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Although an MRI by itself can not diagnose Chiari or tell whether someone
should have surgery, the introduction of the advanced imaging technology has
had a revolutionary impact on Chiari patients. As more and more
machines are installed and put into use, it has become clear that Chiari is
more common than originally thought. In addition, for those lucky
enough to get a scan early, the MRI has resulted in quicker diagnoses,
earlier treatments, and probably better outcomes. Despite it's
diagnostic limitations, if MRI's were cheap and readily available, I have no
doubt that Chiari patients would benefit greatly.
That is why I find two recent trends very disturbing.
The first is a growing backlash from the insurance companies against the
widespread use of MRI's. Across the country, insurance groups are
looking at the large costs associated with advanced imaging, such as MRI's,
and are trying to figure out ways to put them in check. One example
of this can be found in Rhode Island. An article by Marion Davis of
the Providence Business News quotes Blue Cross & Blue Shield of Rhode Island
as saying that high-end medical imaging is "out of control'".
The article goes on to say that the insurer is looking
at various ways to control costs, including preauthorization requirements
and regularly reviewing all imaging referrals. Unfortunately, this is
not an isolated case and insurers across the country are evaluating similar
measures.
What does this mean for Chiari patients? Doctors
already reluctant to order MRI's based on what they perceive to be vague
symptoms will be even more so. Parents will have a harder time
convincing pediatricians that an MRI is necessary for their child.
Reduced MRI use will likely result in delayed diagnoses, which of course
will lead to prolonged misery and poorer outcomes.
The second disturbing item involves new rules in the
European Union set to go into effect in 2008. The rules are designed
to limit workers' exposure to electromagnetic fields and will greatly hinder
certain types of MRI scans. Specifically, according to experts cited
in a Reuters News article, under the new rules technicians will not be
allowed to be near an MRI machine while it is in use. This means that
children will be less likely to have an MRI or will require a general
anesthetic during the scan. Based on feedback from readers, it is
already very difficult to get an MRI done in some European countries, and
these rules will likely make it even more so. It should be noted that
according to the Reuters article, medical experts are speaking out against
the regulations, but so far to no avail.
As stated earlier, an MRI is not currently sufficient
to diagnose a symptomatic Chiari, but it is necessary, and often serves as
the basis for an accurate diagnosis and treatment plan. Clearly,
anything that tends to restrict Chiari patients' access to MRI's will have a
negative effect on our community. While it is difficult to address the
problem of insurance companies placing restrictions on MRI use directly,
there may also be technology trends which will work in our favor down the
line.
A research group from Princeton recently announced a
breakthrough which may lead to cheap, hand-held MRI's. Imagine how
much more quickly Chiari would be diagnosed if front-line physicians could
quickly, cheaply, and easily scan the brain and spine. Also recently,
there has been a renewed focus on a specific type of x-ray, known as phase
contrast x-ray, which is incredibly accurate (more so than MRI's) at imaging
soft tissue, and is cheap as well.
Early, accurate diagnosis is one of the keys to
Conquering Chiari and we can use every advantage possible in this area.
Hopefully the impact of tighter rules from governments and insurance
companies will be offset by human ingenuity and the rapid, relentless
advance of technology.
-- Rick Labuda
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