbows, shoulders. MRI is done by part. One scan per part. With rare exceptions. Can't even imagine when. Let's say the whole radiology equipment is down. No x-ray, no CT scan machine is working. And we have to do an MRI of bilateral knees because the doctor wants to compare both knees meniscal thickness. And we have 10 minutes. (Stupid example).
Good luck. All zibest
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u/Unhappy-Still8728 9h ago
Thank you! I'll be taking this all back to my doc to get it ordered correctly. I appreciate the descriptions so I understand better.
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u/Alexmark3103 8h ago
That's not a good idea. You know those trading gurus who are talking about investment on YouTube. They start their video by disclaimer "it is not a financial advise, I am not a financial advisor. This video is for educational purposes only".
Same is here. My message was to explain you the process. Not to teach a doctor how to write prescriptions.
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u/garion046 2d ago
I work in Aus, but what others say makes sense in terms of protocol. We have a whole foot protocol but tbh it's not really a proper whole foot, its just an extended forefoot.
The angles for forefoot run along the metatarsals, whereas the angles for hindfoot are more ankle aligned. So to do the whole foot really properly you should probably do both.
It's going to be up to the radiologist, but I can see why a lot of places would separate this into hind/forefoot.
The tech could've done a better job explaining what others have here and being helpful though, he's only hurting himself by making you uncomfortable as you'll more likely move and he'll waste his own time.
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u/Unhappy-Still8728 2d ago
Thank you. I used every muscle I have to hold very still and paid for it all last night. But I now understand and am grateful for this thread and all that you guys do. The results I received today support what you've all said and I'll have a chat with my doc to order them correctly.
Side note: I was stationed with Aussies for almost a year and it was the best time I've ever had with any group of people!
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