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Ultrasound tests use sound waves to create images of the internal organs. DVT (deep vein or venous thrombosis) ultrasounds are frequently ordered to evaluate the veins of the legs and arms to look for clots. These clots can cause swelling and/or pain of one or both legs or arms. The clots can migrate into the arteries that supply the lungs,  and cause life threatening pulmonary emboli which present as shortness of breath and chest pain.  Causes of DVT include:

• The veins of the legs "pump blood" back to the heart by motion of the legs. Blood clots can form when you've been sitting immobile for many hours on a long airplane trip for example.
• Foreign objects in the veins, like catheters or wires can act as clotting agents. This is typically seen in patients who have in-dwelling vein catheters for cancer treatment or fluid infusion.
• There are some medications such as oral contraceptives which can increase the risk of clot formation.
• Patients who are smokers or have cancer are also at increased risk for forming blood clots. Pregnancy and obesity are also other risk factors.
• Some people are born with inherent clotting disorders that increase the risk of clot formation.

Below is a brief outline of the procedure in the outpatient setting:

1. Make sure you wear loose, comfortable clothing.
2. After you sign in, you'll be taken to the ultrasound room and will probably be asked to change into a gown.
3. An ultrasound technician will perform the test.
4. The test is done while you lie down on a bed/gurney.
5. The technologist will ask you to lift up your gown/clothing, exposing your skin.
6. He or she will place a a warmed gel solution over the skin.
7. The technologist will use an ultrasound probe and glide it over your groin and take pictures of the veins to your knee or ankle for a lower leg test. If for the upper arm, the technologist will exam the veins along the side of your neck and down to your elbow area or wrist.
   
8. The technologist will push down on the veins to look for clots. Veins that have clots are not compressible.
   
9. The technologist may ask the Radiologist doctor to review the scan before you leave.
10. An official report is generated by the doctor in about 24-48 hours.

If you are insured DVT ultrasounds are covered. However, for uninsured patients these tests can be quite expensive. You can expect to pay anywhere between $200 and $500 for this test.

Have you had a DVT ultrasound? What was it like? Please leave your comments below

Ultrasound tests are used to detect and monitor disease. They use sound waves to create images of the internal organs of the body. They are used frequently to evaluate pelvic organs such as the uterus, ovaries, bladder.  Of course, ultrasound is used quite extensively to monitor pregnancy:

• Confirm that the pregnancy is in the uterus (and not an ectopic in the tubes for example).
• Determine that early pregnancies are viable and the fetus is growing appropriately, particularly if the mother is bleeding.
• Perform screening during the pregnancy to ensure the fetus is growing normally, moving, has a good heartbeat, detect congenital abnormalities, etc.
• In late pregnancy, ultrasounds are also performed to confirm the position of the baby (head or feet down), for example.

Ultrasounds can be performed in different settings such as the hospital, Ob/Gyn office, and outpatient Radiology center. The procedure can take up to 1 hour (depending on the stage of the pregnancy). Below is a short outline of the procedure:

1. After you sign in, you'll be taken to the ultrasound room.
2. The ultrasound technician will perform the test.
3. Once you enter the room, you will lie down on a bed/gurney.
4. The technologist will ask you to lift up your clothing, exposing your stomach and upper pelvis area.
5. He or she will place a a warmed gel solution over the skin.
6. The technologist will use an ultrasound probe and glide it over your abdomen while taking pictures. Some pictures will be captured as mini-movies (see the example video of a 20 week fetal ultrasound below).
7. Some facilities will give you a 1 or 2 page black and white small "polaroid" type of picture to take home.
8. The technologist may ask the Radiologist doctor to review the scan before you leave.
9. An official report is generated by the doctor in about 24-48 hours.

If you are insured ultrasounds during pregnancy are routinely covered. However, many uninsured expectant mothers forgo paying for the tests as they can be quite expensive. You can expect to pay anywhere between $250 to $750 for this test.

Below is a sample video of a 20 week fetal ultrasound. The study is labeled to help orient you to the baby.

Trying to get MRI scan and cost of CT scans is challenging. Even when you have the information, it's not clear what exactly you might be paying for. Does the price include contrast? What about the Radiology report? And what if you need additional testing? This post will be a work in progress, but I hope it sheds some light on what MRI and CT scan costs include and don't include...

Prices vary by body part and medical condition

Most MRI and CT scan exams each have different prices. For example, an MRI of the Brain may not cost the same as an MRI of the Knee. Your test might also be two different tests bundled into one order. A CT scan to look for kidney stones is actually two scans - a CT scan of the Abdomen and a CT scan of the Pelvis.

Price will change if you are going to have contrast/dye

Pricing medical procedures using a multi-tier cost scheme is very common in medicine. For example, most MRI and CT scan be done in three different ways. This changes the cost of the scan.  In order of increasing cost they are:

• Without contrast - images are taken without administering any IV contrast/dye.
• With contrast - images are taken only after the IV contrast is given.
• With and without contrast - images are taken before the IV contrast is given and then again after wards.

Some facilities (particularly hospitals) will also charge for the actual performance of placing the IV. For uninsured patients this cost is usually bundled into the price of the rest of the scan as opposed to a separate charge.

Many CT scan exams are done with IV contrast. IV contrast for MRI scans is usually given if you have had surgery to the area begin scanned, history of cancer or if looking for infection. Even for those tests that are ordered without contrast, sometimes during the scan the Radiologist may see something "unusual" or detect a tumor or infection and then ask for the contrast to be given. 

Note, there is no additional cost if you get oral contrast to drink. That is, if you are given oral contrast for a CT scan of the Abdomen and do not receive the IV contrast it is considered a CT Scan of the Abdomen without contrast.

The Radiology report is included

MRI and CT scan costs include the official Radiologist interpretation. This includes comparing to older scans even if done at another hospital or imaging center. Your doctor receives a copy of the report.

Copies of the CD or films

Sometimes you'll be asked to take a CD or films of your MRI or CT scan to your doctor to review. Most facilities will give you a copy, if requested, free of charge.

Call back for additional images may not be included

You won't be charged for call backs if due to technical issues or if you were unable to complete the exam because of  pain or claustrophobia. However, if it is for "more testing", then yes, there will be additional costs.

Simplifying it for you...

As you can see it is hard to pin down the actual cost of an MRI or CT scan. Unfortunately, much of healthcare works this way.

We've taken a different approach with our Radiology shopping site and are trying to simplify MRI and CT scan prices for you. Our prices include the test and report. There are no extra charges for contrast/dye injections. We think this is a good first step in reforming how medical services are priced and purchased. We hope you do too. 

Do you have any suggestions for us? Please leave your comments below:

MRI scans are frequently used to evaluate the internal structures of the knee (you can read more about MRI here). A variety of trends have increased the use of MRI in evaluating joints - more sports activity, increase in obesity rates, and we've remained much more active into our later years than previous generations.

If you've injured your knee or have chronic knee pain, your doctor will probably first order an x-ray. After an x-ray, an MRI may be needed to evaluate the internal structures of the knee. On your doctor's order for the MRI you might see:

"r/o internal derangement" -  internal derangement is a general term referring to any type of injury/damage to the internal structures of the knee.

"r/o ACL tear"- ACL refers to the anterior cruciate ligament. It is an important stabilizing ligament of the knee and is frequently damaged in twisting injuries.

"r/o meniscus tear" - the meniscus (you have two per knee) is a disc-like structure that acts like a shock absorber between your femur (upper thigh bone) and the tibia (lower leg bone). These are the two bones that make up much of the knee joint.

(FYI - "r/o" is short for "rule out")

An MRI of the knee will evaluate:

Bones

A knee MRI will include parts of the lower femur, upper tibia, upper fibula and the patella. The knee MRI can detect bone bruises, fractures, cysts, tumors, infection and dislocations. An MRI can also determine the extent of arthritis and assist in pre-operative planning.

Cartilage

Knee MRIs are very good at looking at the cartilage of your knee. MRI can detect cartilage fraying (like frayed edges of jeans), fissuring (cracks, similar to a dry river bed), and defects (the cartilage is missing). Damaged cartilage can lead to arthritis.

Tendons and Ligaments

Your knee has a complex set of tendons and ligaments that an MRI can evaluate. In addition to the ACL, it can look for injury to the PCL (posterior cruciate ligament), medial and lateral collateral ligaments, the quadriceps and patellar tendons, popliteus tendon, among others. Any of these tendons and ligaments can be injured and the injury may only be seen on MRI.

Meniscus

Each knee has two menisci (medial and lateral). MRI is quite good at looking for injury to these structures. Mensicus injuries include partial or complete tears and meniscal degeneration. Sometimes an MRI is ordered to look at re-injury even after you've had mensical surgery for a previous tear.

Soft Tissues

This refers to the muscles and tissues around your knee. A knee MRI scan will show parts of the thigh muscles and muscles of the upper calf area. The MRI can detect muscle tears, strains, tumors and infection. It can also detect a common fluid collection called a "Bakers' cyst". This is a joint fluid collection that can cause pain at the back of the knee.

Your Knee MRI Scan

A knee MRI generally takes about 20 minutes or so to complete. If you are going for one, wear loose comfortable clothing and remember to remove all metal (jewelry, phones, rings, etc) before going into the MRI scan room. If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured and need to look up prices and buy an MRI scan of the knee, you can use our website. Click here to see MRI scan costs.

Have you had a Knee MRI scan? What was it like? Please leave your comments below.