Dr. Bailie recognized early in his career that he was seeing many patients who were referred to him because they had already obtained an MRI and the radiologist had reported an abnormality. This often resulted in a referral to Dr. Bailie with the expectation for surgery. However, after a careful history and physical examination, it was clear that the MRI report was not a reflection of the entire problem. This led Dr. Bailie to critically review each patient MRI personally and correlate the findings with the patient's complaints and physical findings, not relying on the report to make a treatment decision.
In 2002, he studied over 500 of his knee and shoulder arthroscopy surgical patients comparing his interpretation of the pre-operative MRI with that of the radiologist and to the findings observed at surgery. What he found was as follows:
- Radiologists in the Phoenix area missed over 48% of clinically important problems and over-interpret other age related changes which are visible on MRI scans as being clinically important.
- The rate of missed readings increased proportionally with patient age
- Although the radiologists may see the same structures on the images,
- While Dr. Bailie was unable to see the complete extent of injury, given
- The most commonly over-interpreted problem noted by the radiologist
- The most commonly missed, treatable problem in the shoulder, was a
- In the knee, the most common mistake made by radiologists was failing (i.e. normal degenerative imaging changes interpreted by the radiologist as abnormal) they interpret the findings differently and thus express it in the age the inherent limitations of all imaging, he was over 93% accurate in interpreting the clinical relevance of the findings in the shoulder was SLAP labral tears (i.e. they stated a tear exists when, in fact, it did not) concealed high grade partial rotator cuff tear (i.e. they stated a tear did not exist when, in fact, it did) to provide the clinically important details associated with degenerative meniscus tears, leading to over-interpretation of normal age-related changes as "pathological tears" (as all degenerative knees have some degree of meniscus tearing and not all tears are clinically significant or contributing to pain)
Multiple published studies, performed in the U.S. and other countries, have since supported his findings in both the knee and shoulder. For example, Susan van Grinsven, et. al., published a study out of The Netherlands recently in the Journal of Shoulder and Elbow Surgery. They found that EXPERIENCED Orthopedic Surgeons, who took the time to carefully review MRI scans and correlate the images with clinical and surgical findings, interpreted MRI scans of the shoulder for instability related findings more accurately than their radiology counterparts. The important part of this study was that, this was only true of experienced surgeons and not all surgeons.
Dr. Bailie concluded that without clinical correlation (e.g. MRI findings should match the symptoms and complaints of the patient), surgery was much less likely to be successful. It is VERY IMPORTANT that Dr. Bailie personally have all imaging studies available for review during your appointment and not just a report of the study.
Dr. Bailie firmly believes it is important that physicians continually learn and critically evaluate themselves, including their ability to interpret MRI scans so they may provide the best treatment options for their patients.
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