by Lee Rice, DO, FAASM, FAAFP
MRI whole-body scans for asymptomatic patients without specific risk factors have become a popular means of early disease identification. With early detection, there is an increased opportunity for a cure. However, that doesn’t mean that preventative total body scanning is always the wisest choice. The people who own the machines and profit from them are entirely behind recommending them but clearly have an inherent conflict of interest. Although scanning may find some tumors, the majority of them are benign and don’t need invasive or expensive radiation involving workups because they either aren’t dangerous or would resolve on their own. The real issue is weighing cost vs. benefit vs. risk. The primary consideration if you have a whole-body MRI is not the result of the scan but rather, what would you do if something “abnormal” is identified?
For me, the key questions are:
- Does the financial cost matter?
Insurances generally won’t cover an elective scan, and whole-body MRIs are costly.
2. Your pre-scan “personality”.
A positive result can sometimes cause significant unforeseen stress if one is a worrier. Do we work it up or not? How dangerous might it be? If we watch it, then how do we monitor it? Could it get worse, might it kill me, do I need a biopsy, etc., etc?
3. Decision-making about what to do about findings.
Will treatment include potentially unnecessary or invasive procedures or radiation? What are the potential complications? What are the costs of doing surgery or radiation to hopefully save a life?
It’s not so much a question of whether one should or shouldn’t for people who have no problem with the cost. Rather, if you do proceed, how will you handle the results? Are you the kind of person that won’t be driven crazy by a positive but probably benign result? Or are you the type of person who wants to know all the info you can and can deal with it? Also, who is on your team to help you through this process?
I’ve copied two position statements, the first from the NIH website on Magnetic Resonance Imaging:
Although MRI does not emit the ionizing radiation that is found in x-ray and CT imaging, it does employ a strong magnetic field. The magnetic field extends beyond the machine and exerts very powerful forces on objects of iron, some steels, and other magnetizable objects; it is strong enough to fling a wheelchair across the room. Patients should notify their physicians of any form of medical or implant prior to an MR scan.
When having an MRI scan, the following should be taken into consideration:
- People with implants, particularly those containing iron, — pacemakers, vagus nerve stimulators, implantable cardioverter- defibrillators, loop recorders, insulin pumps, cochlear implants, deep brain stimulators, and capsules from capsule endoscopy should not enter an MRI machine.
- Noise—loud noise commonly referred to as clicking and beeping, as well as sound intensity up to 120 decibels in certain MR scanners, may require special ear protection.
- Nerve Stimulation—a twitching sensation sometimes results from the rapidly switched fields in the MRI.
- Contrast agents—patients with severe renal failure who require dialysis may risk a rare but serious illness called nephrogenic systemic fibrosis that may be linked to the use of certain gadolinium-containing agents, such as gadodiamide and others. Although a causal link has not been established, current guidelines in the United States recommend that dialysis patients should only receive gadolinium agents when essential, and that dialysis should be performed as soon as possible after the scan to remove the agent from the body promptly.
- Pregnancy—while no effects have been demonstrated on the fetus, it is recommended that MRI scans be avoided as a precaution especially in the first trimester of pregnancy when the fetus’ organs are being formed and contrast agents, if used, could enter the fetal bloodstream.
- Claustrophobia—people with even mild claustrophobia may find it difficult to tolerate long scan times inside the machine. Familiarization with the machine and process, as well as visualization techniques, sedation, and anesthesia provide patients with mechanisms to overcome their discomfort. Additional coping mechanisms include listening to music or watching a video or movie, closing or covering the eyes, and holding a panic button. The open MRI is a machine that is open on the sides rather than a tube closed at one end, so it does not fully surround the patient. It was developed to accommodate the needs of patients who are uncomfortable with the narrow tunnel and noises of the traditional MRI and for patients whose size or weight make the traditional MRI impractical. Newer open MRI technology provides high quality images for many but not all types of examinations.
This statement is from The American Academy of Family Physicians:
Whole-body scanning with a variety of techniques (magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, CT) is marketed by some to screen for a wide range of undiagnosed cancers. However, there are no data suggesting that these imaging studies will improve survival or improve the likelihood of finding a tumor (estimated tumor detection is less than 2% in asymptomatic patients screened). Whole-body scanning has a risk of false-positive findings that can result in unnecessary testing and procedures with additional risks, including considerable exposure to radiation with positron emission tomography and CT, a very small increase in the possibility of developing cancer later in life and accruing additional medical costs as a result of these procedures. Whole-body scanning is not recommended by medical professional societies for individuals without symptoms, nor is it a routinely practiced screening procedure in healthy populations.
At the end of the day, MR technology is a wonderful tool when prudently used and when patients are well-informed about the above information. We will be happy to answer any questions you may have regarding whether this might be of interest to you. Well-informed patients make healthy choices and there certainly is not a “one size fits all” answer to which screening tools are appropriate for any one person.
- NIH. Magnetic Resonance Imaging (MRI).
- American Academy of Family Physicians. Don’t use whole-body scans for early tumor detection in asymptomatic patients.
- ‘Celebrities Are Getting Full Body MRIs — Should You?’ from Medical News, March 1, 2023.