5 ms·

MRI is not an emergency technology. Most hospitals will outright refuse to do them for the vast majority of inpatient stays. This technology will mostly end up

MRI is not an emergency technology. Most hospitals will outright refuse to do them for the vast majority of inpatient stays. This technology will mostly end up in imaging centers, improving throughput.

Mountain_Skies 7y ago
When I slipped on some ice eight years ago and hit my head, the ER gave an MRI. Now I wonder if they were just pumping up the bill, which would be strange because at the time they thought I didn't have insurance.
- prostheticvamp 7y ago
  Could be pumping up billings, but odds are decent they weren’t. An insurance company’s default would be to refuse payment on an ER MRI, so the docs must have felt reasonably confident they needed it and could justify it to insurance or were willing to get reamed out by management if they couldn’t. Still, an ER MRI is wildly unlikely. “Possible evolving emergency” and “an hour in a tube where we can’t see you” don’t play well together. Any chance you’re confusing CT scan for MRI? Cause -that- we would do for a head trauma like 1000% of the time.
  - sterlind 7y ago
    I had an MRI at the ER for a paralysis attack several years ago. I stabilized after IV fluids were given, they found extremely high neutrophils and thought sepsis, but I was lucid and had no fever. They gave me the option of waiting there for ~6 hours for the MRI shift to start, and I agreed. they found no sepsis or cauda equina, discharged me and told me to come back if it happened again. fortunately, it hasn't yet. I think the combination of weird blood work + medical mystery + stabilized meant I got an MRI. wish they'd gotten to the bottom of it..
  - ska 7y ago
    You can do useful imaging in well under 5 minutes with modern MR, so it’s not like like this is fundamentally impractical, it the workflow would have to be tightened up.
    - xattt 7y ago
      Is that 5 minutes with a strong field of a conventional machine?
      - prostheticvamp 7y ago
        Noooooope lol
      - ska 7y ago
        Yes with acceleration techniques, etc. Main field strength isn’t the real issue here it’s how quickly you can set up the other fields repeatedly and how long your pulse sequences run. There are a lot of factors, but somethings can be done quite quickly.
ska 7y ago
This is a bit of a chicken and egg problem. Not sure the units referenced will shift it, bit a good part of the reason MR is not used for emergency workflows is related to siting issues and cost (hence workload, you can’t afford to have one sit idle easily ) as well as time and complexity of imaging. If you solve or alleviate those issues it becomes more attractive. There is a fair bit of research around potential trial benefits if the contrast provided for some emergency procedures already.
cma 7y ago
It is used in differentiating strokes vs aneurisms and extremely important in emergency care for that reason.
- arkades 7y ago
  Sort of? Not quite? Ugh, I just wrote this long-ass post and lost it. Whatever, here's the short version: Stroke is a clinical diagnosis, not a radiologic one. CT will catch hemorrhages or large infarcts just fine. That's the important stuff: big infarcts cause big tissue damage. Tiny infarcts cause tiny tissue damage. MRI's superiority over CT is in that it catches smaller infarcts, and catches infarcts early. If I see a patient that screams "stroke" and the noncontrast CT is negative for hemorrhage, it's ischemic until proven otherwise. I don't need an MRI at the less than six hour stage and, while having one would be nice for malpractice reasons, whatever, I don't actually need one for your care. I may follow-up with an MRI if it's less certain that it's a stroke: tumors, infection, etc. that look like strokes. But, key - those aren't pressing, time-wise, the way a stroke is, if they look like a stroke ("look like" implies things about the nature of the underlying condition.) After 6 hours we've passed the TPA stage and we're looking at clot removals. Here we need to know the exact territory of the infarct. If I'm bothering with imaging, yes, MRI/MRA, but that's not about finding the kind of stroke - it's about telling the interventionalist where to go.
  - exikyut 7y ago
    (Kind of unhelpful after the fact - but regarding chewed posts: The method that works where I didn't accidentally close the last tab associated with a particular renderer process (or, TL;DR, didn't close any tabs), is to promptly figure out which renderer process is behind the tab in question via chrome's task manager, quickly attach to it with gdb, then `generate-core-file (filename)`, and grep through the result for my text. (Usually `grep -aC100`.) Alternatively, hibernating generally seems to always(?) save the disregarded bytes to disk (the associated memory regions immediately get used for something else, so they stay in in the pagemap); then I can reboot the machine, carefully prevent it from resuming, boot to Linux, mount the FS readonly as appropriate (since it was never unmounted cleanly), then go through the hibernation/swap image. (Bonus points for then resuming once you're done.) I recovered a family member's lost draft email this way once (TIL Gmail encodes emails in both HTML _and_ HTML-inside-JSON O.o).)
Amarok 7y ago
It's used in specific emergencies: https://news.ycombinator.com/item?id=22340458 https://news.ycombinator.com/item?id=22340458

Mountain_Skies 7y ago

When I slipped on some ice eight years ago and hit my head, the ER gave an MRI. Now I wonder if they were just pumping up the bill, which would be strange because at the time they thought I didn't have insurance.

prostheticvamp 7y ago
Could be pumping up billings, but odds are decent they weren’t. An insurance company’s default would be to refuse payment on an ER MRI, so the docs must have felt reasonably confident they needed it and could justify it to insurance or were willing to get reamed out by management if they couldn’t. Still, an ER MRI is wildly unlikely. “Possible evolving emergency” and “an hour in a tube where we can’t see you” don’t play well together. Any chance you’re confusing CT scan for MRI? Cause -that- we would do for a head trauma like 1000% of the time.
- sterlind 7y ago
  I had an MRI at the ER for a paralysis attack several years ago. I stabilized after IV fluids were given, they found extremely high neutrophils and thought sepsis, but I was lucid and had no fever. They gave me the option of waiting there for ~6 hours for the MRI shift to start, and I agreed. they found no sepsis or cauda equina, discharged me and told me to come back if it happened again. fortunately, it hasn't yet. I think the combination of weird blood work + medical mystery + stabilized meant I got an MRI. wish they'd gotten to the bottom of it..
- ska 7y ago
  You can do useful imaging in well under 5 minutes with modern MR, so it’s not like like this is fundamentally impractical, it the workflow would have to be tightened up.
  - xattt 7y ago
    Is that 5 minutes with a strong field of a conventional machine?
    - prostheticvamp 7y ago
      Noooooope lol
    - ska 7y ago
      Yes with acceleration techniques, etc. Main field strength isn’t the real issue here it’s how quickly you can set up the other fields repeatedly and how long your pulse sequences run. There are a lot of factors, but somethings can be done quite quickly.

ska 7y ago

This is a bit of a chicken and egg problem. Not sure the units referenced will shift it, bit a good part of the reason MR is not used for emergency workflows is related to siting issues and cost (hence workload, you can’t afford to have one sit idle easily ) as well as time and complexity of imaging. If you solve or alleviate those issues it becomes more attractive. There is a fair bit of research around potential trial benefits if the contrast provided for some emergency procedures already.

cma 7y ago

It is used in differentiating strokes vs aneurisms and extremely important in emergency care for that reason.

arkades 7y ago
Sort of? Not quite? Ugh, I just wrote this long-ass post and lost it. Whatever, here's the short version: Stroke is a clinical diagnosis, not a radiologic one. CT will catch hemorrhages or large infarcts just fine. That's the important stuff: big infarcts cause big tissue damage. Tiny infarcts cause tiny tissue damage. MRI's superiority over CT is in that it catches smaller infarcts, and catches infarcts early. If I see a patient that screams "stroke" and the noncontrast CT is negative for hemorrhage, it's ischemic until proven otherwise. I don't need an MRI at the less than six hour stage and, while having one would be nice for malpractice reasons, whatever, I don't actually need one for your care. I may follow-up with an MRI if it's less certain that it's a stroke: tumors, infection, etc. that look like strokes. But, key - those aren't pressing, time-wise, the way a stroke is, if they look like a stroke ("look like" implies things about the nature of the underlying condition.) After 6 hours we've passed the TPA stage and we're looking at clot removals. Here we need to know the exact territory of the infarct. If I'm bothering with imaging, yes, MRI/MRA, but that's not about finding the kind of stroke - it's about telling the interventionalist where to go.
- exikyut 7y ago
  (Kind of unhelpful after the fact - but regarding chewed posts: The method that works where I didn't accidentally close the last tab associated with a particular renderer process (or, TL;DR, didn't close any tabs), is to promptly figure out which renderer process is behind the tab in question via chrome's task manager, quickly attach to it with gdb, then `generate-core-file (filename)`, and grep through the result for my text. (Usually `grep -aC100`.) Alternatively, hibernating generally seems to always(?) save the disregarded bytes to disk (the associated memory regions immediately get used for something else, so they stay in in the pagemap); then I can reboot the machine, carefully prevent it from resuming, boot to Linux, mount the FS readonly as appropriate (since it was never unmounted cleanly), then go through the hibernation/swap image. (Bonus points for then resuming once you're done.) I recovered a family member's lost draft email this way once (TIL Gmail encodes emails in both HTML _and_ HTML-inside-JSON O.o).)

Amarok 7y ago

It's used in specific emergencies: https://news.ycombinator.com/item?id=22340458 https://news.ycombinator.com/item?id=22340458