Thanks for the offer. The best questions I can think of are:
1) to ask how big of a difference in quality he sees between different MRI facilities, and whether it matters much.
2) any guidelines for avoiding poor MRI facilities (contingent upon Item 1 mattering).
3) What does a new top notch MRI go for (this, more a simple curiosity than anything else).
A list of best machines sounds nice, but I don't know if he would know model numbers off the top of his head.[/QUOTE]
It's time for the resident audioholic radiolgist to weigh in. For the record, I am an abdominal imager at an East Coast academic institution (NOT Emory). I do read MR although of the chest abdomen and pelvis. I do look at a lot of outside MR and CT brought in for rereads and consults by our clinical docs.
There is a HUGE difference in quality especially in MRI when looking at good university MR vs. many outpatient MRI centers. Anything "open MRI" usually has disaster written all over it. Open magnets by design have lower field strength. The result is a lower signal to noise ratio (proportional to the difference in magnet strength all things being equal). Most "conventional" magnets are 1.5Tesla or 3 Tesla. Open magnets can be one tenth that, so the image is much noisier. Opens suck at small body parts like wrists or ones that require very homogeneous magnetic fields over large areas like brains and abdomens. There is a way to get around the SNR but it makes the examination much longer. Since the opens are outpatient high throughput profit centers, taking an hour to do a brain, spine or knee and gett a decent signal kills the profit when a conventional magnet can do the job in half the time. Most outpatient centers will not spend the time to do a good job with an open magnet. Only if you are very claustrophobic or truly huge would I consider an open magnet. I consider them the Bose of the MR world.
I would always want a fellowship trained radiologist in the area of my scan to look at it. You don't always get that in the private practice world and us radiologists are often pretty anonymous to the patient. Academic radiologists are much less interested in profit margin and make less than their private practice counterparts by a good bit. The advantage is that they only read in their specialty. I read abdomens not brains or spines. In private practice you may not get a fellowship trained neuroradiologist to read your brain or an abdominal imager to read your liver. I will grant that the big university hospitals are not as convenient to patients as the place in the strip mall, my university hospital is especially bad. However I think this outweighed by the advantages especially for high end radiology like CT and MRI. I don't know anyone at Emory very well but they are very respected in our world both in neuroradiology and body imaging. To do as well I think you would have to go to Duke, Vanderbilt or Alabama-Birmingham in the SE.
For those who want to know about the gear, the technology doesn't change all that fast lately. A good scanner that is five years old is fine for most anything. The biggest thing was the introduction of the 3 Tesla magnet a few years back. A new 1.5 Tesla goes for between 1.5 and 3 million depending upon the options you get with it. Prices are also negotiable based on the purchasing power of the purchasing entity. The big names in the US are GE and Siemens. Philips is pretty good, the Japanese companies trail. I think I went into radiology for many of the same reasons I am an audioholic.
Most of the comments about charges above are true. The $3600 price for a typical brain MR with contrast is a fiction. That is what we get when a Shiek shows up from overseas and pays cash for everything.
The price is whatever we get paid by the insurer plus the copay. I agree it is all ridiculous.
Also, most clinicians can't really read an MR or even tell a good one from a bad one. Some do well in their specialty area but if the liver surgeon looks at the MR he won't know what to do about the kidney lesion, the neurosurgeon won't know about that salivary gland incidental mass etc. That is our job. We look at this stuff all day long.
