Imaging Isn't the Problem – How We Use It Is
Diagnostic imaging isn’t overused because it’s ineffective. It’s overused because it’s often ordered without clear clinical reasoning, referred without context, and explained to patients poorly. In this episode of the Rehab & Performance Lab Podcast, I sit down with Dr. Lance Mabry to clarify how rehab professionals should be thinking about imaging – when to use it, how to refer for it, and how to talk about it in a way that actually improves outcomes.
The central message is simple: imaging is a rehab superpower when we take ownership of it.
When to Refer for Imaging: What Actually Matters
Guidelines like the Ottawa Ankle Rules are helpful, but they don’t cover every clinical scenario. When you zoom out across the literature, we can create some consistent principles of when to get an x-ray with a suspected fracture:
- A mechanism consistent with fracture or serious injury
- Loss of function (especially inability to weight bear or use the limb)
- Loss of range of motion in a specific direction
- Bony tenderness to palpation
For non-traumatic or insidious presentations, imaging decisions are less about timelines and more about failure to respond to appropriate conservative care, guided by prognosis and expected tissue response.
How You Write the Referral Changes the Result
Radiologists interpret images in a vacuum unless we give them context. Vague referrals (“rule out pathology,” “foot pain”) often lead to reports that miss the clinical question entirely.
Dr. Mabry outlines simple, repeatable ways to communicate clearly:
- SBAR for verbal or phone communication
- A concise written structure that includes age, onset, location, mechanism, key exam findings, and suspected diagnosis
Clear referrals lead to more relevant reports, faster reads, and fewer downstream problems.
The Problem With How We Talk About Asymptomatic Imaging
Research showing imaging findings in asymptomatic individuals is often used to minimize patient concerns. While well-intended, this approach can backfire.
Patients frequently hear:
- “It’s all in your head”
- “Your pain doesn’t make sense”
- “No one really knows what’s wrong”
Dr. Mabry explains why this literature is often misapplied and how it can unintentionally increase fear, reduce trust, and undermine outcomes – especially when symptomatic comparisons and severity are ignored.
Imaging Doesn’t Harm Patients – Poor Communication Does
When imaging is appropriate and explained well, it can reduce fear, improve buy-in, and accelerate recovery. Rehab professionals have the time, training, and context to do this better than anyone else in the system.
The takeaway isn’t to image more or image less – it’s to image better.
If you’re looking to build more confidence in clinical decision-making, clearer communication, and a stronger professional community, check out the Coaches Club – a place for clinicians who want to think deeper and practice better.
