By Sean Shuttleworth BSc (hons) MCSP – Senior physiotherapist at Burton and Derby physio group
With the rise of social media and private medical providers utilising celebrities and influencers to market their services, there has also been increase in the use of imaging and testing without the presence of symptoms. As with any medical provision there will always be pros and cons, but is this something you should consider doing yourself?
For most of us the cost will prohibit this as an option but if you are thinking about engaging with a full body MRI with no symptoms then what might be the risks and rewards. It would be negligent not to discuss that this may identify certain conditions in the very early stages, however, with no symptoms present, this is highly unlikely. If we dig into the data, it is significantly more likely that the investigations will identify a range of incidental findings.
The first question to answer, what are incidental findings? It’s a term to relates to any abnormal finding noted on imaging, however, this doesn’t always mean it is painful, harmful or even relevant. This is where it starts to get really nuanced. In essence, an MRI, X-ray, ultrasound, CT is a picture. Granted it is a technological impressive picture of your insides, but still just a picture. Even in the presence of pain or injury it doesn’t always identify a cause. Consider if we took a picture of every single person on the planet, we would find a range of skin changes, bruises, cuts, grazes, wrinkles and scars, that cause the person no discomfort at all. The exact same principle applies with deeper imaging. Ironically, with modern imaging methods, we are finding incidental findings to be even more common as the clarity of the picture improves. Leaving us with the question being, if they are not always that helpful when people have got pain, how helpful can they be when they haven’t?
Let’s look at the data on a common area of pain, the lumbar spine. From a study by Park et al1 in 2011 there were 107 patients with abnormal findings in a cohort of 1268 patients, with a clear relationship between an increase in age and increase in abnormal findings. Work by Jensen et al2 in 1994 utilised a cohort of 98 asymptomatic patients alongside a randomly distributed 27 symptomatic patients to ascertain if there is a relationship between imaging findings and symptoms, only 36% had no findings at all. Again, finding a correlation between increases in age and spinal changes. Further research developed the table below showing the rates of change present in patients with no symptoms. Really highlighting the likelihood that random imaging will identify changes that we see in the wider population with no reported issues.
In 2023, Wangaryattawanich et al3, conducted research into incidental findings on imaging of the brain, highlighting the difficulty with modern technology being so sensitive we are finding an increasing prevalence of abnormalities on images that would have previously gone undetected. This study suggested our understanding of what is normal and abnormal is starting to morph and adapt as medicalisation changes.
The next question is why does any of this matter? What does it mean if we have found abnormal changes on my images even though I have no symptoms. This is a fairly lengthy question to answer so we’ll break it down into sections. Firstly, unnecessary worry for you, the patient. You feel fine, you have no pain, you’re fit, well and you thought healthy. You’ve just been told something has been found on your scan. It’s completely normal and understandable for that to cause concern. It has even been documented that patients can become symptomatic only after finding out about changes on imaging. In the study mentioned above, it was common to find benign growths on imaging, imagine the worry of being told that a growth has been found.
The next downside follows on and is clinically driven, if changes are found, we need to determine if further investigations are needed. Someone must review the MRI images and determine if further care is needed, that may be further scanning, blood test results, invasive biopsies all for something that wasn’t needed. This could even go as far as resulting in unnecessary surgeries to treat and injury or condition that wasn’t causing any issues.
Lastly, we must look at the financial burden of all this, not only does the full body imaging itself cost a lot of money, any follow ups, further investigations come at a cost. Now I don’t intend to make any assumptions, but we can’t ignore the fact that with private healthcare there is an element of decision making based on profitability and further testing is more money in the pocket of providers. Looking at a provider like the NHS, it is clear to see why widespread screening in such a manner would not be feasible.
On balance I think it is clear to see that the downsides of full body MRI as a screening tool hugely outweigh the potential benefits of its ability to identify early concerning changes. If you are still on the fence about screening, please get in touch and we would be happy to discuss any concerns that you may have around your health.
