Episode notes
🎙 Episode 59 – Should Every Patient Get an MRI and How Imaging Decisions Affect Diagnosis Case Acceptance and Treatment Outcomes
In this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down a nuanced framework for deciding when an MRI actually belongs in your decompression practice.
Most doctors fall into one of two traps: never ordering imaging, or ordering an MRI for every patient. Neither is right. The real question isn't whether a scan looks impressive — it's whether it will change your management plan. History and exam always come first; the MRI is there to confirm or clarify, not to replace them.
He also discusses why over-relying on brief medical radiologist reports can leave you with incomplete information, how to avoid scaring patients with scary-sounding terminology, and why an MRI is just as valuable for identifying good decompression candidates as it is for ruling out surgery.
Key topics include:
- Why an MRI should only be ordered when it will change the diagnosis, treatment plan, or referral decision
- When x-rays are enough — and when persistent radiculopathy or worsening neurological deficits mean it's time to scan
- Why Modic Type 1 changes matter and what they can signal
- How a $30 chiropractic radiologist review can catch what a brief medical report misses
- Why treating the image instead of the patient is one of the costliest mistakes in decompression care
- How to use the MRI as a communication tool — simple analogies like "blown tire" build trust and case acceptance
The big takeaway: an MRI isn't a shortcut to a diagnosis, and it isn't optional busywork either. Used well, it's a tool that sharpens your clinical picture and helps patients understand exactly why your treatment plan makes sense.
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