Tabassum Ali, DC, CCSP, CCCN
Imaging is a diagnostic tool all healthcare providers rely on to help rule out and confirm conditions in patients. With technology constantly evolving, there are many types of imaging available now at your fingertips. One of the most frustrating parts of being a patient and trusting your doctor’s opinion in imaging is understanding the purpose for the type of imaging selected for you. You want to get the most information, with the least amount of radiation, for the best price. For most athletes you can also add to that list a quick report turnaround time. In this article to you will be able to better understand when the following imaging sources are indicated along with the pros and cons:
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Musculoskeletal Ultrasound (MSK US)
Nerve Conduction Velocity (NCV)
Generally speaking, the first source of imaging most health care professionals will choose is X-Ray assuming the purpose of the imaging is related to an osseous structure. It is the simplest source of imaging, relatively speaking when ruling out any underlying condition within the osseous skeleton. The radiation in an x-ray picks up the calcium in bones and will also reflect any metal objects in the imaging once developed appearing white. Fat will show up on the imaging more of a grey scale and for water and air will show up black on x-ray imaging. X-ray imaging also has diagnostic capability in chest views suspecting pneumonia. The main benefits of choosing x-ray as the first source of imaging are:
Quick report turn around
Some physicians can take x-rays in the clinic and can provide immediate information to the patient. X-ray is one of the sources of imaging that has come a long ways with technology. The newer x-ray equipment is digital and imaging can be displayed on a computer monitor for viewing and analysis immediately.
Computed Tomography (CT) would be the next source of imaging of choice if the following are indicated:
A fracture unseen on an X-Ray
A CT scan is best described as a modified version of an x-ray with cross-sectional viewing. A CT is typically performed with the patient lying down and traveling through a device similar to an x-ray machine. In some cases, a contrast dye can also be used for detailed viewing. Although this source of imaging is quiet specific, patients sometimes shy away due to cost. It is important to remember, especially if you are an athlete preparing for an event, you always want to be 100% sure you are not jeopardizing your health by continuing your daily activity- the cost of your health is priceless.
Magnetic Resonance Imaging (MRI) is a common source of imaging used today for many conditions. Most healthcare physicians will prescribe an MRI for the purposes of:
Ruling out any underlying soft tissue conditions
Examining the brain and spinal cord
A patient can expect to be lying down and staying still during the course of the MRI while traveling through a tunnel-size tube for a duration of time. Although the experience of obtaining an MRI doesn’t sound quiet pleasurable, the imaging is very diagnostic with the least amount of radiation and helpful in prescribing the appropriate care needed. There are a few things to be aware of if you are prescribed an MRI:
Be sure to let your health care provider know if you are pregnant
Remove all metallic artifacts
Pacemakers and metallic joints are contraindicated
The final two sources of imaging Musculoskeletal Ultrasound (MSK US) and Nerve Conduction Velocity (NCV) are typically used together diagnostically. Ultrasound is a type of imaging that uses high-frequency sound waves to look at organs and other soft tissues within the body. Because there is no radiation at all in ultrasound it is completely safe to use with women who are pregnant. Musculoskeletal Ultrasound is particularly helpful and diagnostic in the athlete world for chronic sports injuries that are having a challenging course of treatment and healing. MSK US is the newest technology and source of imaging in the athlete world and is becoming increasingly popular. The benefits include:
Low cost; most insurance companies will cover entire cost
Can be performed in the doctor’s office, no need for referral
Nerve Conduction Velocity can be used in conjunction with MSK US to determine whether the soft tissue condition is due to a loss of nerve function. An NCV will measure the speed of an electrical impulse through a nerve and can determine damage and destruction. Two electrodes will be placed on a muscle and information will be collected on the speed of the impulse between the two electrodes.
"Diagnostic Imaging: MedlinePlus." U.S National Library of Medicine. U.S. National Library of Medicine, 11 Sept. 2013. Web. 01 Oct. 2013.
Forbush, Steven W., PT, PhD, OCS, Douglas M. White, PT, DPT, OCS, and Wayne Smith, PT, MEd, DPT, ATC, SCS. "The Comparison of the Empty Can and Full Can Techniques and a New Diagonal Horizontal Adduction Test for Supraspinatus Muscle Testing Using Cross-sectional Analysis through Ultrasonography." International Journal of Sports Physical Therapy. PubMed, June 2013. Web. 1 Oct. 2013. <>.
Settergren, Roy. "Treatment of Supraspinatus Tendinopathy with Ultrasound Guided Dry Needling." Journal of Chiropractic Medicine. PubMed, Mar. 2013. Web. 1 Oct. 2013. <>.
Ntani, Georgia, Keith T. Palmer, Cathy Linaker, E. Clare Harris, Richard Van Der Star, Cyrus Cooper, and David Coggon. "Abstract." National Center for Biotechnology Information. U.S. National Library of Medicine, 15 Aug. 2013. Web. 01 Oct. 2013. <>.