Also, does anybody know how big the files are (say, in megabytes)?
Hello! Sorry, I am just seeing this question. I'm on the fence about being brutally honest, because I don't want anyone to shy away from seeking care. Medical care is big business. It is rare for a spine surgeons to be in a solo practice. More than 60% of spine specialists practice in groups with more than 20 physicians in the practice (Journal of Neurology, Volume 80, Issue 4S, April 2017). You don't see many solo spine specialists anymore -- I can't think of any that come to my mind in the huge metroplex where I work. That is why you will see many large groups if you search online. You will see many groups with "minimally invasive" in their tag line. That is because these doctors work in large groups to route patients.
A typical spine practice will have neurosurgeons, orthopedic spine specialists, anesthesiologist/pain management, and physical medicine & rehabilitation specialists. Because these are large groups, they have marketing teams. So to funnel a patient into a practice, they will usually offer a free MRI review. If the patient has recent, in the last year or so imaging, the will review it at no charge. Usually they would like the imaging to be recent, within the last year. So there are qualifiers. Many of these large groups will be minority partners in imaging facilities. That is just a side note for anyone searching for MRI pricing. You will notice most large diagnostic imaging groups are joint ventures with either a physician's group or a hospital owning part of it. Hence higher contracted rates, and higher prices if you choose to have imaging done in a hospital or joint venture partnership.
Each neurosurgeon and spine surgeon generate MILLIONS of dollars in revenue for hospitals. As these large groups expand, they are likely to be recruited by hospitals seeking revenue. You can search RVUs which is just medical lingo for relative value units by specialty. So adding a spine surgeon is a hot commodity in the world of healthcare.
Reading an MRI of the spine is quick. It doesn't take long at all to look at the cervical and lumbar spine. The thoracic spine can take a little longer, but the vast majority of patients complain of lumbar or cervical pain. When you start talking about other body parts there is a difference. For example an ankle or foot are going to take longer to image, and longer to read because they are more in depth studies. For example, an MRI of the foot without contrast takes about 45 minutes to run all of the sequences because there is a lot of detail in the joints and extremities. An MRI of the lumbar spine can be as quick as 15 to 20 minutes to run an MRI scan. The more detail, the longer the study and there is more to analyze. In the orthopedic world of shoulders, elbows, knees, hips, you tend to find doctors who will only do elbows or shoulders, or specialize in hips and knees, etc.
If your MRI was ordered by a specialist it will usually get a specialty read. Here is another tip if someone is considering getting an MRI -- see your specialist first because they will request a speciality read. If a internal medicine or family doctor orders your exam, the radiologist reading your exam might not have a subspecialty. If a spine group orders an MRI they usually have a protocol developed that might include certain sequences that might otherwise be skipped -- for example on a shoulder the ABER view is usually only requested by specialists, but add to the diagnostic value of your exam. If you had spine imaging ordered by a spine specialist it will almost always be read by a neuroradiologist. If you have for example an MRI of the shoulder is will be read by an MSK radiologist when ordered by a specialist. Due to CMS guidelines imaging facilities or hospitals have a radiologist on site during hours where there is contrast given. That radiologist might read your study, if the radiologist does not have a subspeciality it would be sent out to someone in the radiologists group with a subspeciality, and can literally be read anywhere with telerad technology. In my experience I don't know of any doctors that will accept only an AI read. As a matter of fact there is a term called an overread where you may have an x-ray at a doctor's office and the doctor will interpret it. But then the exam findings will be sent to an actual radiologist to "overread" the physician who is not a radiologist, but interpreted the study while you were in office.
So say you are a brand new patient seeing a spine specialist. Marketing is going to work hard to promote their various subspecialties to family doctors, hospital groups, and the community at large. This is a business, even though it is healthcare. You make an appointment. Most likely your first visit and free MRI consultation will be with a physical medicine and rehabilitation specialist. They will most likely try some conservative treatment, but will keep in mind the direction they will route you should it fail. For example, if they want to try steroid injections you will get routed to the pain management/anesthesiology doctor. If you fail that treatment, or should you obviously need surgery, they will route you to the spine surgeon or neurosurgeon depending on your diagnosis.
Another reason these large spine groups are flourishing is the opioid epidemic. Family practitioners and PCPs are encouraged to refer out to pain management prior to prescribing narcotics. To get a prescription for a narcotic for long term use, many pain management doctors want to see that you have had diagnostic imaging, failed conservative treatment, have maybe tried a neurostimulator first, completed or tried physical therapy, etc. This is actually a good thing in my opinion. Most ERs have even limited the use of narcotics even in the ER setting. Dilaudid was a common drug that may be prescribed if admitted but a lot of ERs will no longer give the medication.
I am not an IT girl. I can tell you that CDs with images are usually burned on a CD-R with 700MB 80 minutes discs. Some studies, like 3D mammography require the use of a DVD for the images. I am not much help with megabytes.
With all of that said, you can find some really amazing doctors. Please do your diligent research. Sometimes that is more than Google. Ask around your community, or find a friend in healthcare because they will have the inside scoop of which doctors are amazing, and which ones you may want to steer clear of.
I hope that helps!
Thank you, smile, for all the detail. That answers my questions, and then some. You have a lot of good insights.
I'm not a patient, btw. I was asking out of curiosity (including why they don't want the images uploaded but require mailing-in).
Also, always ask for a CD with your images on it. When you take it to your doctor it only takes a minute to upload, so ask for the CD back. That is much easier than tracking it down after the fact. There are many third party platforms, such as AMBRA, that make sharing images easy. We had an MRI patient who was on a professional sports team and was injured. Through the third party platform his doctor had his images before the patient even made it home. I know I have given a lot of extra detail... I just want consumers to know all of their options!
I am not sure why free MRI reviews are only for spines. They are not necessarily easier to read. Various academic centers such as Johns Hopkins do provide second opinion services for all types of cross-sectional imaging. Some may charge fees.
To answer your other questions, the majority of MRI's are usually read by radiologists: doctors who go through at least 4 years of college, 4 years of medical school, 1 year of internship, 4 years of residency +/- 1-2 years of fellowship (typically neuroradiology subspecialty in the case of spine MRI's). Although some spine docs may provide preliminary reads on their own, a radiologist still has to issue an official report for billing and/or medicolegal purposes. Artificial intelligence has not yet replaced or even come close to replacing the role of radiologists. It is still very experimental stage at this point. In real life daily practice, artificial intelligence is only being used for computer-aided detection for mammograms; i.e., circling spots that may be of interest. However, it is rudimentary at best, tending to highlight a gazillion potential abnormalities, many of which are false positives. A radiologist still has to review each area of concern and then agree or disagree with those findings.