Low cost medical diagnostics? MRI/CT/Xray/DNA Sequencing?

January 19, 2013 10:20 AM

I want to better understand my body. So, I want data - baseline data. Going to sign up for 23andMe, and I'd also like to get some imaging done. In particular, I'd like an MRI of my body (head and torso) and any other medical diagnostics I can buy. I'm interested in your suggestions for cheap medical imaging, and also for your suggestions on other ways to collect hard data about my body and its condition.

I have cash to do this (say, $2000) and also have health insurance. I don't know how to use my health insurance to accomplish this task.

Please, no lectures. I don't think I can diagnose myself and I know I need a doctor's help to understand the data, and I have plenty of doctors in my life. Baseline data will be useful to see what changes as I age.

posted by fake to Health & Fitness (36 answers total)

Results won't be fast (or private - just anonymized), but for more detail than 23&me will give you, you might be interested in the Personal Genome Project.
posted by deludingmyself at 10:32 AM on January 19, 2013

You will need to check with your health insurer to be sure, but they will probably only pay for services in the recommendations of the U.S. Preventive Services Task Force or that are indicated for diagnosing current symptoms.
posted by grouse at 10:34 AM on January 19, 2013 [2 favorites]

It's important to understand that MRI is not a single medical test or diagnostic tool. There is an enormous variety of imaging protocols designed with a specific diagnostic purpose in mind. Different MRI procedures selectively image water-rich tissue and lipid-rich tissue, others focus on liquid tissue, bony tissue, tissue perfusion, tissue oxygenation, neural connectivity. MR imaging techniques have a complicated set of tradeoffs with regard to their susceptibility to various imaging artifacts and distortions, their practicality in different medical scenarios, and their appropriateness for various regions of the human body. There is no "just MRI," and there's really no way for you to design your own without being in consultation with a working MR radiologist, MR physicist, or a research scientist who collects MRI data. However, there are MRI scanners on many university and medical campuses, where you can participate in medical and research studies for free. Some investigators may be OK with sharing the collected images with you.
posted by Nomyte at 10:35 AM on January 19, 2013 [10 favorites]

Results won't be fast (or private - just anonymized)

Even anonymity is no longer guaranteed.
posted by Blazecock Pileon at 10:39 AM on January 19, 2013 [2 favorites]

Best answer: The typical scan used for this kind of thing is a full-body CT. Radiation is a concern, as is finding a bunch of benign stuff, dealing with which then creates problems. A lot of doctors will do it and will figure out a way to bill your insurance, because it's a great moneymaker for them.
posted by supercres at 10:41 AM on January 19, 2013

Response by poster: Having seen subject data handled in a university setting, I'm not going to use a university or work with university researchers on this. Thanks.
posted by fake at 10:47 AM on January 19, 2013 [1 favorite]

A single CT scan is equivalent to taking many hundreds of "regular" X-ray images at once. It is not a dosage of radiation you want to receive without very good cause. Think twice about using this diagnostic in a casual, exploratory way.
posted by Blazecock Pileon at 10:50 AM on January 19, 2013 [2 favorites]

Response by poster: All cautions are well taken. I understand the issues now and appreciate your concern, however I don't need anymore cautionary answers without further suggestions.
posted by fake at 10:58 AM on January 19, 2013

Best answer: FWIW, an MRI of the brain and spine would probably blow through your $2000 before you could do any other procedures, much less image everything (based on what it cost me to have those done when I had high-deductible insurance). Plus, the odds of any doctor who knows how to interpret the data looking at your old scans, if a future scan comes up abnormal, is nearly nonexistent. There's not a lot they could learn from comparing the old scan to a new one, besides "yup, this problem wasn't there 10 years ago." It would be really unlikely to change how they would treat anything new that comes up.

That said, if you're really looking to establish baseline health stuff for yourself, you'd get more bang for your buck by talking a physician into doing some blood tests on you. Historical thyroid function tests in particular can be somewhat useful if you end up having thyroid problems later. Stuff like a CBC, cholesterol level, blood sugar are all good to know so that you can stop/slow any developing problems with lifestyle changes while it's still possible, but again nobody's going to look at your blood sugar from 5 years ago to compare with a new reading, if that new reading comes back abnormal.

You can also gather some useful data by paying attention to your own body: what's your normal pattern for digesting food (how often do you have a BM and what's it like), what's your resting heart rate, how much sleep do you need to feel rested, etc. That way you can objectively tell if one of those things changes gradually over time.
posted by vytae at 11:01 AM on January 19, 2013 [7 favorites]

FWIW, an MRI of the brain and spine would probably blow through your $2000 before you could do any other procedures, much less image everything (based on what it cost me to have those done when I had high-deductible insurance).

I imagine the cost to the patient is higher in a diagnostic environment. The cost to run a research scanner is about $500-$700 per hour, most of which goes toward coolant, other consumables, and the maintenance service contract. You can get quite a bit done in an hour, or even in half an hour. And unlike CT, there is no radiation exposure.

OP, I'm not sure exactly what you meant in your follow-up comment. If you've been a research volunteer in the past and you were dissatisfied with your experience (or you felt your private information was compromised or handled poorly, or the experience didn't meet your expectations in some other way), the consent form you were given must outline the channels you can work through to report violations and record complaints. These things matter. Please report research that cuts corners and violates your basic rights as a volunteer.
posted by Nomyte at 11:09 AM on January 19, 2013 [3 favorites]

Something else you might want to do is to take measurements of your vital signs periodically (especially weight and blood pressure). That will probably give you more helpful information than an MRI.

I don't need anymore cautionary answers without further suggestions.

Unfortunately, you aren't the only person who can see the answers here. Recommending that someone do a CT scan today for no reason is really irresponsible, and it would be bad for other people researching this subject to come upon that recommendation without a mention of the risks.
posted by grouse at 11:18 AM on January 19, 2013 [11 favorites]

OP, I am a doctor. Having a "baseline" MRI or CT is not going to be helpful for what you are looking to do (or let's just say is exceedingly unlikely to be helpful in any way). This is not a "caution", it's just a fact. You seem to have your heart set on doing this, but I'm not sure why you feel so certain it would be helpful in the face of being told by others that it would not be. I agree with vytae, get some blood work and throw in a baseline EKG. Baseline EKG can be very useful. Get checked out by a fitness center that does health assessments and measures baseline body fat percentage, resting heart rate, etc. Go get your skin looked at - lots of places offer free screening days for skin cancer.

What medical conditions do you believe you will be able to diagnose better in the future if you have a baseline CT/MRI on hand? Do you know cancer runs in your family and you're freaking out about it? If this is the case, just MeMail me and I'm happy to explain to you the best way to address your concerns with your doctor.

If you do this your most likely result is just a completely normal study (which won't change anything in the future if something becomes abnormal) or finding some 'incidentaloma' such as a (most likely benign) nodule that requires follow up studies to be done and will burn more unnecessary money, not to mention causing you stress. I mean, people do this stuff, but it is just sad that they do because it seems like such a waste of a lot of money.
posted by treehorn+bunny at 11:25 AM on January 19, 2013 [10 favorites]

Best answer: As for other methods for collecting data about your body and its condition, I would recommend getting a DEXA (Dual-energy X-ray absorptiometry) body scan. It tells you your body fat, lean, and bone measurements and how you compare to the general population of people your age. When I first had one done, I was surprised by how high my body fat percentage was. The scan shows you your body fat distribution for different parts of your body. You can then get follow up scans every few months to see how your body composition is changing. Each scan runs around $100.
posted by Jasper Friendly Bear at 11:52 AM on January 19, 2013 [2 favorites]

Response by poster: I've used AskMe a lot, and I understand the impulse to answer a question that wasn't really asked because you know better. And well you might - doctors, armchair expert keyboard jockeys, and overly-cautious alike. So, as I said above, point taken.

Given the controversial history of health-related questions on askme, I should have known that the question would tough. I mean, the best answer I have is the one I already linked. (Also big points for Vytae's offering).

This is my body, curiosity, and money. I'm looking for cheap medical diagnostics of all kinds, and I was hoping that Ask would provide some interesting, location-specific suggestions. I'm not fixated on any one of them, sorry if it comes off that way; I want to see the spectrum and the price. I really don't care if you think it will be useful or not.
posted by fake at 11:52 AM on January 19, 2013

Response by poster: On preview, Jasper Friendly Bear, thanks.
posted by fake at 11:53 AM on January 19, 2013

I highly encourage NOT getting a CT scan. I had a physician recommend this with an explanation that seemed reasonable at the time, but upon completion and after finding out what he was trying to discover, it turned out I should have pushed for MRI instead (or sought another physician).

CT scan is so punishing to the system. I wish it had never been done. I've been known to brood on it, even. If you worry enough about your health to go through a testing regimen like this, the CT scan will cause more worry than it will resolve.
posted by batmonkey at 12:03 PM on January 19, 2013 [1 favorite]

Best answer: Get your eyes checked? You can get a fundus image from many optometrists for cheap (like $50 at my optometrist). It's useful for diagnosing things like macular degeneration and glaucoma and could actually be a useful baseline measure for the future. You can/should get your intraocular pressure checked while you're there, but that's just good preventative medicine.
posted by wondercow at 12:13 PM on January 19, 2013

Best answer: Allergy testing? There is a particular kind of extra-sensitive test that is done for food allergies (gluten, casein, soy, etc) when they don't show up on whatever the normal less-sensitive test is. (I've had a couple of friends who discovered through this test that they had gluten etc allergies and have changed their diet as a result and feel better.) I don't know how much the testing costs, though, or what it is called.
posted by LobsterMitten at 12:19 PM on January 19, 2013

You may not have the money to do this with imaging. I just had a CT of only my sinuses, and it cost $1600. I'd go for comprehensive metabolic and endocrinological bloodwork instead.
posted by KathrynT at 12:35 PM on January 19, 2013

Best answer: Go to the dentist and get them to do a test of your gums for "pocket depth" this will give you a good baseline for detecting current or future periodontal disease. Not super sexy but will let you measure something concretely for not too much money that you can compare to later results.
posted by jessamyn at 12:49 PM on January 19, 2013 [2 favorites]

Best answer: The Human Microbiome Project and other microbiome projects worldwide have laid an important foundation for understanding the trillions of microbes that inhabits each of our bodies. However, opportunities for the public to get involved in such research has been limited. Now, American Gut gives you an opportunity to participate and to compare the microbes in your gut to those in the guts of thousands of other people in the US and elsewhere. American Gut is a project built on open-source, open-access principles. Our data are for the good of understanding and will be shared both with participants and with other scientists. Our experience has been that our best ideas and work come when we involve people in as many steps of our work as possible, be they scientists, educators, roofers, ultra-marathon runners or corporate leaders. Everyone has something to offer, whether their sample, their hypotheses, their analyses or their dog (yes, their dog, we will get back to that). The more we can understand the complex microbial ecosystems on which we depend, the more everyone will benefit.
posted by Blasdelb at 12:49 PM on January 19, 2013 [5 favorites]

LobsterMitten, you might be thinking of IgE blood tests for allergies, which are more specific than something like skin prick testing. However, it's worth noting that the positive predictive value of such tests decreases when they are done on people in whom allergies are not suspected. That is part of the reason why doing medical tests without an indication is not a good idea, but I digress... in any case, the American Academy of Allergy and Immunology specifically noted in their ChoosingWisely campaign about unnecessary testing that they do not endorse the use of "an indiscriminate battery of IgE tests".
posted by treehorn+bunny at 12:50 PM on January 19, 2013 [3 favorites]

treehorn+bunny isn't kidding,

Q: Say a new medical procedure has been shown to be effective in the early detection of an illness, and as an otherwise healthy patient you take it. The probability that the test correctly identifies the illness as positive is 0.99, and the probability that the test correctly identifies someone without the illness as negative is 0.95. The incidence of the illness in the general population is 0.0001. You test positive, what is the probability that you actually have the illness?

A: About 1 in 500, because statistics.

Diagnostics is a really non-intuitively complicated discipline.
posted by Blasdelb at 12:56 PM on January 19, 2013 [10 favorites]

A recent blood test for Crohn's disease ran about $700 and was not covered by insurance. You may not want to hear this, but you'll most definitely be able to find a doctor who will be happy to part you from your $2000, so be sure to check with your insurance about what's actually covered before ordering tests, if you plan to load up on a bunch at once (especially if you are presenting no symptoms).
posted by Blazecock Pileon at 1:00 PM on January 19, 2013 [1 favorite]

Best answer: There is another project to sequence the human microbiome that is based on research from the Human Microbiome Project as well.

uBiome allows anyone in 196 countries (whether inside the United States or not) to sequence their microbiome and learn about their health.

As the world's first citizen science project to sequence the human microbiome, uBiome incorporates the ideas of the public to sequence the microbiome. uBiome is that has an opt-in data policy; each participant owns their own data, but it will not be released to the world without their consent.

The more people participate, especially outside the US, the more we can all learn about health, disease, evolution, native vs. rural populations, the benefits of various diets, native vs. transient populations, the spread of disease, and how the microbiome affects conditions ranging from asthma to diabetes to anxiety and depression, and more. Very, very interesting stuff.

Also, uBiome only costs $79.
posted by carolinaherrera at 1:05 PM on January 19, 2013 [2 favorites]

An executive physical is likely to have imaging but also other medical diagnostics that are useful for a baseline. The cost may be beyond your budget, however.
posted by dreaming in stereo at 1:10 PM on January 19, 2013

Best answer: I've heard that South Korea is the place to look for a comprehensive baseline. A friend went through the process (work related physical) and mentioned that is was very comprehensive and that the hospital also catered to people who would fly in, stay at a local hotel for a night, go through the diagnostic procedure and fly home. (I'm not sure how jet lag would shift any baseline so YMMV)...
posted by NoDef at 1:49 PM on January 19, 2013

I get hearing tests through my job each year, specifically to establish a baseline because there is a risk of job-related hearing loss in my field. However I am not sure how much these tests cost.
posted by tr0ubley at 3:30 PM on January 19, 2013

The FDA doesn't recommend them, but Full/Total/Whole Body Scans are totally a thing - they cost $500 - $2000 and quite a few places provide them. There are even mobile units that travel around and do entire groups.
posted by clerestory at 5:37 PM on January 19, 2013

Best answer: MoleMap!
posted by lollusc at 6:19 PM on January 19, 2013

Not recommending this or anything else.
Just that if I were in your situation and determined to proceed - I would be on the lookout for an ambulance chasing attorney. From there it shouldn't be too difficult to hook up with a physician who will work with you to achieve your goal of having your insurance provider contribute to the max of your policy.
posted by notreally at 7:13 PM on January 19, 2013 [1 favorite]

Best answer: If you haven't already, ask this question over at Quantified Self.

Also, you might want to look into the self-experimentation of Seth Roberts. He's made great progress while spending next to nothing.
posted by Surprised By Bees at 11:30 PM on January 19, 2013 [1 favorite]

Just an FYI--I had an MRI on my back several months ago. I have insurance, so got the insurance discount, but my deductible applied to the procedure. Cost was $770, plus $50 for the neurologist appointment to interpret it for me, $50 for the GP visit to get the MRI order, and (I think) another $75 for the radiologist.
posted by WorkingMyWayHome at 11:50 PM on January 19, 2013

Best answer: You could get one of those drugstore blood glucose monitors - the ones intended for people with diabetes - and test your blood sugar throughout the day; fasting blood sugar in the morning, blood sugar after a normal meal, blood sugar after a high-sugar meal.

IANAD and I don't know if that data would be useful, but I would find it interesting. And it's fairly cheap.
posted by insectosaurus at 11:25 AM on January 20, 2013

Best answer: Speaking as someone who works in genomics and DNA sequencing, I would recommend banking (freezing at -80C) some of your DNA or stool (for the the gut microbiome stuff), rather than getting sequencing done now.

Why? Because the technology of sequencing and assaying is getting faster, cheaper, and more accurate. Ten years from now, when you want to compare your DNA against your baseline, the Illumina 1 million SNP microarray used by 23andme will be a total joke. It would be more informative to thaw that sample and compare it to you of ten years from now using ten-years-from-now technology.

Not 100% sure how to go about it, but I know people bank eggs and sperm with fertility clinics, so there should be an option that way.

Anyways, that's what I would do.
posted by Mercaptan at 3:44 PM on January 20, 2013 [1 favorite]

Best answer: Late to the question. I had an echocardiograph earlier this year. It's very beautiful, and quite revelatory about the intricate structures of your heart. Not sure how you'd go about getting one without cause, but it's by far the most interesting artifact I've ever seen produced from patterns, structures and electrical impulses in my own body.
posted by judith at 9:05 PM on January 29, 2013