I am the developer of this test, and would like to add a few points for informational purposes.

The examination has several technical differences from Dr. Collins' excellent test in LA.

The interpretation of the test is focused more on the anatomy that is described in decades of surgical literature. I have been told by a very well-respected prestigious university that my report on each patient is "like I read the surgical report". In other words, the focus of my examination addresses the presence or absence of all the anomalies the surgeons would look for BEFORE they go in and do any procedure. The purposes are:

1. To prevent surgery on those patients with a syndrome like TOS but without correctable anatomic or pathologic problems. Some studies in the medical literature have demonstrated that up to 30% of TOS patients do not have anatomic anomalies of the scalene muscles. Why do surgery on these patients?
2. To prepare the surgeon for what he or she might expect before they go in. There are numerous vascular anomalies as well, with arteries in a very superficial location that the surgeon would want to avoid.
3. To provide objective evidence of pathology in TOS patients struggling to convince their physicians or insurers to take the symptoms of TOS seriously
4. To enable the medical community to correlate the known anatomic anomalies in any single patient with the patient's symptoms. This will hopefully allow docs in the future to better understand why some clinical signs and symptoms occur in some patients and not in others, which patients do better with surgery and which do better with PT, and to allow minimal or less invasive surgery in those patients with certain minor anomalies, rather than a rib resection or more major procedure.

While some of these may not be at their full potential right now, the design of the examination is based on hundreds of papers in the literature, and on the experience I have with hundreds of patients to date. I am optimistic that i can continue to contribute to understanding of this condition.

I visited with Dr. Sanders, a very nice man, and observed surgery, clinical examination of patients, and a pec minor block. I got to spend about fifteen minutes demonstrating some of this new MRI to Dr. Sanders, and he asked me to teach him how to read the examination. I think it is admirable for any physician to want to learn new things, but radiologists spend five years learning in residency and more years in fellowship, which makes it nearly impossible for a non-radiologist to learn ANY MRI, much less a new technique with up to a thousand images, in fifteen minutes. I CAN tell you that there are several physicians in the SF Bay area that use my examination on a regular basis, and I consult with them regularly to try to help them learn little bits over months to years. So Dr. Sanders is likely unable to read this new test, but that does not in any way mean it is too complex. It HAS to be complex because TOS is by nature so complex. I think Dr. Sanders is just setting his personal bar rather high, high enough that I wouldn't expect anyone, even as knowledgable as Dr. Sanders, to be able to meet it. Bear in mind that there are numerous papers in peer-reviewed radiology journals that are widely-accepted by expert radiologists. I think that expert opinion carries a lot of credibility.

Since we all know how complex TOS is, we should all expect that the MRI would be complex, as well. I have worked very hard over several years to be comprehensive, yet concise and and organized in my reports.

The website explaining more about this test will be up within a week. I welcome any questions people might have about the examination, although I cannot answer specific medical questions.

Have a great Sunday!