mri brain research

Diagnosing Traumatic Brain Injury: CT Scans and MRI Tests

21 Jan 2019 Health Care, MRI

Researchers suspect that the true rate of mild traumatic brain injuries remains much higher than reported, suggesting the need for broader awareness of the condition. Diagnosis through imaging studies can help.

Neuroradiologists possess powerful tools for revealing the presence of traumatic brain injury (TBI): the CT scan and the MRI scan. Not every patient with suspected TBI requires imaging studies, but for those who do, these two techniques can greatly improve outcomes through prompt diagnosis.

Each of these diagnostic techniques carries its own strengths and hazards, and physicians order them in different cases. A thorough understanding of brain imaging studies can help the medical community identify cases of TBI more readily, leading to better, faster interventions.    

This is a subject of increasing concern among doctors; traumatic brain injuries — especially of the mild variety, more commonly known as concussions — are fairly common. In 2013, around 2.5 million people visited an emergency room with TBI-related complaints. Most cases in the 15-24 age range are related to motor vehicle accidents, but among causes, there’s a close second: playing sports.   

Measuring TBI in the Sports Community

The sports community is particularly interested in improving treatment for TBI, and for good reason. Remember that more concussions and brain injuries come from playing sports than any other cause except for car accidents.

A brief glimpse through the numbers paints an alarming picture:

These statistics explain why researchers are working so hard to find fast, field-side imaging tests that can pinpoint the severity of TBI immediately following the event. Promising options include stadium MRI rooms and highly portable ultrasound; still, for most players at all levels, radiology-assisted diagnosis of TBI will involve a trip to the imaging center. This places us firmly back in CT/MRI territory.  

CT Scans in the Diagnosis of TBI

Computerized tomography (CT) scans take multiple X-rays and combine them into cross-sectional “slices” of internal structures. While this exposes the patient to small doses of ionizing radiation, but it’s also the fastest, most accurate way to identify bleeding and swelling in the brain.

Clearly, edema (brain swelling) and hematoma (bleeding in and/or around the brain) are serious conditions. The faster doctors discover them, the better for the patient. Typically, then, physicians order CT scans for suspected acute injuries to the brain. The CT scan is the modality of first access.

Later, doctors may order more CT scans to track healing in TBI instances that don’t require surgery. As with every order of an X-ray procedure, physicians weigh the benefits of the treatment against the risks posed by exposure to radiation before making a referral.  

MRI Scans in the Diagnosis of TBI

Magnetic resonance imaging (MRI) is the go-to tool for identifying subtle effects of injury, including bruising, scarring, and microscopic damage to nerve fibers. Images produced by CT scan won’t reveal these conditions, though nerve fiber injury is a common cause of stubborn symptoms.

Sometimes brain tissue is injured too severely to recover, so MRI scans can track the results of a TBI for years following the precipitating event. This imaging modality is another powerful tool in the neuroradiologist’s brain-injury kit.  

Schedule Diagnostic Imaging for Patients with TBI

Ultimately, health care providers will determine the appropriate imaging technique for each patient showing signs of TBI. Plenty of non-radiological tests exist; these may be enough to recognize and begin treatment for milder injuries to the brain.

Physicians who need fast access to radiology services in cases of TBI can make referrals through the Precise Imaging physician’s portal. This online tool provides anytime access to the crucial services we provide.

Call Precise Imaging at 800-558-2223 to make a referral or schedule an appointment today.


Centers for Disease Control and Prevention Justification of Estimates for Appropriation Committees, Fiscal Year 2016.” CDC. Centers for Disease Control and Prevention, U.S Department of Health and Human Services, 2016. PDF. 2 Jan. 2019.

Orenstein, Beth. “A Closer Look at Concussions.RadiologyToday. Great Valley Publishing Company, Inc., Sept. 2016. Web. 2 Jan. 2019.

Prince, Carolyn and Maya Bruhns. “Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology.NLM. Brain Sciences, Aug. 2017. Web. 2 Jan. 2019.

Traumatic Brain Injury (TBI) and Concussion.ASNR. American Society of Neuroradiology, n.d. Web. 2 Jan. 2019.

Diagnostic Imaging and Pre-Existing Conditions in Car Accident Claims

Diagnostic imaging is a powerful tool for car accident claims — but that’s true for insurance companies as well as plaintiffs. Personal injury attorneys often seek MRI scans and X-rays to demonstrate undeniable proof of injury. On the other hand, insurance companies will pounce on any hint of a pre-existing condition to avoid hefty payouts.

Don’t let insurers confuse the jury on the subject. In most states, a long-standing legal doctrine upholds the plaintiff’s right to damages in car accident cases. Pre-existing conditions are rarely the lone cause of injury for victims of car wrecks, and aggravating a condition still counts as injury.

Here’s what you need to know about car accident claims involving evidence of a pre-existing condition uncovered during imaging tests.

Degenerative Disc Disease in a Car Accident Case

Suppose you have a client who has been in a car accident, and is now suffering from lower back pain. An MRI scan reveals lumbar strain, but it also shows clear signs of degenerative disc disease. The insurer is likely to argue that the pre-existing condition reduces their liability for the injury.

This is by no means a rare scenario. Degenerative disc disease is extremely common; in fact, disc degeneration is all but inevitable for people older than 60. But many people who technically meet the diagnostic criteria for the condition don’t experience any symptoms at all.

The question under the law is not whether the pre-existing condition caused the injury; it is to what extent the accident produced the damage. The patient’s susceptibility to injury should not affect the value of the settlement; the court must consider the extent of the injury, not the plaintiff’s fragility.

The Eggshell Doctrine in U.S. Personal Injury Law

The Eggshell Doctrine is well established in most states. The maxim holds that defendants remain responsible for at-fault injuries regardless of the plaintiff’s pre-existing health conditions. In the above example, this would mean that, if the car accident led to a lumbar sprain in the victim, the presence of asymptomatic degenerative disc disease should not invalidate the claim.

In short, there’s no need to worry that an MRI scan, X-ray, or other form of diagnostic imaging will harm the plaintiff’s case. Even if advanced imaging techniques reveal pre-existing conditions, if the victim was injured in a car accident and another driver was at fault, the case remains strong.

Precise Imaging works with personal injury attorneys to obtain restitution for plaintiffs in multiple states. We offer the experience, flexibility, and patient-centered care it takes to win car accident cases, and we offer a suite of resources just for attorneys. Browse our online tools for lawyers here.   

To book an appointment for a client, call Precise Imaging at 800-558-2223 today.

Comparing MRI and CT Scans in Personal Injury Cases

16 Nov 2018 MRI

Comparing MRI and CT Scans in Personal Injury Cases


Diagnostic imaging is crucial to many personal injury lawsuits, but what type of imaging do your clients need? Odds are, doctors and legal teams will point toward one of two options: an MRI scan or a CT scan.


These procedures could provide crucial evidence in your case, clarifying to jurors and the judge what was merely conjecture before. Here are the main differences between CT scans and MRI scans, along with a few things personal injury attorneys should know about these popular diagnostic imaging modalities.

CT Scans and How They Work


Computerized Axial Tomography, otherwise known as a CT scan, uses X-rays to produce detailed images of the human body. The basic concept is this: The machine shoots a narrow beam through the target area of the body. Then it rotates the beam, creating a cross-sectional image.


Most of the radiation passes through the body, but when it hits denser material such as bone, it stops. This is how bones show up on the screen as a contrast. Through the use of multiple images stacked on top of each other, the computer program creates a 3D picture of the patients insides.  


The scan is a non-invasive procedure. Note, however, that it does expose the patient to ionizing radiation.      

MRI Scans and How They Work


Magnetic Resonance Imaging, or MRI, uses powerful magnets to create a strong magnetic field. The machine then sends pulses through the patient’s tissues to create clear 3D images of the target area.


This technology does use damaging radiation during photo capture, and it’s totally non-invasive. The patient rests inside a large magnet during the procedure, and must remain quite still during the whole process, or else risk a distorted result. However, resulting images are often highly accurate and detailed.


The Benefits of MRI Scans and CT Scans in Personal Injury Cases


If a picture is really worth a thousand words, in the courtroom, it could be worth many thousands of dollars. Some sort of diagnostic imaging can strengthen virtually any case.


Of course, each imaging modality offers specific benefits to the patient and client, depending on the nature of the injury itself. CT scans, for example, are far better at diagnosing breaks, fractures, and other types of bone damage.


Due to a lack of water in bones, a necessary component to MRI imaging, they don’t provide a lot of detail in MRI images. On the other hand, MRI scans are excellent at imaging soft tissues, like ligaments, muscles, tendons and nerves.

The Disadvantages of CT Scans and MRI Scans in Establishing Injury


Both of these image modalities have disadvantages, although not serious ones. CT scans sometimes do use contrasting agents, so make sure there is no allergic reaction history before agreeing to this aspect of the procedure. CT scans also use X-rays to produce image, although only those who are pregnant should avoid them as a result and even then, only the areas of the abdomen and pelvis should be avoided.


In regards to an MRI, due to the strong magnetic field used, people with certain implants (especially those with iron, such as a pacemaker), should never enter an MRI machine. The MRI is also quite loud, and in certain cases could induce claustrophobia, so if there is a patient history of this clinical diagnoses should generally avoid MRI scans.


The main takeaway here is that both CT and MRI scans can provide tremendous legal benefits during a personal injury case. They may provide powerful evidence of the extent of injury. Of course, attorneys should take their lead from doctors. The leading factor in deciding which image modality is determining the type of trauma after consultation with a medical professional.

Digital Sharing for Medical Images: PACS vs. VNAs

Digital Sharing for Medical Images: PACS vs. VNAs


Health care providers are virtually required to have digital infrastructure that includes sharable medical images these days. But if you’re looking to upgrade your system, or you’re implementing your first digital image archive, you have many software products to choose from.


The leading technologies for storing and retrieving medical imaging files are picture archiving and communications systems (PACS) and vendor neutral archives (VNAs). While the two competing formats look similar on first glance, there are notable differences between them. Before we get to the contrasts, though, it’s important to note what PACS and VNAs have in common. Here are a few of the constants across both types of imaging technologies:


  • Both PACS and VNAs provide remote access to images. Radiologists can upload images on one terminal, while physicians in a different office can log in to access them. This is the crucial requirement of all digital image-sharing systems.


  • Both systems operate with the same file format and transmission protocol: DICOM, which stands for “digital imaging and communications in medicine.” File formats can lead to accessibility problems, as each application is only equipped to handle certain types of files. The universal use of DICOMs between PACS and VNAs seems to suggest that migrating images between the two systems would be seamless. Unfortunately, that’s rarely the case. We’ll get into that a little later.


  • Both options may or may not also operate as a platform for non-DICOM images. This is an important question to ask when considering changes to an image-sharing system for medical care. If departments other than radiology are hoping to upload and access images through the same system, it is vital to choose software that can support non-DICOM images.


  • Designers of both PACS and VNAs are working to improve mobility and access to images across different types of devices. That’s one of the leading requests by radiologists and other health care providers — physicians want to be able to call up an image, safely and with full HIPAA compliance, on a tablet or even a phone in the examination room with their patients. They also want access at office desktops for consultation and reporting.


Despite these similarities, PACS and VNAs have very different sets of advantages. To complicate matters, many PACS are beginning to provide some of the features that initially launched the popularity of the VNA. Before making a system-wide purchase (or subscription service, which is also available from many vendors), it’s important to consult all stakeholders in your health care system, and to get to know your vendor and their product well.


That said, there are some broad-strokes difference between your average PACS and a typical VNA. We’ll get into those next.


PACS vs. VNAs: Differences Between Medical Image-Sharing Platforms


According to the trade publication Diagnostic Imaging, the VNA tends to focus on archiving and backing up data, while the PACS usually emphasizes workflow and user experience. Of course, these general principles are less significant in today’s market, where there are a wide variety of VNAs and PACS, and their strong points have begun to overlap.


That said, here are some of the differences between PACS and VNAs that users and medical industry analysts have pointed out:


  • The PACS is the original technology used to archive and retrieve digital medical images. As such, it’s often the choice of individual radiology departments, which were among the first to adopt digital imaging. VNAs, on the other hand, are more often found in multiple departments.


  • PAC systems are more highly proprietary than most VNAs. That is, each individual PACS will require its own user interface and its own log-in information. VNAs were designed to support storage and access across systems and vendors. Of course, new developments in PACS technology renders this difference conditional, but it remains the conventional wisdom among medical technology experts.


  • A VNA, by definition, divorces the storage/access functions of a PAC from a particular workstation or data silo. It uses its own application engine, allowing users to access images from multiple sources with the same user interface. That’s what makes VNAs typically better for interoperability between systems compared to a traditional PACS.


While the above list does seem to argue for the dominance of VNAs over PACS, in actual practice, implementation isn’t always the best choice for every provider. It can be expensive and time-consuming to migrate data from an existing PACS to a brand new VNA.


That’s because DICOM files contain both metadata and location pointers. The former attached patient information to the image; the latter helps the system find and pull up the specific image the user searches for.


During transition, all of this supplemental information can become scrambled, preventing access to images. In order to avoid this outcome, vendors often must reset DICOM headers and location pointers to ensure accuracy and access in the new system. That can be a lengthy and cost-intensive process.


Ultimately, then, institutions with the time and the money will benefit from an upgraded VNA system. More practically, some users will choose a PACS, with or without newly developed features. Regardless of the archiving and retrieval system, digital transmission for diagnostic images is practically a requirement in today’s medical system. Choose an imaging software product that makes it easy to share images with other departments and institutions.




Jackson, Whitney. “What You Need to Know About VACS and VNA.DiagnosticImaging.” UBM, 4 Sept. 2014. Web. 15 Oct. 2018.  


O’Dowd, Elizabeth. “Pros and Cons of PACS, VNAs for Medical Image Data Storage.HitInfrastructure. Xtelligent Healthcare Media, LLC, n.d. Web. 15 Oct. 2018.


Gadolinium Retention Research Roadmap Now Available

7 Nov 2018 Health Care, MRI

Gadolinium Retention Research Roadmap Now Available


On February 15, 2018, The National Institute of Biomedical Imaging and Bioengineering brought together an international group of researchers, scientists, and medical doctors to look at the current and future concerns regarding the human body’s retention of gadolinium-based contrast agents (GBCAs). Ultimately, they wished to identify any potential safety hazards associated with this common MRI contrast agent. In September, the results were published, mapping out a path for future research into this subject. Physicians can now access the work for a greater understanding of GBCAs used in diagnostic imaging settings.   


The report states that “in spite of more than 30 years of use of GBCAs, important information about the biodistribution and tissue interactions of each GBCA in clinical use remains unknown. It is clear that gadolinium retention in a number of tissues, including bone, skin, and brain, beyond 24 hours may occur with all types of GBCAs, although the magnitude of observed retention is greater with linear GBCAs than with macrocyclic GBCAs.”

What Researchers Know About GBCAs Today


More simply put, the researchers found the body does have a tendency to retain GCBAs for more than 24 hours after injection, although the degree to which they are retained depends upon the GBCA type as well as the specific organ. Another finding by the authors of the report essentially states that much more research is needed to determine more exactly how much the body retains GCBAs, and what, if any, safety risks accompany this retention.


Despite an estimated 450 million or more intravenous doses of GCBAs, very little is understood regarding their potential health consequences. While the substance is largely regarded as safe, some types of GCBAs have been linked to nephrogenic systemic fibrosis in patients with advanced forms of kidney diseases. This is why the use of GCBAs is usually contraindicated for patients with serious kidney problems.


The GBCA Research Roadmap Plots a Course Forward for Researchers


The new roadmap illustrates key concerns and identifies certain subsets of the population that need to be more closely studied. Populations of study include pregnant women, the elderly, younger patients, and lactating women. Research efforts should be aided by utilizing large database sets such as those at the Mayo Clinic, or studies in which patients underwent contrast aided imaging using GCBAs. Use of large amounts of data could help to uncover inconsistencies or particularly vulnerable groups when it comes to GCBA retention.   


The study acknowledges that future research will bridge important gaps in knowledge. The roadmap generated by the researchers prioritizes discovering  “(a) if gadolinium retention adversely affects the function of human tissues, (b) if retention is causally associated with short- or long-term clinical manifestations of disease, and (c) if vulnerable populations, such as children, are at greater risk for experiencing clinical disease.”


While this new document does not offer any answers to these questions, it does lay the groundwork for future research efforts in order to fill in these gaps. In fact, by plainly stating what is not known regarding GCBA retention, the authors of the “roadmap” have already taken an important first step.  


Access the full text of this special report here.




Will Artificial Intelligence Replace Radiologists One Day?

Will Artificial Intelligence Replace Radiologists One Day?


Artificial intelligence (AI) has undergone dramatic growth in recent years; its effects can be seen in virtually every field, from oil drilling to games of chess. Deep learning, a method which teaches computers to recognize objects within pictures, has significant potential impact on the medical imaging field.


That’s why some AI researchers say the technology could spell the end of human radiologists. Computers, they say, would be able to quickly, cheaply, and accurately perform the same job functions. While the power of AI cannot be denied, it seems premature to make assumptions about the important role trained human radiologists play in the contemporary health care industry. Artificial intelligence will almost certainly help radiologists do their jobs; we just doubt it can replace them entirely.


Radiologists may certainly be worried about the future of their profession, but any concern would be premature at this point. In fact, the adaptation of AI into imaging technology has great potential for increased productivity among radiologists and increased profitability for those institutions housing them. There are several current and future avenues in which AI may prove a useful augmentation to radiologists, as well as certain restrictions which ensure radiologists will continue to have gainful employment well into the future.


How AI Can Improve Radiology as the Tool of Human Radiologists


The first way in which AI may serve radiologists is in a quicker diagnosis of certain types of fractures and cancers. This would free the radiologist for more difficult-to-detect cases that could not be handled by current machine learning technology. In many cases, AI could also confirm a diagnosis that may have otherwise been in doubt, providing clinical decision support. The increased usage of deep learning in imaging also would allow the radiologist to spend more time focusing on the patient and their treatment plan, potentially creating greater job satisfaction for that individual.


A second major reason for the medical field to embrace AI is the potential for increased demand in imaging procedures. In countless cases throughout history, increased automation meant greater efficiency, which in turn brought the price of the given product down. Often throughout history, increased automation brought about fears of workers losing their jobs; however, the lower prices usually resulted in such a significant uptick in consumer demand that more jobs were created than lost. The same potential exists for the relationship between AI and radiologists.


Third, many conflate the type of AI learning being applied to radiology with the AI seen in science fiction movies. The deep learning being applied in to diagnose fractures or occurrences of cancer is an extremely focused technology used for that purpose and that purpose only. The AI is not suggesting a treatment pattern, or consoling a patient who has received devastating news. AI is only reading an object in a picture, albeit to a highly accurate degree in some cases.  


Why Human Radiologists Will Always Be Part of Diagnostic Imaging


No machine will ever be able to replace the empathy that medical providers develop throughout their careers. There’s no substitute for a warm hug, a meaningful conversation, or time spent with a trusted physician.


Artificial intelligence has the potential to greatly alter the field of radiology in many ways that generate a positive impact for all those involved, from the patient to the radiologist to the medical institution. Imaging specialists need not worry about job loss at the hands of a faceless algorithm. Instead, opportunities to increase patient well-being and diagnoses accuracy should be adopted whenever possible.      


Taxes on Personal Injury Settlements: Tax Cuts and Jobs Act Rewrites the Rules

12 Oct 2018 Personal Injury

Taxes on Personal Injury Settlements: Tax Cuts and Jobs Act Rewrites the Rules


On December 22, 2017, the U.S. President signed the Tax Cuts and Jobs Act, more properly known as Public Law No. 115-97. This law makes sweeping changes to tax brackets and multiple changes to once-familiar deductions. As it turns out, though, the new tax code also has major impacts on plaintiffs awarded settlements or damages in personal injury cases.


In short, payments resulting from personal injury cases are not always tax-free. In fact, thanks to the new rules, plaintiffs may end up paying taxes on money that they never receive in the first place. The latest tax overhaul adds to the confusion of an already-complex taxing situation.


Here’s what plaintiffs need to know about the tax obligation associated with damages for personal injury cases, including provisions added under the latest tax overhaul:



  • Only compensatory damages are eligible for tax-free treatment. Personal injury damages can be either compensatory or punitive. Only compensatory damages — funds awarded to make up for losses, such as medical payments, property damage, or reduced earning potential — qualify as tax-free. Punitive damages, intended to dissuade the defendant from similar action in the future, are taxed as plaintiff income.   




  • Emotional distress — and physical manifestations of emotional distress — are subject to taxes. Plaintiffs in personal injury cases sometimes receive awards for mental anguish or emotional distress. The IRS taxes these funds as income. Only damages awarded for physical injury or illness may escape taxation.



Of course, developing research attests to the close relationship between the body and the mind. Emotional distress can lead to physical symptoms, many of which mirror those of a physical illness. However, even if mental anguish leads to physical symptoms, and the plaintiff receives damages reflecting the condition, those funds remain taxable as income. The root cause of the illness or injury must be physical for damages to go untaxed.



  • Damages awarded for emotional distress resulting from a physical injury may be tax-free. Here’s where the existing tax code gets tricky. Damages reflecting emotional distress that leads to physical illness are taxable income. However, damages reflecting emotional distress arising from physical illness may, in fact, be tax-free.



As attorney Robert W. Wood points out in Tax Notes, this leads to a difficult chicken-and-egg dance between collecting plaintiffs and the IRS. An unthoughtful worded case could lead the IRS to conclude that injuries are primarily emotional, and therefore fully taxable. On the flip side, a cleverly worded argument may place the primary injury in the physical realm, leading to tax-free damages. Note that in either case, the symptoms may be identical — under tax law, the real question is which came first: The physical or the mental injuries?  



  • Under the new tax law, plaintiffs cannot deduct taxable recovery payments including those that go to pay legal fees. This is perhaps the Tax Cuts and Job Act’s most striking change to taxation of personal injury damages. Plaintiffs with contingent-fee attorneys, who take payment as a percentage of the damages or settlement, are now responsible for taxes on the full value of the taxable pay-out.



Under previous law, the plaintiff could deduct legal fees taken out of damages. No longer. Say a plaintiff receives $1 million in damages for emotional distress. This is taxable income, according to the IRS. Now, say this plaintiff hired a contingent-fee attorney, who collects 50 percent of the damages. The plaintiff will walk away from the case with $500,000, but will pay taxes on the full $1 million.    



  • Legal fees associated with workplace claims may, in fact, be deductible. In some cases, plaintiffs can escape the tax burden of their legal fees. Claims against an employer may allow the plaintiff to deduct legal fees. If the defendant is not the employer, though, plaintiffs are on the hook for taxes on the full amount of damages or settlements, regardless of what their legal team takes home.



Given the shifting legal ground and the tax complexities associated with personal injury lawsuit damages, plaintiffs should work with tax professionals to ensure they meet all obligations under the law. Tax laws surrounding personal injury cases get terribly complicated.


Consider, for instance, that many cases involve damages with a mixture of taxable and non-taxable awards. For instance, a plaintiff may be awarded half the damages for emotional distress not arising from physical injury, and the other half for the injury itself. That plaintiff would have to pay taxes on the amount awarded as compensation for the emotional injury, but not funds deriving from the physical ailment.


If settlements aren’t written very carefully, with exact amounts attributed as compensation for exact conditions, the tax obligation becomes very murky indeed. As in cases of medical care themselves, these issues are best left to the professionals. Taxes on personal injury settlements in the wake of the Tax Cuts and Jobs Act are certainly not for the faint of heart.  


Note: This analysis is not intended as legal advice.


How Digital Access to Medical Images Helps Personal Injury Lawyers

How Digital Access to Medical Images Helps Personal Injury Lawyers


Diagnostic imaging is one of the clearest, most powerful ways to demonstrate objective manifestation of injury in a lawsuit. But like any piece of evidence in trial law, quality matters. Standard-quality images that clearly show a broken bone or inflammation to a trained radiologist might be meaningless to the jury. Medical images in the legal realm must be pristine.  


Luckily, we’ve come a long way from the days of lightboxes in the courtroom. Precise Imaging offers attorneys 24/7 access to medical images in their cases through a dedicated portal built just for them. These digital files provide a number of advantages that can make it much easier than it used to be to prove objective manifestation. Here are just a few of these benefits:


  • Digital images are easy to display in high-definition in a variety of settings. High-definition digital images look great whether you’re working with an iPad on the train or displaying on a large-screen TV in front of the entire courtroom. You can also send them in an instant, rather than relying on physical CDs or film.


  • Cloud access allows attorneys to work when and where they must. Cloud storage keeps reports and images themselves available for working remotely. Lawyers simply log into the Precise Imaging attorneys portal to view their clients’ medical imaging results at any time of the day or night. Even the tech support is available 24/7, ensuring the sort of flexibility today’s personal injury professionals need.  


  • Collaboration is easier when all parties can remotely view the same images and reports. It isn’t always easy to get the whole team together in a room. The cloud makes it possible for attorneys, their clients, and their legal teams collaborate remotely by viewing images together, at the same time, but in different places.


  • Digital files are easy to share with opposing counsel during discovery. The plaintiff’s team isn’t the only ones who need access to medical images. When it comes time to share this critical data with the opposing counsel, digital access makes things easy. The remote characteristics of cloud storage let everyone appropriate — including opposing counsel — access medical images when they must. Attorney’s web portals through Precise Imaging streamline the process.    


The Precise Imaging attorney’s portal is just one of the ways we serve attorneys. We also accept letters of protection and liens, whether they’re associated with personal injury suits or workers’ compensation cases.


Perhaps most importantly, we have the capacity to handle an attorney’s entire case load with a single point of contact. Rather than searching through multiple log-ins and customer-service numbers for imaging services, attorneys who work with Precise Imaging can keep all of their case data at hand, with HIPAA-compliant security.


To learn more, or to refer a client, call Precise Imaging at 800-558-2223.  


Workers’ Compensation Cases for Musculoskeletal Disorders: The Role of Diagnostic Imaging

5 Oct 2018 Health Care

As of 2015, work-related musculoskeletal disorders accounted for more than 30 percent of all reported nonfatal injuries incurred on the job. When employers ignore ergonomic hazards, requiring staff to lift heavy objects, engage in repetitive tasks, or assume awkward postures, they increase the risk of musculoskeletal disorders in the workforce.


As a result, musculoskeletal disorders often lead to workers’ compensation. Examples of these types of injuries include:


  • Chronic back pain
  • Carpal tunnel syndrome
  • Arthritis
  • Hernias
  • Muscle tears
  • Sprains


In the event of a contested workers’ compensation claim, however, the injured party may turn to attorneys to prove their case. When that happens, personal injury lawyers should not neglect the power of diagnostic imaging to prove preventable injury and hardship. Doctors may order any of the following imaging tests to detect work-related musculoskeletal disorders:



  • MRI scans. This noninvasive, radiation-free imaging modality produces strong images of soft tissues like ligaments, tendons, and muscles. It can reveal the presence of a muscle tear or other soft-tissue damage, making the MRI scan a top choice for legal teams working to demonstrate occupational injury.




  • Ultrasonography. Ultrasound scans are another safe, radiation-free imaging modality that can reveal musculoskeletal disorders. The resulting images are particularly suited for displaying inflammation around joints and tendons.




  • X-rays. While X-rays do expose patients to small amounts of ionizing radiation, they’re also the best way to document bone injuries, such as fractures and osteoarthritis. X-rays are not suitable for imaging soft tissues, so in cases of sprains and strains, physicians will usually order MRI scans or ultrasound imaging instead.   



  • Computed tomography. In some cases of bone injury, doctors will order CT scans. These devices take multiple X-rays, digitally sewing them together to create a 3D image. When a typical X-ray doesn’t reveal injuries, physicians may turn to CT scans for more details.


Diagnostic imaging is an important part of treating musculoskeletal disorders. In a workers’ compensation lawsuit, it can also provide the proof plaintiff attorneys need to sway a judge or jury. Having clear, high-quality images in hand can even encourage defendants to settle favorably for a client.


If you’re an attorney working on a workers’ compensation case, refer your client to Precise Imaging for quick, high-quality diagnostic tests. Call the imaging experts at 800-558-2223 to schedule an appointment or visit our attorney resources page here.   




Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2015.BLS. U.S. Bureau of Labor Statistics, 10 Nov. 2016. Web. 1 Aug. 2018


Villa-Forte, Alexandra. “Tests for Musculoskeletal Disorders.MerckManuals. Merck Sharp & Dohme Corp., Dec. 2017. Web. 1 Aug. 2018.


Work-Related Musculoskeletal Disorders & Ergonomics.CDC. Centers for Disease Control and Prevention, nd. Web. 1 Aug. 2018.

How Diagnostic Imaging Could One Day Affect Tax Laws for Personal Injury Settlements

How Diagnostic Imaging Could One Day Affect Tax Laws for Personal Injury Settlements


With the 2017 passing of the Tax Cuts and Jobs Act, IRS tax policy on personal injury cases is back in the spotlight. At the same time, for the past few years, the legal profession has been absorbing the impact of ever-more detailed imaging studies that, some argue, display a physical basis for certain neurological phenomena, including disorders like PTSD and subjective experiences like pain itself.


Strangely, these two seemingly unrelated forces — tax laws for personal injury cases and the use of advanced imaging technologies in the courtroom — could combine to affect the take-home damages that plaintiffs receive from a successful lawsuit. Here’s how, in a point-by-point analysis:


  • Tax laws for compensatory damages are complex, even circular. According to the IRS, damages paid out for physical injuries are tax-free. Damages for emotional injury, however, are fully taxable.


  • As researchers uncover more about the complex unity of physical and emotional systems in the human experience, courts and the IRS are faced with a challenge. Emotional trauma often leads to physical symptoms. Likewise, bodily injuries often result in emotional side effects. The two are difficult to separate. So which set of compensatory damages can legally go tax-free?  


  • Under current precedent, the IRS holds that taxability is associated with the principal injury. Cascading effects are lumped in with the root complaint. So if a defendant physically injures or sickens the plaintiff, compensatory damages awarded in the case are tax-free, even if some of those damages are paid out for emotional effects associated with the injury. Conversely, if the defendant’s negligence leads to emotional harm, and that psychological trauma manifests in physical symptoms, damages are fully taxable, even if some portion is awarded in compensation for bodily sickness arising from emotional distress.  


  • The Tax Cuts and Jobs Act raises the stakes on this issue of taxation. Plaintiffs who hire contingent-fee attorneys are now responsible for paying taxes on 100 percent of case-related payments — including that portion that goes to pay the lawyer. Under previous law, attorneys and plaintiffs each assumed their share of the tax liability associated with taxable payments resulting from the same case.


  • Here’s where advanced imaging could change the landscape. In 2008, the Arizona Superior Court in Pima County heard a landmark case, Koch v. Western Emulsions, Inc. The court allowed evidence of chronic neuropathic pain obtained with an fMRI scan, which the plaintiff’s expert witness said showed a clear physical pattern of brain activity “proving” the existence of the pain. Ultimately, the defendant settled for $800,000, more than 10 times their initial offering.


  • Since Koch, the scientific community has warned against using advanced imaging as a sort of “painometer.” The science just isn’t there yet, and there are ethical issues involved in imposing “mind-reading” technologies on plaintiffs, researchers say.


  • But brain scans are showing physical changes associated with a lot more than pain. In one study, MRI scans showed changes in the physical structure of the hippocampus in  Vietnam veterans with PTSD. Some had an 8 percent reduction in volume of the right hippocampus.


The question this all leads us to, then, is where to draw the line between physical and psychological injury. Advanced imaging technologies will continue to show greater levels of detail in the troubled brain. At some point, the courts and the IRS will have to wade into one of the most philosophically murky questions of all time: the mind-body problem. More to the point: Is there any injury, psychological or otherwise, that cannot be described as physical?


The answers we come up with will have dramatic effects on the value of settlements, damages, and tax payments in the years to come.



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