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Think before you scan

BMJ 2018; 362 doi: (Published 04 September 2018) Cite this as: BMJ 2018;362:k3754
  1. Giles Maskell, radiologist
  1. Truro, UK
  1. gilesmaskell{at}

A truism in radiology is that the more we image, the more we will find. Some of it will help to advance the patient’s health, but much of it won’t

Two fictional friends, Mick and Mack, both in their mid-fifties, underwent magnetic resonance imaging (MRI) for back pain. Mick’s scan showed a little “wear and tear” and a small disc prolapse but nothing warranting intervention if his symptoms could be managed in other ways.

Mack’s scan showed very similar findings, including a small disc prolapse, but he was also told that there was a lump in his left kidney. After further scans, an inconclusive biopsy, and a lengthy discussion, he decided it was best to have the kidney removed. The lump in his kidney was an oncocytoma—a benign tumour often hard to distinguish from cancer. The surgery was complicated by a chest infection resulting in a prolonged stay on the intensive treatment unit, after which he developed chronic lung damage. Recuperation was slow, and in the following winters …

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