How to be sure your MRI is done according to MS Protocol

Question

I have had two MRI's. Brain and Cervical/Thoracic, both were ordered with MS written on the script. 
However, my brain was imagined with diffusion weighted and T1 and T2 weighted. 
NO FLAIR at all!!

Protocol for Brain is:
Sagittal Flair
Axial Flair
Axial T2 
Axial T1 pre and post gadolinium

My Cervical/Thoracic was imagined with Sag T1  weighted fast spin echo, Sag T2 weighted fast recovery fast spin echo, Axial T1 weighted fast spin echo, Axial T2 weighted fast recovery fast spin echo with fat saturation. Sag T1 weighted FLAIR
After Gadolinium, a Axial T1 weighted fast spin echo and a Sag T1 weighted fast spin echo with fat saturation, Sag T1 weighted FLAIR with fat saturation.
NO STIR or PD at all! and mostly Axial imagines!

Protocol for Spine is
Cervical and Thoracic Cord Coverage
Sagittal T2
Sagittal PD or STIR
Sagittal T1
Post Gad T1

My Brain MRI did show enough lesions to make a diagnosis
My Spine showed no lesions....although I have many symptoms consistent with spinal lesions

How do I make sure that the radiology dept performs the MRI according to the correct protocol??
After my Brain MRI was not done according to protocol...I made sure to ask before the spine, and was told by the tech that is was being done with MS protocol.

Do the Radiologists get the update protocol from the CMSC?

Thanks:)

Fluffysmom · Accepted Answer

I've felt the same way as you many times.  I've been frustrated that the radiologists reading my films don't follow the Protocol in reporting the size and location of lesions, etc.  I had a 3T brain, cervical, and thoracic done at a well known teaching hospital and the reports were atrocious. The films of the cervical and thoracic were poor quality; the MS specialist that finally diagnosed me (at another hospital system) was disappointed in them.  
The brain MRI was excellent and he didn't care about the report.

I just got a new 3T brain MRI at another hospital, and the quality is different.  There are 4 mm slices with spaces between instead of the 3 mm contiguous slices that there should be.  I'll have to look again to see which series were done, but I don't recall seeing the Flair.  I didn't see the actual orders, but I know it was for a MS follow-up/new symptom MRI on a 3T machine.  The tech asked me what new symptoms I was having.

Previously I've asked to make sure that my MRIs were done according to MS protocol, with 3mm slices, and was told at the teaching hospital that they don't reset the machine; all the MRIs were done with thin slices.  The techs are good, but they aren't  the radiologists.  They  just do their jobs as they understand them.  Here the radiologist read the MRIs after they're done, when they get to them.

Around here it doesn't seem that the MS protocol is well understood it the imaging facilities I've been to.  I hope that my MS specialist will be OK with what I've just had done.  It sure looks different from my last 3T!  They'll be difficult to compare.  

Oh, the whole thing took maybe a half an hour.  When they injected the contrast, I was back in the machine in a minute or two.  The did two more scans; one for 1 1/2 min, the other for 2 min.  

I'm hoping my report will be done today; it will be interesting to see what it says.

It is strange that they did Flair for your spine but not your brain.  I think ess is probably right about annoying the radiologist; they're an interesting breed.  

You could ask your neurologist to be very specific in writing the orders next time, if he/she will.  That way the tech can know ahead of time specifically which series to do, instead of what's standard for that imaging facility.

take care,

Kathy

tonyad · Answer

I am going to Ditto what Shell had said.
Come right out and ask!  you are your own best advocate and if you do not ask then no one else will.  Personally I would not care if they got pissed at me for asking or not.
that's your right to know that things are being done correctly. It's YOUR health at stake here, Not theres......Just a 9 - 5 to them   

   keep us posted. Have a good weekend :)
~Tonya

Fluffysmom · Answer

Ooops, I meant what Shell said, not ess!  Where's my brain today?

daisy.girl · Answer

thank you for responding.

I am not fired up over this, and I don't feel I am assuming something was done incorrectly. 

I just don't understand, if there is a specfic protocol (CMSC 2009 MRI Protocol) to follow, then why don't the MRI facilities follow it?  You would think if all Imaging facilities used the same protocols for a specfic DX then comparing past films would be so much easier.

sllowe · Answer

You'll either insult them because they are accredited and pride themselves in proper sequencing to enable the radiologist to see what they need to see. 

Or, you'll enlighten them on the fact that you know the protocol. 

Or, I just don't know, but you sound fired up over this. Why don't you just ask them what sequences are run for your script? Just a thought. That way you have facts infront of you before assuming something was done incorrectly.  Just my opinion...

-shell

daisy.girl · Answer

No FLAIR sequence on my Brain was performed. just the diffusion weighted and the T1 T2 weighted. Flair is MS protocol for the brain.

No STIR or PD on my spine. A FLAIR was done on the spine....but that is not MS protocol. STIR or PD is MS protocol.

I have the CMSC protocol printed out....Should I take it with and give to the MRI tech?

The protocol I posted (1st post) is what is recommended by the CMSC, not what was done on me.

sllowe · Answer

Hi there,

It does appear the flair imaging was performed from what you document here. To put your mind at ease, flair is performed even when ms protocol is not ordered on the script. So, when if yours was written in this manner, you should be in good shape.

This HP is a review of the protocols written as guidelines:

http://www.medhelp.org/health_pages/Multiple-Sclerosis/MRI-Protocol-Review-2003--2006--2009-Basics---A-Comparative-Look/show/1065?cid=36

Hope this helps,
-Shell

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