Question to an expert: Do I need to do an MRI just in case and what does it mean?

We are used to searching online for ANSWERS TO MOST OF THE QUESTIONS OF EXCITING US . In the new series of materials, we ask just such questions: burning, unexpected or common – to professionals in various fields.

Examination methods that allow you to see different organs and systems without pain and cuts, including even before the birth of a person, are called imaging (or imaging techniques in English). True, many still doubt that these methods are safe: there are rumors about the dangers of even such an ordinary thing as an ultrasound scan. As a result, two extremes arise: some are afraid of imaging studies like fire, others insist on regular “tomography of everything.” How justified are the fears? Who needs such research and when? Should pregnant women be afraid of them? We asked an expert to answer these questions.

chief freelance specialist in radiation diagnostics of the Moscow Health Department, Doctor of Medical Sciences, Director of the Scientific and Practical Center for Medical Radiology of the Moscow Health Department

Concerns about the safety of hardware examinations are quite understandable, because they somehow affect the cells of the body. The first thing we think about is how it will affect our health in the future (especially if the word “radiation” is used in the sentence). But in fact, not all types of imaging diagnostics use radiation: ultrasound and MRI have nothing to do with it at all.

In the case of an ultrasound, the machine creates vibrations, or waves; when the ultrasonic wave reaches tissues with a certain acoustic impedance , it is refracted. The part of the wave that affects the tissues with less resistance will be absorbed by them and pass further, while the other part, in front of which the resistance of the tissue is stronger, will be reflected. Roughly speaking, the more ultrasonic waves are reflected, the brighter and clearer the picture on the screen of the device will be. With MRI, the story is a little different – but the main role here also belongs to waves, only electromagnetic. They create a strong magnetic field and record the response to it from some particles (the nuclei of hydrogen atoms are responsible for this). In fact, the device registers the response electromagnetic radiation of the body and displays an image. This is not a “photograph” of the organ under study, but rather a map of its electromagnetic signals.

Such methods are safe for the patient’s health, since they propagate sound or electromagnetic waves that are not able to change the structure of cells. Ionizing radiation (for example, X-rays or gamma rays, which are used by computed tomography) acts differently: the wavelength under such an effect can turn neutral particles in our tissues into charged ones, that is, ions (hence the name). For health, this is dangerous because the structure of the tissues changes. If ionization catches dividing cells by surprise and acts on a protein synthesized using DNA, then the resulting anomaly will repeat itself many times, like on a conveyor belt. This is how mutations arise that can lead, for example, to cancer.

Of course, this is not a reason to categorically refuse X-rays or CT scans. It’s about the radiation dose; for structural changes to start, it must be very large (symptoms of acute radiation sickness appear at a radiation level of 300 millisieverts, and a safe dose is up to 100 millisieverts). Modern diagnostic devices in this regard spare the body: for example, during an X-ray of the lungs, a patient can receive less than 1 mSv of radiation; with a CT scan, the figures will vary depending on the area under study, but in general should not exceed 16 mSv. In higher doses, radiation is used to treat cancer – this is called radiation therapy. At the same time, the risk of developing a second tumor is not excluded, although this happens extremely rarely .

It turns out that it is difficult to achieve a dangerous dose of radiation, and there is no need to be afraid of examinations. Vo-the first, the deleterious effects of ionizing radiation so far recorded only in the framework of large catastrophes like Chernobyl, where radiation doses were extremely high. Secondly, we receive a certain amount of radiation without medical examinations: a person who regularly leaves the house receives up to 2-3 mSv of radiation per year. Our body has adapted to this kind of stress and copes with it using defense mechanisms, including immune cells that capture and destroy abnormal cells, as well as apoptosis (programmed cell death).

Use only safe methods so as
not to face radiation at all, rather a utopia
than a reality

On the other hand, it is definitely not worth doing radiation diagnostics in any incomprehensible situation: although the harm of radiation in small doses remains in question, experts try not to expose patients to radiation in vain. Some organs are especially sensitive to radiation – these are the thyroid gland, skin, retina, glands (including mammary glands), and pelvic organs. To protect patients, certain protocols are followed: for example, lead aprons are used to block X-rays, and machines are adjusted to use the minimum dose sufficient to obtain a good image.

Specialists treat children and pregnant women with extreme caution: if the examination is recommended, but there is no urgent need for it, it may be postponed for some time. On the other hand, dental radiography is safe for pregnant women if it is performed according to all the rules – much more dangerous for both the mother and the fetus is the source of infection in the mouth, that is, caries or pulpitis. Ultrasound and MRI during pregnancy can be done without fear – in this case, ultrasound is used to determine not only the gender of the child, but also the risk of developing Down syndrome or congenital anomalies. The dangerous effect of ultrasound and MRI on the fetus is no more than a harmful myth, because there is no ionizing radiation from such studies.

To use only safe methods, so as not to face radiation at all, is more a utopia than a reality. If only because different types of diagnostics allow you to look at the area of ​​interest in different ways. The mechanisms of CT and MRI do not coincide, but they have the same task – to display the object in three-dimensional form. At the same time, with the help of computed tomography, fractures, hemorrhages, vascular function , and the condition of the abdominal cavity are better diagnosed, although in general this method is also suitable for other cases. MRI is better suited for soft tissue, allowing you to see tumors and examine, for example, the brain and spinal cord, although again this method can be used for other parts of the body.

Ultrasound, on the contrary, has a limited spectrum of action. It is believed that it does not see the organs that are hidden behind the bones (the ultrasound wave simply does not reach them). And yet it is not amenable to automation, that is, a specialist is needed to interpret the ultrasound results. Nevertheless, the device is easy to install right at the patient’s bed, which cannot be done, for example, with a massive MRI tunnel. Classical X-ray diagnostics is now used less often than before, but sometimes it is indispensable, for example, before complex surgeries. In fact, much depends not only on the purpose of the study, but also on the price, time spent and, in fact, the availability of the device in the clinic.

A healthy person under forty does not need to have a CT scan on a regular basis. It is worth making an appointment with a doctor when something really bothers you. If it seems that something like a medical examination is needed, it is enough to go through a simple check-up program (this usually includes ultrasound of various organs, ECG and echocardiography – ultrasound of the heart, but a chest X-ray may also be included). For older people, radiographic examinations are indicated as part of regular examinations. For example, after fifty to sixty years, everyone is recommended to have an annual lung cancer screening – that is, a CT scan of the lungs, and women over forty – also breast cancer using mammography.

My parents did not particularly delve into this story, they said to go to the doctor if something hurts – and if the doctor said that everything is fine, then it is. In the summer, after the fourth year, I promised my parents to go by car to my grandmother, and this is two days’ journey from St. Petersburg. Before that trip, they knew about the pain only from my words in the format “my stomach ached again” – and this was the first time they saw me turn pale, break out in cold sweat, cry quietly and throw pills. Only after that did my family begin to take the problem seriously; when we returned, I went to the doctors whom I had advised to my parents, and from there I got to my surgeon. When I went to the operation, I had three or four mutually exclusive diagnoses from different specialists on my hands. The doctor said that it doesn’t matter what is there – you need to remove it.

At the age of 21, I had my first operation, and it was one of the happiest moments of my life. I began to take light hormones, a new life began without pain. I led an active lifestyle, three workouts a week, English courses, and then business courses were added to my studies and work as a tutor. After a couple of months, the stomach began to pull again. During a routine examination, the uzist named one of those diagnoses that I had been given before, and I realized that everything had returned. A week or two later, I was operated on again. I joked that this is a unique opportunity to rehabilitate for my boyfriend and friends who did not come to the hospital the first time. After both operations, histologists who examine tissue samples under a microscope wrote that I had leiomyoma (a benign tumor), but there was not a word about endometriosis. Nevertheless, the doctor who operated on me prescribed a drug for the treatment of endometriosis – after all, she saw with her own eyes what was inside me.

Everything was fine with this drug – except that it is very powerful and with a bunch of side effects, and it is usually prescribed for several months. In fact, he introduces the body into an artificial menopause. I drank the medicine for a year and felt great, but because of the risks associated with it, they told me to cancel it. Within a month, I realized that something had changed inside, went for an ultrasound scan and saw new nodes on the screen. It was a couple of months before the defense of the graduation collection. For almost a month I lay at home and cried. I do not remember what pulled me out of that state, I remember that I read the book “Depression Is Canceled” and forced myself to leave the house. It seemed that the world was closed, there was nothing to breathe. Then something clicked in my head, and I looked at the situation from the outside. Then we parted with the young man, I stopped crying and was able to sew a collection and get a diploma.

I worked a lot, arranged some kind of filming, went to German courses, and in general I had no time for doctors. My stomach began to hurt again, I was throwing pills, and one evening, when I was at home alone, the pain suddenly surged in an instant, my legs gave way, and I just rolled down the wall in the corridor. Papa from Komarov arrived faster than the ambulance. I called the doctors at eight o’clock , they took me only at about eleven, saying that most likely it was appendicitis. By midnight I was in the first medical school, where everything is beautiful, like in American TV series about doctors. They put me on a gurney and took me to rescue. Only bad luck – they quickly realized that it was gynecology, not appendicitis, and the gynecological wing was being repaired. As a result, I waited in the emergency room to go to another hospital. Anesthesia was not allowed in order to preserve a picture of symptoms for the following doctors. I thrashed, my teeth chattered, and for the first time in my life I howled in pain. As a result, when I finally ended up in the hospital, I was treated with antibiotics, removing “inflammation of the appendages.”

In January, I was sent to a new surgeon in Moscow, saying that the brightest luminaries should deal with such intricate cases. I went there several times for an appointment, received a federal quota for the operation, and by April I had it. They sent me all the documents and set a date for hospitalization, a few days before departure, I phoned the surgeon’s assistant and he clarified the details. I arrived there by night train with all my things, and when I went to the doctor’s office in the morning, she said that she was on vacation from tomorrow , and then she was starting to work in another hospital. Anecdote according to Kant: tense expectation, suddenly turned into nothing. She didn’t understand what the problem was; her assistant timidly said that I had come from another city, to which she replied that it was not scary, “he will come again.” I sobbed in the hallway, not knowing how to react to this. I went to Pushkin, looked at the Cranachs and returned home. I understood that no matter how cool and famous this doctor was, I would not lie down on the operating table with her – I no longer trusted her.

Gathering my courage, I went to the doctor who performed the first two operations on me. In June 2016, I underwent the third operation, during which it turned out that during the month of my wanderings in hospitals with inflammation of the appendages, these very appendages disappeared. No one will say exactly what happened then, but it was probably a torsion of the fallopian tube, and I lost my right ovary. The operation was long-awaited, and everything would be fine, but in that ill-fated hospital I was again given a histology report on leiomyoma – and it would not have mattered if it had not tied the doctors’ hands in prescribing drugs. I did not have the right to officially prescribe the only drug that helped . Then I took the glass and went to the laboratory of the oncological center. A week later, I was holding a piece of paper in my hands, on which was written “adenomyosis node”. I’m not sure the lab staff understood why I was so jubilant.

In the entire history of my illness, treatment consisted of three laparoscopic operations and four options for hormonal drugs – I do not consider the attempts of the first doctor to prescribe herbs for me and send me to treat pain to a psychoanalyst. Now I have been taking pills every day for more than two years: the main hormonal drug and additionally others for the prevention of thrombosis. Previously, it seemed that taking pills at the same time every day was difficult, now I’m used to it. A couple of times I forgot and missed a few days – but a strong pain became a reminder, once accompanied by bleeding. I need to regularly do ultrasound and donate blood to check blood clotting and liver parameters. Sometimes I do this without visiting a doctor, because I already know what to look for, and I go to the doctor only in case of any abnormalities. You cannot go to baths, saunas, solariums and the like. It is not recommended to sunbathe at all and ride a bike. In theory, as with any other medications, I cannot drink alcohol – this is the only restriction to which I close my eyes.

Even when I was first diagnosed with uterine fibroids, I was very worried about it. I had a terrible sense of inferiority, I felt broken. It created a wall between me and my friends, because no one was ready to discuss it with me. Parents also did not take this news as something to talk about. Are you not dying? So everything is all right. And when the situation began to escalate, there was no time for discussion. Sometimes I wished I had a “real” illness, something life threatening, where I could fight and win or lose. Because dying is not as shameful as suffering endlessly.

At the very beginning, I shared my problems with the master at the academy, she really supported me then. Then I heard her tell my story to another of our teachers, to which she gave out that I was just sitting on pills and inventing pains for myself. In general, I often heard that I did not look sick and that I was inventing everything – and sometimes I answered that I just knew how to paint well. “If you don’t find a sexual partner and don’t get pregnant in the next six months, you will remain disabled,” – this is the phrase after which I cried for the first time in my life in the doctor’s office. Even when he was discharged from one hospital, when asked whether it was possible to play sports, a male gynecologist said: “Well, go to the gym, maybe you can at least find a man there”.

When the same thing is repeated over and over again and it seems that there will be no end to the pain, then the hands drop. There were several periods when there was no strength at all, and people around did not understand my depression. It was scary when there was nothing left but misunderstanding why this was happening to me. After a month in hospitals, I was so desperate that I was ready to give up traditional medicine and go to any healers, fortune tellers, homeopaths – but I went to a psychotherapist. In addition, my work and German language courses helped me to get over what was happening; one and a half to two hours with other people is a good way to disconnect from your life and problems, immerse yourself in another world. This is a real reboot. In this regard, I am a happy person: I was very lucky with my students and their successes give me strength. I am happy for them, as for myself, when they enter where they wanted to, win contests or participate in exhibitions.

I have such a long and strange story that I would like to lead to something, but only there is no moral in it. I cannot give one-size-fits-all advice. There may be a doctor anywhere who goes on vacation the day of your surgery. Probably, I would like the girls to be a little more attentive to their health and not start the situation. To believe their feelings more than the words that enduring pain is a woman’s lot. So that they are not afraid to change the doctor if something seems suspicious or they simply do not explain anything to you. To support each other and not be afraid to talk about what worries, and know how to be close to those who have difficult times.

local_offerevent_note July 28, 2021

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