<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 46-year-old woman comes to the physician because of increasingly severe lower back pain for the past week. The pain is constant, and she describes it as 9 out of 10 in intensity. Six months ago, she underwent a lumpectomy for hormone receptor-negative lobular carcinoma of the right breast. She has undergone multiple cycles of radiotherapy. Vital signs are within normal limits. Examination shows a well-healed surgical incision over the right breast. There is severe tenderness to palpation over the 12th thoracic vertebra. The straight-leg raise test is negative. The remainder of the examination shows no abnormalities. Serum studies show:Glucose 76 mgdLCreatinine 1 mgdLTotal bilirubin 0.8 mgdLAlkaline phosphatase 234 ULAspartate aminotransferase AST, GOT 16 ULAlanine aminotransferase ALT, GPT 12 ULγ-Glutamyltransferase GGT 40 UL N550Which of the following is the most appropriate next step in management?? A: Positron emission tomography, B: Bone biopsy, C: X-ray of the spine, D: MRI of the spine, E: Bone scintigraphy,  <response>: This is a patient with severe localized back pain and a history of breast cancer treated with radiation therapy. The description of tenderness over the 12th thoracic vertebra suggests a possible pathological fracture or metastatic disease to the spine. The key next step is to obtain imaging of the spine to evaluate for a fracture or metastatic disease. PET scan is not suitable as the initial test. Bone biopsy is invasive and should only be pursued if imaging reveals a suspicious lesion. Plain x-ray may miss early bone lesions. MRI of the spine would provide the best initial imaging to evaluate the spine for pathological lesions. Bone scintigraphy is reasonable but less sensitive than MRI.D: MRI of the spine 