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Would you know if you had a pelvic fracture?…
Date Recorded
May 03, 2016 Health Topics (The Scope Radio)
Bone Health Transcription
Dr. Miller: Could you have a pelvic fracture? We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.
Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. David Rothberg. He's an orthopedic surgeon and specializes in trauma care. David, how would one know if they had a pelvic fracture? Now I know that these are fractures that don't just occur spontaneously. Generally, people will have some type of trauma. Tell us a little bit about how that happens. How does one suffer a traumatic pelvic fracture?
Dr. Rothberg: There really are two separate patient populations that will have a pelvic fracture. One is the patient with a devastating life-threatening injury. These are not ones where you're questioning. These are patients that come in as a Level 1 trauma activation, but really a lot of these come in in an older patient population who have had a ground-level fall. They've tripped on the carpet, or over a dog, or something like this, and they can have pain anywhere from there groin, their abdomen, or low back, and that's when the work-up starts.
Dr. Miller: Is it sometimes confused with a hip fracture?
Dr. Rothberg: Commonly. The type of pain that you have with those two fractures is extremely similar, and we typically will figure out which one it is by taking x-rays.
Dr. Rothberg: Now a pelvic fracture, I guess depending on the type of patient, generally those are surgically repaired. They're fixed and treated, and then there's a recovery period. What about a pelvic fracture? How do you treat those? It seems like it would be kind of hard to cast a pelvic fracture.
Dr. Rothberg: Yeah, that's true.
Dr. Miller: It's like a rib. You can't cast ribs.
Dr. Rothberg: We don't cast pelvic fractures. What we're trying to figure out when we're working up some of the pelvic fractures is is the pelvis stable or unstable? And what that means is how much motion is in the pelvis when someone would walk.
Dr. Miller: And how do you determine that?
Dr. Rothberg: It's based on physical exam, the x-rays, and oftentimes a CT scan really looking at the pattern of the fracture, or how the bones are broken, and trying to determine the best course.
Dr. Miller: So in a pelvic fracture, would you operate on them from time to time?
Dr. Rothberg: Yeah, it's a very common operation for us. We do them almost daily, if not weekly. It really depends on the age and patient health status and mobility, and a lot to do with what they've broken.
Dr. Miller: Is the recovery time similar to a repaired hip fracture, or is it longer? Is there a difference in the type of recovery?
Dr. Rothberg: It's pretty much in the same ball park depending on the pattern of fracture they had. The surgery is a little easier to recover from. The surgery is not as invasive, but the ability to get back walking is about the same. It's tough in the early period, but we do expect that most people will get back to their daily life.
Dr. Miller: So the real key is if someone falls at home, especially an older person, and they have persistent pain they ought to be checked out and receive some type of radiologic study in order to determine at least initially if there's a fracture.
Dr. Rothberg: That's exactly right.
Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
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What do doctors consider when determining whether…
Date Recorded
July 31, 2018 Health Topics (The Scope Radio)
Brain and Spine Transcription
Dr. Miller: Benefits of having a CT scan versus having an MRI. We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.
Dr. Miller: I'm here with Dr. Ulrich Rassner and he is a radiologist here at the University of Utah. And we're going to talk a little bit about the difference between a CT scan and an MRI scan. Ulrich, can you tell us a little bit about the difference and kind of in a nutshell what would be the concern for patients? I know that some patients are concerned about the potential for radiation exposure with CT scans and MRIs use magnetic fields and there's no ionizing radiation in there. So should everybody have an MRI?
Dr. Rassner: No, not everybody should have an MRI. It depends very much on the question that we're trying to answer.
What Is a CT Scan?
In general terms, a CT is a fancy X-ray. And fancy in the way that we acquire a lot of individual X-rays and then the computer can assemble them and allow us to have cross-sections like we're cutting through the patient. And that is tremendously helpful with complex anatomy. So for example, the facial bone fractures, where if you tried to figure out what is going on a plain film on an X-ray, it is very difficult because there are so many overlapping structures. While on a CT scan, you can see them to much greater detail and see what is injured and needs treatment.
What Is an MRI?
Dr. Miller: Now, how about the MRI? Does it not do the same thing?
Dr. Rassner: The MRI does do the same thing. However, MRI uses the magnetic properties of tissues. So when we put the patient in the scanner, and the scanner's a very powerful magnet, the patient actually will become magnetic while they are in the scanner. And then we can manipulate that magnetization in the patient with radio waves and they are just the same wavelength as a TV channel or so you might tune in.
Dr. Miller: But that's not dangerous.
Dr. Rassner: That is not dangerous and there are very specific guidelines from the FDA in how much energy we can put in a patient. But there is no ionizing radiation so there is no cancer risk associated with that.
Dr. Miller: Now, a CT scan's ionizing radiation exposure is multiple times that of a plain X-ray so get that better imaging, it comes at a cost of greater ionizing radiation.
Dr. Rassner: With CT, yeah. CT has higher radiation doses than a radiograph, but in a lot of cases, the added information that you get is beneficial. And also, in some cases, for example, if you want to look at the skull with a radiograph, you need a lot of different views so you can't just look from the front. You may have to look from the side and then obliquely, and so all those individual radiographs can add up to a similar dose as a CT and yet you don't get as much information out of them. So sometimes, doing the correct study or the better study right away can actually save radiation, rather than doing the first one and then decide, "Well, we can't actually see what we need to see."
MRI, again, just to come back to that point, looks at a magnetization, and then we can look at tissue property. In a sense, when we manipulate it with the radio frequency waves, how long do they stay magnetized and how long does it take to regain magnetization? And the differences between soft tissues is quite striking with that and so we can resolve soft tissue detail that is invisible in CT. And so we can pick up lesions that cannot be seen with other imaging studies. And there are certain things we can see and certain things we cannot see so we are basically looking at hydrogen in the body, which is mostly is in water and which is in fat. And so those tissues that contain that, we can see very well. Other tissues, like bone, we do not see directly. We see the bone marrow, but not the bone.
Dr. Miller: So tell me how a patient would know or how they might sense they would be better off with an MRI versus the CT. I mean, there are a lot of articles out now in the press about the dangers of ionizing radiation. And some patients may think that they should have an MRI just simply because it doesn't have any exposure to ionizing radiation. We talked a little about the need for CT scan for certain types of tissues in the body and MRIs look at another set of tissues in the body, maybe better than the CT scan. So what would a patient to sort of distinguish whether they would benefit most from an MRI or a CT scan?
Dr. Rassner: It depends very much on the question that's trying to be answered. And again, if there are certain soft tissue tumors, it might easier to see them with MRI than with CT, but there is no general rule. What also enters into the equation is that an MRI scan is a much longer study.
Dr. Miller: More expensive, perhaps?
How Long Does an MRI Take Vs. a CT Scan?
Dr. Rassner: More expensive, as well and in part because it is longer. So while a CT scan, the actual scanning part, may take 10 seconds, an MRI examination may take 50 minutes to an hour or even longer. And so a lot of images, to just acquire them, may take on the order of five minutes. And so, for example, if you're imaging the chest, you can hold your breath for 10 seconds, but you can't hold your breath for five minutes. So there may be much more issues with breathing motion so some lesions that are easily seen on CT, we might see as well on MR because there's a lot of movement during the examination.
Dr. Miller: I suppose one appropriate question from a patient might be, "Have you discussed with radiologists which test might be best for me?"
Dr. Rassner: Yeah.
Dr. Miller: I don't think that happens very often, but that could be a very good question for a practitioner to hear. "Have you discussed that with the radiologist," and that might give them some additional comfort in which test was being ordered.
Dr. Rassner: Yeah. We are always happy to discuss it with our clinicians, and in fact, it often helps us, especially in complex cases, when we do know more of the history of the patient and what is specifically of concern, especially with MRI. The MRI is a much more targeted exam and there are many different ways we can acquire images. And we target those for a specific question. And so, in difficult cases, having that specific information helps us do the best study for that question.
Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.
updated: July 31, 2018
originally published: January 28, 2016
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