Seven Years to a Diagnosis: The Wrong Way to Spare a Patient From Radiation

Published in Doximity Op-Med · July 20, 2026

Seven Years to a Diagnosis: The Wrong Way to Spare a Patient From Radiation

A man in his early 30s arrived with seven years of back pain, two lumbar MRIs, and no radiograph of his sacroiliac joints. The reason given, every time, was radiation.

The essay works through what that deferral actually trades away: the dose figures for an axial series, why radiographs and MRI answer different questions, how the ACR, EULAR, and NICE sequence the two, and what a systematic read does for patient safety that skipping the film does not.

• 1.5–4 mSv Full axial series for axSpA, depending on protocol and habitus
• ~3 mSv/yr US background radiation, before any medical imaging
• 6.7 years Pooled mean diagnostic delay in axSpA (Zhao et al., 2021)