“Doctor, I need an x-ray.” As a rheumatologist, I hear this statement many times from patients who believe imaging will help determine the cause of symptoms, such as back pain or knee pain. It seems simple, take a picture, and find out what is wrong. However, radiology is not always black and white.

Radiology is the medical specialty that uses medical imaging to diagnose and treat disease. Radiologists are physicians, trained in interpreting various types of imaging such as x-rays, CT scans, MRIs and more. Rheumatologists often depend on imaging to help manage diseases such as rheumatoid arthritis. However, the rheumatologist, radiologist, and patient must work as a team to determine which type of radiology will be most effective for each specific clinical situation.  

For example, an x-ray of a patient with knee pain tells us about the bones, cartilage (space between the joint), and degree of joint fluid present. But it tells us little directly about tendons, ligaments, or muscles because these soft tissues do not show up on a basic x-ray. Therefore, an x-ray may not be the most informative option and performing one may not change the treatment plan. 

Radiology offers a wide range of tools for physicians and patients today. What began with x-rays has evolved into a broad field that includes both interpretation and intervention. Interventional radiologists perform various minimally invasive procedures using medical imaging guidance, such as x-ray or ultrasound. Interventional radiology can treat problems with blood vessels such as blockages or clots and place stents to open them up. They can insert medicine directly into tumors, perform biopsies and other procedures. Additionally, patients generally tolerate interventional radiology procedures much better than major surgery.

With this in mind, when a patient presents their specific set of symptoms, I consider the wide spectrum of radiological tools and talk to the patient about which are most likely to help us find the information we need to improve their particular situation. Sometimes the right tool is an x-ray, but other times it is not. Once the information is gathered, physicians and radiologists work together to interpret the data and make a diagnosis. At that point, we are better prepared to make treatment decisions and determine if the patient needs medicine, injections, a brace, physical therapy, or referral to specialist. 

Without a doubt, radiology is integral to good medicine, but it’s not always black and white.  

Jennifer May, M.D. is a contributing Prairie Doc® columnist. She practices rheumatology in Rapid City, South Dakota and serves on the Healing Words Foundation Board of Directors. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.org and follow Prairie Doc on Facebook.