Head MRI

MRI Scans with Contrast and How They Differ From MRI Scans Without Contrast

When recommending MRI examinations, physicians often encounter concerns from their patients—which is understandable, but largely unnecessary. Compared with other imaging technologies, MRIs provide high-quality images with very limited risks.

Even so, physicians should certainly understand the current science surrounding various gadolinium-based contrast dyes when making their recommendations. Gadolinium dyes provide enhanced clarity, which can be essential when making a diagnosis, but they’re not always necessary, and in some cases, they may be unsafe. Speak with a radiologist in order to make appropriate decisions on a case-by-case basis.

In this article, we’ll address several recent studies; note, however, that this is not intended as a comprehensive set of recommendations or as a thorough analysis of health risks.

What are the risks of gadolinium-based contrast agents?

Research shows that gadolinium can accumulate in the brain, most notably in the dentate nuclei and globus pallidus. As these regions of the brain are involved in motor function, it’s conceivable that motor function could be affected over time, particularly in patients who undergo numerous MRIs. Some forms of gadolinium may also disrupt the action of thyroid hormone, which is an important concern to keep in mind when administering MRIs to pregnant patients.

One perinatal in vivo study (performed on adult mice) found that:

… when gadoterate meglumine or gadodiamide was intravenously injected into dams during perinatal period (embryonic day 15–19, single injection/day), which is the critical period for the functional organization of neuronal circuits, both GBCAs disrupted motor coordination and impaired memory function [8]. The magnitude of disruption was higher with gadodiamide.

However, in human patients, these neurological effects haven’t been established. There’s no evidence to suggest that gadolinium deposition in the brain affects neurological function, and the mere presence of gadolinium deposits shouldn’t be perceived as a reason to forego dye-enhanced MRIs, particularly when dyes would provided a diagnostically useful image that wouldn’t be attainable otherwise.

A more pressing concern is nephrogenic systemic fibrosis, a rare condition which has been proposed as causally linked to gadolinium contrast dyes. This typically isn’t a concern in healthy patients, but gadolinium agents should not be administered to patients with severe kidney issues.

In the vast majority of cases, gadolinium contrast agents could allow for faster, more thorough treatment of serious health conditions, and the benefits of contrast dyes will greatly outweigh the potential risks.

Should physicians recommend contrast-free MRI scans to patients?

Since gadolinium deposits accumulate in the brain, contrast dyes shouldn’t be used haphazardly. A 2017 review from the International Society for Magnetic Resonance in Medicine (ISMRM) recommended that the MRI community avoid using gadolinium-based contrast agents when they are not necessary.

Of course, this is a fairly obvious conclusion for physicians—the real question is what constitutes a medical necessity. The ISMRM stopped short of recommending wide changes to the way that contrast dyes are used, and to date, there’s no evidence linking gadolinium deposits in the brain and adverse health effects.

It’s also important to note that different contrast dyes accumulate in different ways. While all gadolinium-based agents seem to form deposits in the aforementioned regions of the brain, the size of these deposits vary; gadoterate meglumine (macrocyclic GBCA), for instance, does not seem to significantly change thyroid hormone action.

With this in mind, physicians should recommending MRI scans with gadolinium-based contrast agents to pregnant women. When patients are likely to undergo numerous MRI scans, gadolinium-based contrast agents should be used as infrequently as possible.

Finally, patients who have a high susceptibility to renal failure should not be exposed to gadolinium-based contrast dyes, unless there is no viable alternative. When this is the case, lower-risk gadolinium agents are obviously preferable.

However, it’s important to note that, at this point, there is no evidence showing that gadolinium is inherently unsafe. When compared with the iodine-based agents used for x-ray examinations, gadolinium contrast dyes are largely preferable.

Physicians who need fast access to MRI services 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.

References:

Ariyani, W., Khairinisa, M.A., Perrotta, G. et al. The Effects of Gadolinium-Based Contrast Agents on the Cerebellum: from Basic Research to Neurological Practice and from Pregnancy to Adulthood. Cerebellum. (2018) 17: 247. https://doi.org/10.1007/s12311-017-0903-4

Goischke, HK. MRI With Gadolinium-Based Contrast Agents: Practical Help to Ensure Patient Safety. J Am Coll Radiol. 2016;13(8):890. https://doi.org/10.1016/j.jacr.2016.05.007

Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. The Lancet. 2017;16(7):564-570. Published 2017 Jul 1. doi: doi.org/10.1016/S1474-4422(17)30158-8

Khairinisa MA et. al. The Effect of Perinatal Gadolinium-Based Contrast Agents on Adult Mice Behavior. Invest Radiol. 2018;53(2):110-118. Published Feb 2018. doi: 10.1097/RLI.0000000000000417

Schlaudecker JD, Bernheisel CR. Gadolinium-associated nephrogenic systemic fibrosis. Am Fam Physician. 2009:80(7):711-4. Published Oct 1 2009. PMID: 19817341.

Metal Worker

The MRI for Metal Workers: Hazards and Solutions

Sheet metal workers, welders, and others exposed to tiny metal fragments face particular risks during an MRI scan. An adequate screening questionnaire will ask patients if they’ve been exposed to metal fragments well before they enter the MRI suite. In order to minimize anxiety both before and during imaging procedures, physicians should educate patients who work with metal early in the conversation.

Here are the key things to communicate to metal workers when referring them to a diagnostic imaging provider:

  • The presence of metal in the body may not present a health risk, but may still contraindicate MRI as an imaging modality. Even if metal fragments don’t react to the magnet in ways that can cause harm, they can still disrupt magnetic field homogeneity. This can cause visual artifacts and signal loss, limiting the diagnostic value of the resulting images.

    Senol and Gumus present a novel example of this distortion in a brief submission to the journal Quantitative Imaging in Medicine and Surgery. The patient they describe was a metal worker; despite the fact that he had showered and washed his hair prior to his MRI scan, some metal dust remained on his scalp. These fragments created strange circular objects, like water bubbles, on the resulting images. (These images were obtained on a 1.5 Tesla MRI scanner.)

  • Sheet metal workers are more likely than others to have tiny metal shards in their eyes, and these objects may not produce any symptoms at all. Patients are often unaware of the presence of intraocular foreign bodies. For instance, see this article from the American Journal of Ophthalmology Case Reports.

    Even if patients aren’t experiencing discomfort or pain, physicians may elect to obtain images of the eyes via nonmagnetic means before progressing to the MRI study.

  • Standard procedure is to order a CT orbit scan prior to MRI for patients who face higher risks of metal fragments in their eyes. CT scans don’t use magnets at all, and are safe for patients who have metal shavings in their eyes. The orbit CT scan is a quick, noninvasive way to make sure patients can safely receive an MRI in scanners of any strength.

  • Regardless of the findings of preliminary scanning, patients will always have a way to stop the MRI procedure for any reason. Patients will always have a route of communication with the attending technologist. If they have any concerns during the procedure, they can always tell their technologist, who will stop the scan and evaluate the situation before proceeding.

  • If the MRI scan poses any health threat at all, plenty of alternative imaging modalities are available to meet diagnostic goals. In the rare event that technologists and radiologists do find ferromagnetic metal fragments within the patient’s eyes or body, they can always use an alternative imaging technique. Scans involving X-rays don’t create magnetic fields, and won’t interact with metal implants or particles.

The pre-MRI screening process is designed to ensure safety for patients, and a big part of the effort is discerning the presence of ferromagnetic metallic objects within the body. The high-powered magnetic fields involved in an MRI scan can cause these objects to heat up, vibrate, or even shift location — clearly, this presents a health risk for patients, contraindicating MRI as a diagnostic imaging modality.

Despite these risks, physicians can help to provide a more comfortable treatment experience by discussing the above issues with qualifying patients from the beginning of the diagnostic process. Doctors can continue to order the MRI for metal workers with a high degree of confidence in the safety, efficacy, and comfort of their patients, and communication plays a central role in the process.

References:

Platt AS, Wajda BG, Ingram AD, Wei XC, Ells AL. Metallic intraocular foreign body as detected by magnetic resonance imaging without complications- A case report. Am J Ophthalmol Case Rep. 2017;7:76-79. Published 2017 Jun 22. doi:10.1016/j.ajoc.2017.06.010

Senol S, Gumus K. A rare incidence of metal artifact on MRI. Quant Imaging Med Surg. 2017;7(1):142-143.

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.

References:

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.

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.

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.

  

 

  

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.  

 

5 Ways Physicians Can Keep Imaging Costs Down for Patients

According to the American Medical Association (AMA) Code of Medical Ethics, “Managing health care resources responsibly for the benefit of all patients is compatible with physicians’ primary obligation to serve the interests of individual patients.” In other words, doctors should consider the cost of treatment, and save their patients money when they can.

 

At a time of record health care costs — more than $28,000 for the typical U.S. family in 2018 — this isn’t just an issue of saving patients a few dollars here and there. When patients can’t afford to pay their health care bills, they’re more likely to delay seeking treatment. That delay can affect the outcome of eventual care.

 

Of course, as the AMA states, “Physicians’ primary ethical obligation is to promote the well-being of individual patients.” Sometimes that well-being hinges on cash or its lack. So how can general practitioners and other referring physicians limit the cost of care for their patients? Diagnostic imaging is a great place to start. The cost of imaging studies has grown faster than wages, overall inflation, and health care expense.  

 

Luckily, doctors are pushing back against hospital pricing for these services. Here are a few ways referring physicians can provide excellent care for their patients without overspending on imaging studies:

 

 

  • Involve patients in the decision to seek or omit imaging tests. When a patient presents with conditions that aren’t life threatening, doctors have significant leeway to work within the patient’s preferences. Often, this leads to fewer imaging studies, with associated savings. In a recent study, doctors who used shared decision-making tools with their patients ordered 7 percent fewer advanced imaging tests and 30 percent fewer standard imaging studies.  

 

 

 

  • Avoid ordering full-body scans to screen for tumors unless patients show symptoms. The American College of Preventive Medicine discourages the use of whole-body scanning to screen asymptomatic patients for tumors. They point out that no data suggests survival improvement for patients, and that less than 2 percent of asymptomatic patients screened had tumors.
  • Choose imaging providers with upfront pricing, and share that information with patients. It shouldn’t be difficult to find pricing for imaging procedures before making a referral. If a provider conceals prices, choose another imaging clinic. With accurate pricing information in hand, physicians can work with patients to conduct a cost-benefit analysis of ordering a study.

 

 

 

  • Refer patients to high-quality imaging clinics rather than relying on hospital radiology departments. As we’ve mentioned in this space before, an MRI from a freestanding independent imaging center is often thousands of dollars less than the same procedure at a hospital — even with the same doctors and the same equipment. Choosing a high-quality imaging provider that’s free from hospital pricing is the easiest way to save patients money on diagnostic tests.  

 

 

 

  • Take advantage of digital delivery of diagnostic images and radiology reports. Doctors and patients can access digital reports anywhere and at any time, leading to lower costs and greater access. Precise Imaging offers doctors digital access and 24/7 tech support through a dedicated physician’s portal.

 

 

With the ongoing public discussion of the U.S. health care system, awareness of the role of finances in treatment continues to rise. It’s time to have these discussions; as of 2013, only 36 percent of surveyed physicians believed they had a “major responsibility” to control care costs on their patients’ behalf.

 

But we know that affordability can translate into real-world effects on outcomes. Patient well-being and the costs of care are not two separate issues; they are bound together in complex, intractable ways. By choosing dedicated, patient-centered providers like Precise Imaging, doctors can get patients the services they need without unnecessarily adding to their burden of medical debt. Call us at 800-558-2223 or fill out our online form to make a referral today.   

 

References:

 

Bradley D, Bradley K. The value of diagnostic medical imaging. North Carolina Medical Journal [serial online]. March 2014;75(2):121-125. Available from: MEDLINE Complete, Ipswich, MA. Accessed August 16, 2018.

 

Choosing Wisely, an initiative of the ABIM Foundation. American College of Preventive Medicine: Five things physicians and patients should question. Choosing Wisely. [online]. February 25, 2015. Available from www.choosingwisely.org. Accessed August 16, 2018.

 

Herdman MT, Maude RJ, Chowdhury MS, et al. The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh. Ali M, ed. PLoS ONE. 2016;11(4):e0152965. doi:10.1371/journal.pone.0152965. Accessed August 16, 2018.

 

O’Reilly K. The AMA Code of Medical Ethics and health care spending. AMA Wire. [serial online]. April 18, 2018. Available from wire.ama-assn.org. Accessed August 16, 2018.

 

Rainey M. Health care costs for typical American family hit record high. The Fiscal Times [serial online]. May 23, 2018. Available from www.thefiscaltimes.com. Accessed August 16, 2018.

 

Smith-Bindman R, Miglioretti DL, Larson EB. Rising Use Of Diagnostic Medical Imaging In A Large Integrated Health System: The use of imaging has skyrocketed in the past decade, but no one patient population or medical condition is responsible. Health affairs (Project Hope). 2008;27(6):1491-1502. doi:10.1377/hlthaff.27.6.1491. Accessed August 16, 2018.

 

Tilburt JC, Wynia MK, Sheeler RD, et al. Views of US Physicians About Controlling Health Care Costs. JAMA. 2013;310(4):380-388. doi:10.1001/jama.2013.8278.

 

The World Bank. Poverty and health. The World Bank. [online]. World Bank. August 25, 2014. Available from www.worldbank.com. Accessed August 16, 2018.

 

Veroff D, Marr A, Wennberg DE. Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health affairs (Project Hope). 2013;32(2). doi.org/10.1377/hlthaff.2011.0941 Accessed August 16, 2018.

 

Diagnostic Imaging for Traumatic Brain Injury (TBI): What Every Attorney Should Know

Traumatic brain injury (TBI) can be one of the most devastating results of an at-fault accident, in a car, on the job, or even just walking down the sidewalk. The sheer volume of human systems that the brain controls — all of them, essentially — leads to an extraordinarily diverse set of symptoms in cases of TBI. Convincing judges and jurors that these disparate symptoms can all be traced back to a preventable injury is not always easy.

 

The irony here is that a moderate or severe TBI can lead to challenges that most deserve restitution. Some brain injuries are so severe that they deprive the victim of the ability to work. Others might even prevent a patient from participating in the tasks of daily living necessary for independence. If a client in a TBI-related personal-injury case is to be made whole, settlements may have to provide for them for the rest of their lives.

 

This combination of high stakes and soft proofs makes it imperative that attorneys in such cases understand diagnostic imaging. After all, while a defense team may be able to convince the judge that behavior changes are unrelated to an accident, it is hard to argue with an image of a damaged brain.

 

Here are a few things that personal injury lawyers should know about diagnostic imaging as it relates to TBI:

 

  1. Different modalities excel at documenting different types of injuries. Radiologists are likely to use standard diagnostic tests like CT and MRI scans to diagnose TBI. They might order X-ray scans, but only in cases of suspected damage to the skull; X-ray images do not differentiate between soft tissues. Doctors might even prescribe advanced imaging techniques, such as perfusion CT, diffusion tensor imaging (DTI), or magnetoencephalography, a form of fMRI.   

 

 

  • CT scans without contrast are the primary modality used to identify most primary, acute injuries. A TBI is not a single injury, but a cluster of related events. Doctors divide TBI into primary and secondary injuries. The first occurs at the moment of impact, causing a chain-reaction of events within the brain that often lead to further damage: secondary injuries. This is why doctors typically prescribe ongoing diagnostic imaging for TBI patients.

 

 

While advanced imaging modalities including brain-function tests like PET scans and functional MRI may identify secondary injuries, the first-line test for diagnosing primary TBI is the noncontrast CT scan. This is the fastest way to accurately expose bleeding that requires immediate surgery.   

 

  1. Doctors use MRI scans to identify certain types of TBIs that do not always show on a CT scan.  While doctors typically order CT scans first, there are some types of TBI that require MRI for identification. When a primary TBI does not result in intracranial bleeding, MRI scans are often the better choice. Injuries that the MRI identifies better than CT scans include brain bruising and traumatic axonal injury (TAI), shear-strain damage to white matter caused by the brain’s rapid acceleration within the skull.       

 

As in any case involving diagnostic images, attorneys should engage expert witnesses such as neurologists or radiologists to explain what’s going on in the pictures. This is particularly important in brain-function scans, such as fMRI and PET scans, which are often inscrutable for untrained viewers.  

 

The good news for attorneys new to TBI cases and the diagnostic interventions that document them is that expert help is available. This brings us to our next point.  


Expert Assistance for Personal Injury Cases Representing Victims of TBI

 

Personal injury lawyers and their clients deserve the chance to focus entirely on a TBI case. That can’t happen when they’re navigating complex scheduling systems at large hospitals or arguing with insurance companies. That’s why Precise MRI always strives to provide for attorneys and their clients with what they need, when they need it.

 

Precise MRI offers quick turnarounds on radiology reports, with same-day scans and results within 24 hours. We provide more than 70 imaging centers in California, Arizona, and Nevada for convenient, close-to-home access for patients. Our friendly scheduling staff will find an appointment that works for your client, even on weekends and evenings.

 

Attorneys themselves have their client’s crucial information at their fingertips thanks to an online portal designed for legal professionals. It’s available 24/7, and so is IT service, ensuring that patients and their lawyers can access medical data at their own convenience.

 

We accept personal injury liens — and even offer a free, downloadable lien form for immediate access — and attorney letters of protection for personal injury. Our teams of fully certified medical professionals have long-term experience working with attorneys on all sorts of personal injury cases, including those involving TBI. Even more important, they’re devoted to a patient-based model of care, and work hard to ensure quality, comfort, and convenience for all.

 

To learn more about attorney resources from Precise Imaging, or to schedule a CT or MRI scan for a client, call us today at 800-558-2223.  

 

References:

 

Hill CS, Coleman MP, Menon DK. Traumatic Axonal Injury: Mechanisms and Translational Opportunities. Trends in Neurosciences. 2016;39(5):311-324. doi:10.1016/j.tins.2016.03.002.

 

Kim JJ, Gean AD. Imaging for the Diagnosis and Management of Traumatic Brain Injury. Neurotherapeutics. 2011;8(1):39-53. doi:10.1007/s13311-010-0003-3.

MRI Scans Could Lead to New, Non-Invasive Tests for Alzheimer’s Disease Before Symptoms Appear

23 Jul 2018 MRI ,

 

There are currently 5.7 million people living with Alzheimer’s disease (AD) in the United States, and this number is projected to reach 14 million by the year 2020. As of 2018, AD was the fifth-leading cause of death of seniors, taking more lives than breast or prostate cancer combined. With such staggering and ever-increasing numbers, the need for early detection and treatment has reached a crisis point.

 

But understanding AD hasn’t been easy. Researchers have struggled to identify the true cause of this disease, develop a standard treatment plan, or find a cure. While an AD diagnosis may seem dire, early detection of the disease can help identify how the disease progresses, which in turn can help to create a treatment option.

 

New Research on AD Biomarkers and How to Detect Them

 

Recent research has shown a connection between changes in the brain’s anatomy and biomarkers known to appear at the early signs of AD. These biomarkers occur before any sign of cognitive problems, meaning these markers could possibly lead to a new, non-invasive AD screening test. Researchers have already discovered that the build up of amyloid-Beta and tau proteins on the brain, as well as a loss of volume in the hippocampus, are early signs of AD.

 

To further examine any links between these two phenomena, researchers from McGill University and McGill-affiliated health institutes studied 88 AD at-risk individuals with no signs of any cognitive decline from the disease. The subjects were given MRI scans to check brain volume, and also had cerebrospinal fluid samples taken to test levels of amyloid-Beta and tau proteins.

 

The researchers found that high levels of both amyloid-Beta and tau proteins were associated with loss of hippocampus volume, but there was no loss in volume when only one of the proteins accumulates within the brain. This suggests that doctors may someday be able to use MRI scans to monitor changes in the brains of AD patients at a microstructural level, before more serious changes begin to take place.

 

The recognition that symptoms of AD progress from physiological to cognitive can help diagnose those most at risk of developing this disease. These biomarkers might also help with testing the effectiveness of trial medications, and might one day allow physicians to target at-risk individuals with a simply MRI scan rather than a painful lumbar puncture.

 

The Expanding Role of MRI Scans in AD Diagnosis and Treatment

 

Non-invasive tests for AD have ramifications that extend well beyond patients themselves, to friends, family, and society at large. The fact is, in addition to being heartbreaking, Alzheimer’s is an incredibly costly disease. Many AD patients require more hospital visits, as well as full-time, long term care. However, accurate and early diagnosis of Alzheimer’s disease could help save $7.9 trillion is medical costs—and relieve some strain on family members and friends.

 

Thanks to MRI scans and their potential role in spotting Alzheimer’s before cognitive symptoms appear, we seem to be edging ever-closer to the ultimate goal of treating AD effectively.   

 

References:

 

Alzheimer’s Disease Facts and Figures.ALZ. Alzheimer’s Association, 2018. Web. 28 June 2018.

 

A non-invasive method to detect Alzheimer’s disease.McGill. McGill University, 19 Dec. 2017. Web. 28 June 2018.

Diagnostic Imaging in Spinal Injuries: A Guide for Personal Injury Lawyers

It’s difficult to overstate the importance of diagnostic images in spinal injury litigation. When properly presented, a diagnostic image offers clear, compelling evidence—but if the image doesn’t clearly show the injury, or if there’s any question as to the validity of the attorney’s interpretation, the entire case can be compromised.

Of course, every personal injury attorney understands these points, but in order to use images effectively, they should understand the basics of different imaging technologies. That includes the tactics that radiology professionals must employ to deliver high-quality, diagnostically relevant images.

 

How Types of Spinal Injuries Affect the Diagnostic Imaging Process

 

The first consideration is the severity and location of the injury. Magnetic resonance imaging (MRI) provides the best diagnostic images for spinal cord and soft-tissue injuries, both for radiology professionals and for laypersons (while diagnostic images need to be evaluated by a trained professional, the images are obviously more useful to attorneys if the injuries are clearly visible and easy to explain).

MRIs can show chronic issues such as spinal misalignment. Spinal fractures are easier to identify via computed tomography (CT), while spinal vascular injuries can be evaluated with either technology. In any case, trained radiology professionals working with the latest tech can discern a surprising amount of information, including the approximate age of the injury, which can help attorneys build winning cases.

 

Choosing Diagnostic Imaging Services for Personal Injury Cases

Personal injury attorneys should keep other practical considerations in mind when directing their clients.

As mentioned earlier, timing is often a crucial factor, particularly in spinal fracture cases. An imaging facility should be able to produce high-quality results quickly and at a fair cost — and, for the benefit of the attorney, those images should be in commonly used digital formats, ready for reproduction. Many attorneys choose to highlight certain parts of MRIs and CT scans with software designed for the purpose; without exceptional images, this can be a difficult process.

 

Finally, as we’ve mentioned on other blogs, imaging centers should be prepared to handle various types of remuneration and should have experience with workers’ compensation and letters of protection.

 

Precise Imaging offers dedicated tools for attorneys through a specialized HIPAA-compliant web portal, which provides 24/7 access to images, case details, and payment information. We’re dedicated to keeping patients comfortable, and with more than 70 facilities, we offer unequaled access to qualified imaging experts and state-of-the-art technology.

To learn more about Precise Imaging’s commitment to assisting in personal injury cases, or to refer a client today, call 800.558.2223. You can also make an online referral here.

 

References:

 

Goldberg AL, Kershah SM. Advances in Imaging of Vertebral and Spinal Cord Injury. The Journal of Spinal Cord Medicine. 2010;33(2):105-116. PMID: 20486529

 

Parizel PM, van der Zijden T, Gaudino S, et al. Trauma of the spine and spinal cord: imaging strategies. European Spine Journal. 2010;19(Suppl 1):8-17. doi:10.1007/s00586-009-1123-5.

 

Ellingson BM, Salamon N, Holly LT. Imaging Techniques in Spinal Cord Injury. World neurosurgery. 2014;82(6):1351-1358. doi:10.1016/j.wneu.2012.12.004.

 

https://www.bermansimmons.com/law-articles/medical-imaging-picture-worth-thousand-words

 

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