When some physicians hear about whole-body MRI, a common initial reaction is often a mix of dread and skepticism. They envision their clinic visit derailed by a complex report with 20-plus incidental findings and patient demands for an expedited workup of a 1 cm kidney cyst or a 2 cm liver hemangioma. Hence, there is debate within the medical community on the role and value of direct-to-consumer whole-body MRI.
Yet, while we debate these clinical guidelines in committees or national meetings, patients have already decided that they want more information about their bodies. Driven by rapid growth in longevity medicine, executive health, and concierge medicine, tens of thousands of individuals have made it clear that they want to detect diseases earlier rather than waiting for symptoms. People are now paying out of pocket for blood tests, DEXAs for body composition analysis, genetic testing, and wearables to track their sleep or their heart rhythm. Patients want to gather more information about their body and take charge of their health proactively. Whole-body MRIs represent the next frontier in this trend. Patients want to know if they have early-stage hepatic steatosis, an asymptomatic brain aneurysm, or occult prostate cancer, and they are entirely willing to bypass the traditional insurance and primary care referral loops to pay for that knowledge out of pocket.
Right now, radiologists are at a critical crossroads. We can continue to dismiss whole-body MRIs as a fad that will disappear in a few years. Or we can acknowledge there has been an enormous, permanent shift in our patients’ desire to be more proactive about their health and provide the clinical framework that they deserve. If we continue to ignore this, consumers will continue to turn to purely commercial and corporate entities. In this model, companies focus on bottom lines, and corporate shareholders dictate the patient experience, not MDs.
The clinical consequences of abandoning this space to these corporate entities that are purely commercially driven are already clear. In these companies, patients get imaging, with little to no radiologist input on the image protocols or the image quality. They may even use older, low-field, or low-quality magnets to scan these patients to cut capital costs. Some “whole-body” MRIs only include the head and torso, skipping the legs and spine. Patients and referring physicians both may be expecting a comprehensive evaluation only to find out that the patient’s knees or lower back wasn’t adequately addressed after the fact. These decisions are all made in the name of profit.
Often, there is a cookie-cutter, “one-size-fits-all” protocol that doesn’t consider that a retiree and a young athlete are looking for very different answers in their whole-body MRI scans. They all get the same sequences of the brain or joints without the quality to answer critical questions about the retiree’s brain health or the athlete’s joint and spine health.
In the worst models, patients get a PDF of their report with lots of radiology jargon and are left to figure out what to do on their own. In some models, the company hires inexperienced nurses to read the complex radiology report verbatim to the patient, expecting that to make a difference. Predictably, this results in lots of health anxiety and unnecessary visits to their primary care physician and specialists. By refusing to engage with the consumers, we let companies that only care about the bottom line provide substandard care and are more than happy to let the traditional healthcare system bear the downstream effects of their cost savings.
Instead of allowing these corporate entities solely focused on profits to grow and proliferate, radiologists and other physicians must lead the design, delivery, and investment of the whole-body MRI business. We alone have the expertise to make sure the generated images are diagnostic and that shortcuts are not taken at the expense of our patients. We know ultimately that better machines create a better patient experience, have better image quality, and allow for the radiologist or other physician to feel more comfortable diagnosing abnormalities, instead of characterizing everything as “indeterminate.” In the uncommon instance that there is a lesion that may benefit from active surveillance, many patients choose to get these scans annually, giving radiologists the ability to follow lesions instead of directly recommending a biopsy.
The opposite of the corporate entity is the physician-backed and -led model. Its ultimate value is superior clinical engagement and an excellent patient experience. In the physician-led model, radiologists actively make adjustments to the protocols to make sure that the patient’s concerns or questions are answered. For example, in an athlete, we optimize the scan to ensure that we can evaluate the cartilage and tendons in the joints of interest. In addition, radiologists actively go over the results with patients, giving us the opportunity to clear up any questions or confusion patients have. This consultation is important, as it gives radiologists the chance to explain why this simple cyst is benign or why a lesion in the prostate appears suspicious and warrants a biopsy. Radiologists can then generate patient-friendly reports that contain both the necessary medical diagnosis as well as an explanation for patients that is easy to digest so they don’t have to depend on LLMs and other internet resources that may give them the wrong answer. Additionally, instead of leaving the patients to manage serious results like a brain aneurysm by themselves, we, as physicians, have the expertise and connections to make sure that they get to the right specialists and get the correct treatment. One of the biggest criticisms of whole-body MRI is the anxiety that it can produce, but in my experience, with this system and support, patients feel relieved after getting their results instead of feeling anxious.
The medical community can continue to admonish patients from the sidelines and tell them why they are wrong about wanting to learn more about their health. Or we can build a physician-led ecosystem and model that provides the information that patients seek in a responsible manner. Whole-body MRI has the potential to benefit everyone, from the young adult who wants to understand their visceral fat and muscle quality to the new grandparent worried about cancer and memory. Let’s stop treating whole-body MRI as a burdensome enemy and start building and managing it as a powerful tool that can help patients learn more about their health and identify life-threatening diseases earlier — when (statistically) there is a much better chance of survival.
What are your thoughts on whole-body MRI? Share in the comments.
