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  • Donald Corenman
    Post count: 52

    Hello Dr. Corenman,

    I am currently a first year medical student enjoying everyday new knowledge (and of course watching your videos).

    When I was digging into Youtube to find on how to read MRI and X-ray images I found yours, and it was amazing! (You know that “Aha!” moment)

    But I am still very confused about the orientations of images. So, when I read X-ray, CAT scan, and MRI images should I imagine myself being in front of a pt (in coronal sections) and being on top of the pt (in horizontal sections)? I know there are AP and PA images in x-rays, but how do you differentiate from one to the other?

    Since most of the images have L side of the pt’s body on my R side, it makes sense that I am facing the pt. But what about with horizontal images? Am I looking at the pt from the bottom up or the other way around? Is a pt in supine position or prone position?

    Thank you for posting very nice educational videos for us!!

    (originally posted on Facebook and moved to forum by admin)

    Donald Corenman, MD, DC
    Post count: 8660

    You are now going to enter the world of “image dyslexia” and confusion by reading MRIs. Persevere as these images open up a great new world. There are two standard views that need to be projected at the same time to read an MRI, the axial view and the sagittal view. When you initially view the MRI, bring up the T2 images as these are the easiest to understand. Most programs have “scout lines” which will allow you to know where you are on the images. It will show by a “cut line” where you are on the corresponding image. You have to surf the program embedded in the image system (eFilm, Stryker or Dicom) and with trial and error, you will find the right application.

    Almost all of us in the profession would assume that when looking at an axial image, you would be looking at the cut section from the top down, but no- radiologists do this in a dyslexic fashion! When you have an axial image- you are looking at the bottom up view. It takes some time to get use to, but once you do, even though it will infuriate you, it does make understanding the images easier to comprehend.

    The T2 images are the easiest to gain the most information as water and fat are both white. The T1 images make fat white but water dark, good for looking at the nerve root in the foramen and for malignant processes in the bone. The STIR images (inversion recovery) are very useful for bone inflammation as the fat in the bone is suppressed (dark) but water (inflammation) in the bone is bright. Sagittal images are normally filmed left to right but that is not always the case- so be wary and use your cut lines.

    Really- just spend lots of time looking at any MRI teaching films to understand the subtlety of the brights and darks and what they mean. Also, know your anatomy hands down so you will know what structures reside in the area you are viewing.

    Good Luck!

    Dr. Corenman

    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Donald Corenman
    Post count: 52

    She responded via Facebook. “Hi Dr. Corenman, Thank you for your thorough response. I greatly appreciate it. I will definitely spend more time to become familiar with the images so that I can tell right away where I am looking at. I just thought of an analogy of a neonate learning to recognize his parents’ faces. At first, he will have difficulties identifying them, but as he grows he will find the parents among many different people no matter how they pose. :)”

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