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  Izdanje: 07-07-2019


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When a doctor suspects that we have a health problem, they usually point us to an ultrasound scan. In case of doubt about the nature of the symptoms we complain about is more serious, he/she will suggest the magnetic resonance (MR). However, this diagnostic method is a rare choice because it is more expensive compared to the ultrasound, which is the most common reason why the doctor recommends it more cautiously. The weakest link of our health care system - the shortage of cash - is in many cases the main culprit that we do not get the MR instruction as often as it may be needed.
On the other hand, in the developed and rich world countries, going to the MR belong to the category of preventive examinations. The key motive is to detect the disease at the earliest stage, which increases the possibility of cure, improves the quality of life and ultimately prolongs the patient's life expectancy.
Dr Sci Bojan Banko talks for “Dan” about the benefits of taking MR and the details of the diagnostic procedure. He is a specialist in radiology, a team leader of the "City Medic" hospital and a doctor of the Centre for Radiology and Magnetic Resonance of the Clinical Centre of Serbia. Dr Banko is one of the most prominent experts in the region that has been on trainings in Austria, the Netherlands and Spain and has been trusted for many years by a large number of Montenegrin citizens.
- Diagnostics is the most important act that introduces us to the possibility of proper and timely treatment - says Dr Bojan Banko for "Dan". "Early diagnosis in many cases gives us the space to cure even the most serious diseases. Preventive examinations are therefore the best predictor to not detect the disease too late, when there are no symptoms or are not strong enough, so we ignore them. The MR in the most perfect way that shows the tissues and organs, hence certain changes in them, and therefore so important in diagnosis. If there is a certain change in the body, thanks to MR we can determine its exact localization, relationship with the surrounding structures, blood vessels, what is its composition... Based on all this information we provide to the surgeons, they can choose the appropriate treatment.
● Is MR a method of scanning all organs and changes?
- In most cases it is. I would emphasize that this non-invasive radiological diagnostic method allows the most accurate visualization of all tissues and organs, and thus the diagnosis of a large number of diseases - both oncological and systemic - and is almost unavoidable in the diagnosis of various types of injuries of joints and soft tissues. For example, in the visualization of the brain, spinal column and joints it has always been the first method, and today shooting, such as small pelvic, abdominal and heart cannot be imagined without magnetic resonators.
● Is it the most important thing that a magnetic resonance device is the latest generation?
- On one hand, it's always nice when it comes to the latest generation. However, that is not crucial. Also new appliances after a few years become cuddly, but they are both good and in use. It is important that they are regularly maintained. On the other hand, it is crucial to diagnose or “read” your findings. The human factor is most important. It is important that the radiologist knows what to look at, how to write the report so that later the doctor you go to knows how to treat you. The standard is that the MR device has a magnetic field strength of at least 1.5 T (Tesla), and everything below is unacceptable today. So, always look for a radiologist, not a machine.
● It is commonly believed that magnetic resonance is used only in the case when there is a suspicion of cancer and the worst changes. How much do we make mistakes when we think in this manner?
- That's one of the mistakes. In the world, and more and more often in some private hospitals, magnetic resonance is also used for systematic, preventive examinations. This should be the number one choice because it gets the best insight into the body's condition without any radiation. Due to its high softening resolution, MR is the most perfect way to show the tissues and organs, and hence whether there are any changes in them. It is the only absolutely harmless diagnostic device, with no radiation, and non-invasive. Both children and pregnant women can be taken on MR. Preventive examinations are recommended once a year as part of a systematic review (preventive medicine). Many people ask me, so why it is then that ultrasound is used more frequent? The answer is simple: ultrasound is cheaper, and therefore more accessible.
● Do people with embedded prosthesis, pacemakers, and even tattoos can use MR?
- All people who have embedded artificial joint prostheses should have a written statement about which dentures have been made or have a card that records the dentures. In the last twenty years, all these prostheses are made of titanium alloys and are not contraindications for magnetic resonance imaging. The latest generations of magnets are also compatible with magnetic resonance imaging, but a large number of people still have old-fashioned pacemakers, which are absolute contraindications in many cases. Today's biodegradable colours used in tattooing are not a stumbling block. It should be emphasized that eye and ear implants are also a major contraindication for the MR.
● Is it necessary for the patient to be awake during the magnetic resonance imaging?
- It's not always nice to be in the MR apparatus. The preview usually lasts 15 minutes to half an hour. It is true that people who suffer from claustrophobia often cannot endure the examination to the end.
In these cases, they are introduced into angling. It is a mild dream and it is important to say that anaesthesiologist is always present.
● Is it possible to record the whole body at MR?
- The MR of the whole body, known as "whole body MRI" has a long history and in clinical terms is a "quick" searcher for deep metastases, so it has always been applicable. In recent years it has also been present in the diagnosis of muscular diseases, for example in various types of muscular dystrophy. However, recording the entire body in the form of preventive screening programs has lately become very important in the world. When asked, it is a healthy population that will want to "wait" from head to toe for a short period of time. Such a preventive review is also present in our premises in recent times and represents the best imaging way to look at. Almost all patients get frightened and think what our radiologist will find and go satisfied because the vast majority of us is healthy, and this review can be confirmed.
Snežana Moldovan

"Reading" is of crucial importance
● We lately often hear "I will search for another opinion." What do you think of that?
"I would always advise those who have a dilemma, who should make an important decision themselves to take some radical measures, who doubt the diagnosis or whatever problem they have, to seek other professional opinions. This should not bother anyone, and the patient will only help fix the decision to "break" in the right way and ultimately to calm down. I often come across in practice to bring me a MR shot that was taken somewhere else, and ask me to read it. It happens that the same recording is read differently. The difference in the professional reading of the recorded material, therefore, is that the human factor, i.e. the expertise of the doctor who is watching/reading the recorded material is of crucial importance in the diagnosis.


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