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

 

sports medicine diagnostic imaging

Diagnostic Imaging in The AMA’s Guides to the Evaluation of Permanent Impairment

Diagnostic Imaging in The AMA’s Guides to the Evaluation of Permanent Impairment

 

If you had to pick one book to be the authority on assessing personal damage in U.S. tort-civil law, you might choose The American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA Guides). Personal injury law is more complicated than a single book could encompass, of course, but to this day, many U.S. courts rely on the systems set forth in the AMA Guides to determine a “quantitative estimate of function losses” within a victim’s life. Many states use the AMA Guides to settle questions of workers’ compensation and disability claims.

 

The AMA Guides assessment can also be a powerful tool in a personal injury case.

 

Note that the types of losses evaluated in the Guides may lead to pecuniary and/or non-pecuniary damages. In the former category, the Guides systems might uncover a loss of earning capacity or, in cases of disability, the necessity of long-term care. The AMA’s Guides to the Evaluation of Permanent Impairment may also play into a claim of quality-of-life loss or limited ability due to the injury, both non-pecuniary damages.  

 

As we’ve mentioned in previous posts, diagnostic imaging can also occupy a major role in personal injury cases. So the question is: How do The AMA’s Guides to the Evaluation of Permanent Impairment implement diagnostic imaging as a factor in their determination systems? And which modalities most clearly demonstrate injury, according to the Guides?

 

Here are a few key facts about the intersection of diagnostic imaging and The AMA’s Guides to the Evaluation of Permanent Impairment that every personal injury attorney should know:

 

 

  • Diagnostic Imaging Studies are an Important Part of Injury Assessment in the AMA Guides to the Evaluation of Permanent Impairment

 

 

In assessing impairment or disability, as in health care itself, diagnostic imaging plays an outsized role. The AMA Guides present each body system in its own chapter, introducing principles of assessment for each system. In nearly every chapter, some form of diagnostic imaging appears in the Guides’ assessment criteria.

 

The results of all diagnostic studies — including imaging — must also be part of the physician’s report, according to the Guides.  

 

 

  • Imaging Modalities May Differ from One Edition to the Next

 

 

Editions matter. Depending which state you’re in, the worker’s compensation code may defer to the 6th and latest edition of the AMA Guides — or it might not. Some states use the 5th or even earlier editions, while others prefer state-specific criteria for evaluating injury, unrelated to the Guides. And while these codes relate specifically to worker’s compensation rather than personal injury cases, the court’s familiarity with a particular edition could add up to more compelling evidence of preventable injury and lasting impairment.  

 

Differences between editions complicate the evaluating physician’s choice of imaging modality. For instance, according to analysis from health care news site Medscape, methodology changes between the 5th and 6th editions of the Guides upend the rules for assessing impairment in a knee joint injury.

 

“No provision was made for ratings based on magnetic resonance imaging (MRI) or arthroscopic findings of cartilage pathology in the 5th edition of the Guides,” reports Medscape. “However, in the 6th edition of the Guides, there is provision for full-thickness articular cartilage defects, with a range of 5 to 9 percent impairment…MRI and arthroscopy are objective measures with accepted grading systems for cartilage lesions.”

 

So should an attorney ask the evaluating physician for an X-ray or an MRI scan in a knee-injury case? It may depend on which court tries the case.

 

 

  • Imaging Findings Alone are Not Enough

 

 

The 5th Edition of the AMA Guides makes the important point that the results of an imaging study alone aren’t enough to classify an injury as impairment or disability.

 

The purpose of an assessment using AMA Guides systems is to establish a diagnosis-related estimate, or DRE. DRE categories are a measure of the “impairment of the whole person,” expressed as a percentage range, with 0 percent impairment equating to no injury and 100 percent representing imminent mortality.

 

“To be of diagnostic value, clinical symptoms and signs must agree with the imaging findings,” the 5th edition AMA Guides claim. “In other words, an imaging test is useful to confirm a diagnosis, but an imaging result alone is insufficient to qualify for a DRE category.”

 

So where does all of this leave personal injury attorneys considering the inclusion of diagnostic imaging into a particular case? The key is to work as closely as possible with the client’s attending physician or, in some cases, a court-approved health care provider. In the medical setting, imaging is a crucial part of diagnosis, which is necessary for healing. In a court of law, radiographs and MRI scans are just as valuable — but for the very different purpose of assessing injury for a fair damage claim.

 

Interested attorneys can purchase a copy of The American Medical Association’s Guides to the Evaluation of Permanent Impairment at the AMA webstore, here. For more information on how Precise Imaging can help personal injury firms better serve their clients, see our Attorney Resources page, or contact us at 800-558-2223 today.      

Understanding the Personal Injury Lien as Payment for Diagnostic Imaging

Personal injury liens help victims obtain medical treatment and stay afloat financially while their case is being decided. While this agreement entitles medical centers to repayment after a case has been settled, it can be greatly beneficial to attorneys and their clients as well.

 

Because many people cannot afford to pay major unforeseen medical bills, liens provide a lifeline until a settlement is reached, and attorneys benefit by ensuring that their clients get medical procedures and imaging completed in a timely manner. Still, there are a few things to consider when advising clients on this complicated subject.

 

The first thing to consider is what kind of experience the health care facility has with liens. Many smaller medical centers and imaging facilities don’t accept personal injury liens; others may have a poor history of working out reimbursements. While the client may not have a choice of their initial point of care, they can certainly choose where subsequent imaging is done.

 

And that medical imaging is important for not only the person’s future medical care, but also the outcome of their personal injury case.

Magnetic resonance imaging (MRI) scans can make or break a case.

Some physicians are reluctant to order MRI scans for accident victims — they feel that the scanning technology is so good at detecting problems that it can reveal false positives through asymptomatic abnormalities. However, there are many reasons that American courts encourage MRI scans.

 

For one, an MRI scan is completely objective. While radiologists may have differing interpretations of the scans, the scans themselves cannot be manipulated to distort the truth. That makes for powerful evidence to a judge or jury. Seeing the results of negligence in a black and white scan trumps many other forms of evidence.

 

Furthermore, seeing clear evidence of an injury can increase the value of a claim. Injuries in the brain, spinal discs, nerves, and joints can be difficult to verify without this state-of-the-art imagery. An MRI shows what many other forms of imaging cannot, and that’s makes it invaluable to winning and maximizing personal injury lawsuits.

Of course, some patients may be reluctant to get MRI scans for a variety of reasons.

In these cases, victims of injury should be aware of how beneficial these scans can be for correct diagnosis and beginning recovery (not to mention, winning a case). Magnetic resonance allows doctors to pinpoint the source of an injury with the very latest technology available.

 

Some people hesitate to complete scans because of anxiety over claustrophobia. These fears are completely understandable, but there has been progress in recent years in making the technology more patient-friendly. For instance, open MRIs can help keep patients calm by eliminating the closed spaces that exist in traditional MRI machines. Even simple strategies, like prescribing an anti-anxiety medication or providing headphones with music can help anxious patients get through a scan.

Choosing an imaging center with personal injury experience can make the process easier for patients and attorneys.

The biggest reason is that facilities with experience offer a patient-centered focus and streamlined approach to accessing medical images. These facilities understand HIPAA regulations, know the preferred formats for images, and offer web portals for easy accessibility.

 

Using a single, preferred diagnostic company can also simplify caseloads for attorneys.

By relying on a trusted imaging center, firms know that crucial evidence is always just a click away — no matter what time of day. Attorneys can also trust that their clients are getting the best rates, so that injury victims can hold onto the lion’s share of their settlement.

 

Finding a diagnostic imaging center that can handle time-sensitive requests is also important. Many hospitals experience lengthy delays in scheduling scans. Because Precise Imaging has over 70 locations, we can schedule same-day scans. Even better, our radiologists will file reports no later than 48 hours after the scan (and sometimes much sooner). The quick scheduling and prompt reading allows personal injury cases to clear significant hurdles without taking up too much time.

Look for an imaging center with web portals for attorneys.

Because legal cases are time-sensitive, having a 24-7 web portal available is crucial. Precise Imaging provides such portals so that attorneys can access important information night or day. Our web portals provide medical images, payment information, and case details, all while fully complying with HIPAA regulations. This service keeps attorneys organized and on track without having to rely on the medical center being open for service.  

 

Our facilities are well-acquainted with the needs of personal injury lawyers, and our patient-centered facilities can comfort distraught patients who have recently suffered injuries. We offer a number of anxiety-reducing strategies to make our MRI scans as comfortable as possible.

 

We can schedule scans for the same day and get you results within 48 hours. All of the information an attorney or patient needs to access can be found on our 24-hour-per-day web portal. These services simplify a personal injury case and keep you on track.

 

We have partnered with patients and attorneys for thousands of personal injury cases and take our responsibilities to all parties seriously. We are prepared to accept all forms of payment, including workers’ comp, liens, and deferred payment (through a letter of protection).

 

Precise Imaging makes scans fast and easy for patients and provides streamlined results for attorneys. If you’d like to partner with Precise Imaging for your personal injury cases, call 800.558.2223 or make an online referral here.


References

 

7 Steps to Approaching Lien Claims in Personal Injury Cases.” FindLaw.com. n.d. Web. 3 May 2018.

 

Coye Law Firm. “What Is A Letter Of Protection? Learn More About The Pros And Cons Of Using A Letter Of Protection Or LOP.” HG.org n.d. Web. 3 May 2018.

 

Jacobson, Martin & Schweers, R. “Ethical Considerations in Personal Injury Settlements and Lien Resolution.” Bill of Particulars. Vol. 1 2012. Web. 3 May 2018.

 

Medical Liens: A Primer.” The Steve Dhillon Law Firm. n.d. Web. 3 May 2018.

 

Weiner, Ron “Lien vs. Subrogation.” MedLien Solutions. 3 Nov. 2015. Web. 3 May 2018.

 

Choosing Diagnostic Imaging Services for Personal Injury Cases

Magnetic resonance imaging (MRI) scans can be crucial pieces of evidence in personal injury lawsuits. The detailed images can convince a jury or judge that an injury occurred as a result of an accident or negligence, rather than aging and genetics.

 

MRI scans are universally accepted by insurance companies and courts because of their objectivity and superiority to older forms of imaging, like X-ray. Different radiologists may have differing interpretations of the scans, but in general, the results of an MRI scan provide definitive evidence to a judge or jury.

 

Another great advantage of MRI scans is that they use no radiation, and thus are safer than alternative forms of medical imaging. Instead, MRI scans use powerful magnets to develop highly detailed scans of the body. These powerful magnets require special attention for those with pacemakers or other implanted devices, but scans can still be safely given to most cardiac patients.

 

Litigation MRI scans are helping everyone from injured motorists to football players with traumatic brain injuries. It’s this versatility that makes MRI scans the gold standard for determining medical history.

Unfortunately, MRI scanners at hospitals are expensive and in high-demand.

This may lead the doctor to prescribe rest for your client’s injury before signing off on an MRI scan. If you’d like to move your case along, we can help schedule an affordable and timely scan. Precise Imaging has years of experience and accepts cases on lien. Advantages of working with us include:

 

  1. Fast and easy scheduling – Call Precise Imaging at (800) 558-2223 or schedule an appointment online. We have over 70 locations, many open nights and weekends, to get your scans done quickly and professionally.
  2. A variety of delivery options – Obtain scans on compact discs or other secure media for reliable access. We’re experienced in handling potential evidence and same-day reporting is available in many locations.
  3. A range of imaging modalities – Whether you need dual-focus X-ray tubes or an open MRI machine, we’ve got you covered. For any type of medical imaging, we’ll harness our flexibility to get you the best images for your case.
  4. Our facilities are patient-focused – We know that patients who have suffered an injury are under stress and possibly in pain. Our highly trained techs will make sure patients are comfortable and stress-free as they undergo imaging.

 

Precise Imaging has served more than 150,000 patients throughout California, Nevada, and Arizona. Whether you’re an attorney or a patient, we can schedule an appointment at a convenient time and place. Call (800) 558-2223 or make an appointment online.

 

References

 

Cherniak, Todd. “Litigation MRI: Why Lawyers Are Asking for It and Why Your Patients Need It.” British Columbia Medical Journal. Vol. 47, No. 7. Sept. 2005. Pp 358-361.

 

Magnetic Resonance Imaging (MRI) Safety.” RadiologyInfo.org. 5 Apr. 2017. Web. 1 May 2018.

 

MRI is Safe for Most People with Pacemakers and Defibrillators.” Harvard Health Publishing. Harvard Medical School. Jan. 2018. Web. 1 May 2018.

 

Brown, Francis H. “Recent Developments in Traumatic Brain Injury Litigation.” American Bar Association. 12 Sept. 2016. Web. 1 May 2018.

Preparing Patients to Read Their Own Radiology Reports

Preparing Patients to Read Their Own Radiology Reports

 

Increasingly, diagnostic imaging providers use web portals to give patients full access to their own radiology reports. Despite early fears that patients would misinterpret complex medical information, leading to unnecessary anxiety, most studies of direct access to radiology reports suggest that this is a positive step for patients and health care providers alike. When patients take a more active role in their care, they provide an extra level of oversight, reducing the chance of an error. Informed patients are also more likely to ask radiologists helpful questions, potentially preventing unnecessary testing.  

 

In order to realize the full benefits of open access, however, primary care physicians or radiologists themselves should start educating their patients on how to read radiology reports. Otherwise, the fears of the opponents of patient access are more likely to be borne out in the patient population.

 

Here are a few of the key points to emphasize to patients who may be accessing their radiology reports for the first time:     

Explaining Radiology Reports to Patients: The Breakdown

 

Patients may be more comfortable with the radiology report when you explain it section-by-section. Luckily, radiology reports are broken down into six sections, which is a good place to start when explaining the documents to patients. Let patients know that the typical radiology report will include the following: The type of exam performed, the patient’s clinical history, the comparison, the imaging technique, findings, and the radiologist’s final impressions. Encourage patients to ask questions if they encounter anything they don’t understand in any of these six sections:  

 

Section 1: The Basics

 

Radiology reports that begin with naming the type of exam will explain which imaging modality (MRI, CT, X-ray, etc.) was used in the procedure — and, crucially, which part of the body technologists scanned. They’ll also include the time and date, as well as any details about preliminary procedures, like the use of contrast.

 

When discussing this first section, make sure patients understand the basics of the modality, and risks involved. This is a good time, for instance, to mention that MRI scans don’t expose patients to ionizing radiation, or that intravenous contrast has a low incidence of negative side effects.

 

Section 2: The Patient’s Backstory

 

The “clinical history” section of a report includes information such as the patient’s age, sex, and pre-existing conditions or diseases, and any other relevant medical information needed.

 

Patients can find the reason for the scan and, often, a suspected diagnosis in this section. This information helps the radiologist focus the report to each patient’s individual medical situation. Conversations with patients about their clinical histories can ensure that physicians have access to all relevant data before referring the patient for diagnostic imaging.

Section 3: Comparing New Scans to Previous Radiology Reports

 

If the patient has had other imaging done in the past, sometimes those images need to be used as comparisons. The “comparison” section of the typical radiology report is where past images will be mentioned. Typically, radiologists only consult scans of similar regions of the body when making comparison notes.  

Section 4: Technical Details

 

When patients have questions about a radiology report, they often turn up in the “technique” section. Ironically, the details provided here — exact scientific descriptions of the imaging procedure — may not give the referring physician or the patient strongly relevant information.

 

However, the information contained herein is vital for radiologists, who may need to recreate or alter technical procedures in later scans. In reading through the technique portion of the radiology report, physicians may need to explain medical terminology, such as the use of anatomical planes, as well as structures of the body.   

Section 5: The Radiologist’s Findings

This is what every patient wants to know—what was found during a scan. Don’t let patients place too much emphasis on the findings, however; the detailed analysis comes with the radiologist’s impressions, in the final section of the typical radiology report.

 

Here, radiologists provide their notes on the normality or abnormality of the scanned area. Sometimes, patients don’t see a certain organ or bodily structure that they know was part of the imaging procedure. Let them know that this usually just means the radiologist didn’t find anything worth commenting on in that area. That’s usually good news.

Section 6: The Radiologist’s Diagnosis

The “impression” section of a medical report is where patients will find the radiologist’s diagnosis, along with recommendations for future testing for confirmation. Commonly, radiologists offer differential diagnoses, which include any number of potential causes of the patient’s symptoms. This can be confusing to patients new to reading radiology reports, so it can be helpful to spend extra time discussing each of the diagnoses on the radiologist’s list, and planning for future diagnostics that can uncover the true illness.  

The Growth of Portal-Based Radiology Reporting

 

Even if the diagnostic imaging facilities you refer patients to don’t offer online access to radiology reports, odds are they will in the near future. The latest survey found that nearly 80 percent of patients who responded said they preferred to view radiology reports through online portals compared with more traditional methods of reporting. Tellingly, this includes getting the details verbally from their referring physician.

 

Another survey of 617 patients found that 64 percent of the study participants said they wanted to review their radiology reports themselves. An impressive 85 percent reported a desire to see the diagnostic images themselves.

 

In a consumer-driven health care market, these preferences are bound to win out. Prepare patients to read their own radiology reports to improve the efficacy of patient web portals at diagnostic imaging centers.

 

References:

 

Cabarrus, M et al. Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports. Journal of the American College of Radiology. June 2015; 12(6):556-562. DOI: https://doi.org/10.1016/j.jacr.2014.12.009. Accessed March 14, 2018.  

 

Johnson, AJ et al. Access to Radiologic Reports via a Patient Portal: Clinical Simulations to Investigate Patient Preferences. Journal of the American College of Radiology. April 2012; 9(4):256-263. DOI: https://doi.org/10.1016/j.jacr.2011.12.023. Accessed March 14, 2018.  

 

Landro L. Radiologists Push for Medical Reports Patients Can Understand. The Wall Street Journal. September 2014; Web. Available here. Accessed March 14, 2018.  

 

Orenstein B. Reporting to Patients. Radiology Today. January 2013;14(1):22. Available here. Accessed March 14, 2018.

 

Patients accessing medical records online more than ever. Becker’s Hospital Review. July 2016; Web. Available here. Accessed March 14, 2018.

 

MRI Technique Shows Brain Differences in People on Autism Spectrum

Researchers have observed abnormal neural networks in preschoolers with autism spectrum disorder (ASD) using a specialized magnetic resonance imaging (MRI) technique. The discovery gives hope that MRI scanning may one day allow early diagnosis, intervention, and treatment in ASD.

The study included 21 children with ASD and 21 children with typical development (TD).

It took place over four years in the Chinese PLA Hospital in Beijing. The researchers used a special MRI technique called diffusion-tensor imaging (DTI), which allowed them to observe the location, orientation, and anisotropy of white matter tracts in the children’s brains.

 

Other scientists have used a similar technique to study the brains of patients with Alzheimer disease, multiple sclerosis, epilepsy, and other psychiatric disorders. The approach has led to

an improved understanding of topological organization of the brain network in patients with these disorders.

 

There were similarly useful results in the study of preschoolers with ASD. The researchers observed alterations of white matter in the children with ASD compared to children with TD. The scientists were able to correlate the alterations in the white matter networks with delays in verbal communication, object use, visual response, body use, and listening response.

The study also observed increased nodal efficiency in children with ASD compared with TD.

That observation agreed with previous studies that had observed this phenomenon in adults on the autism spectrum. The researchers believe this is a reflection of a delayed maturation process in people with ASD.

 

“Altered brain connectivity may be a key pathophysiological feature of ASD,” study co-author Lin Ma told Science Daily. “This altered connectivity is visualized in our findings, thus providing a further step in understanding ASD. The imaging finding of those ‘targets’ may be a clue for future diagnosis and even for therapeutic intervention in preschool children with ASD.”

Medical professionals from around the world weighed in on the study.

“This discovery gives us a more objective diagnostic method by using MRIs to aid us in the diagnosis of children who do have autism, and also gives us a better understanding of the abnormal differences in the brain,” psychiatrist Dr. Matthew Lorber told HealthDay Reporter.

 

Doctors presently diagnose ASD through observing difficulties with social use of communication and interaction in children. A standardized MRI technique that could identify the disorder could give parents and therapists an earlier chance at intervention and treatment.  

 

It’s still too early to rely on MRI scans for the diagnosis of autism, but the study’s results show that it’s possible. The study also provides other researchers with imaging biomarkers that may speed the development of this technology.

 

References

Abnormal Brain Connections Seen in Preschoolers with Autism.” Science Daily. 27 Mar. 2018. Accessed 29 Mar. 2018.

 

DSM-5 Diagnostic Criteria.” Autism Speaks. 2018. Accessed 29 Mar. 2018.

 

Ma, Lin et al. “Alterations of White Matter Connectivity in Preschool Children with Autism Spectrum Disorder.” Radiology. 27 Mar. 2018. doi: 10.1148/radiol.2018170059. [Epub ahead of print]. Accessed 29 Mar. 2018.

 

Preidt, Robert. “MRI Sheds New Light on Brain Networks Tied to Autism.” HealthDay Reporter. 27 Mar. 2018. Accessed 29 Mar. 2018.

mri-biopsy

Precise Blog – How MRI Scans Can Reduce the Need for Biopsies

How MRI Scans Can Reduce the Need for Biopsies

 

Researchers at the Simmons Comprehensive Cancer Center have authored a study detailing a multiparametric magnetic resonance imaging (mpMRI) technique that predicts a malignant type of kidney cancer without performing a biopsy. The results of the method are impressive, but require more refinement to fully take the place of a biopsy.

 

Doctors frequently find kidney tumors accidentally while conducting CT scans for other reasons.

These scans alone do not yield the necessary information that tells doctors whether they are malignant or benign. Instead, a biopsy is usually performed. These procedures can save lives by correctly identifying the nature of the tumor, but they are also invasive and can cause complications.

 

“Using mpMRI, multiple types of images can be obtained from the renal mass and each one tells us something about the tissue,” Dr. Ivan Pedrosa, Professor of Radiology and Chief of Magnetic Resonance Imaging told the UT Southwestern Newsroom.

 

Identifying malignant masses in the kidney is extremely important because treatment is highly effective before the tumor metastasizes. However, once it spreads to other parts of the body, survival rates are low. Clear cell kidney carcinoma is an aggressive subtype of malignant masses that the researchers.

 

Seven radiologists studied the records of 110 patients with cT1a masses.

 

These patients had all undergone an MRI as well as a partial or radical nephrectomy. The observing radiologists did not know the final pathology findings, but instead relied on an algorithm to judge whether tumors were metastatic.

 

The researchers had 78 percent accuracy when rating that the mass was “probably” or “definitely” clear cell kidney carcinoma. When rating that the mass was possibly carcinoma, they had a 95 percent success rate.

 

The promising results show that biopsies may not be necessary for identifying certain cancers.

 

Because some patients are reluctant to consent to biopsies, this new technique is potentially lifesaving. As it stands, patients who do not want a biopsy may learn important information if an MRI shows that their kidney mass has a high probability of becoming metastatic. This new information could convince them that the pain of a biopsy is worth going through.

 

Using these methods to identify clear cell histology is still a work in progress. The doctors at Simmons Comprehensive Cancer Center will have to achieve a higher degree of accuracy in predicting malignant kidney masses for the method to become mainstream.

 

However, as standardization of imaging protocols and reporting criteria are refined, accurate results should increase. When MRI scans alone are sufficient to identify clear cell kidney carcinoma, doctors will have another powerful tool in the fight against cancer.

 

References:

 

Anderson, Avery. “State-of-the-Art MRI Technology Bypasses Need for Biopsy.” UT Southwestern Medical Center, 2 Jan. 2018. Accessed March 14, 2018.

Canvasser, N. et al. “Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Identify Clear Cell Renal Cell Carcinoma in cT1a Renal Masses.” The Journal of Urology, volume 198, no. 4, Oct. 2017, pp. 780-786. Accessed March 14, 2018.

National Cancer Institute. “Kidney Cancer.” Kidney (Renal Cell) Cancer—Health Professional Version. Accessed March 14, 2018.

 

National Institute of Health. “Clear Cell Kidney Carcinoma.” The Cancer Genome Atlas, National Institute of Health. Accessed March 14, 2018.

Advances in Machine Learning (AI) for MRI scans

Open-Source MRI Dataset from USC Now Available to Researchers

 

The University of Southern California has released an open-source dataset of anatomical brain images taken from MRIs of stroke victims. The dataset is intended to spur advances in machine learning by providing a large set of manually-traced lesions.

 

Manually-traced lesions are useful, but labor intensive.

 

Researchers have attempted to automate lesion segmentation through algorithms. However, this automation is in its primitive stages, and machines cannot yet identify lesions with great accuracy. Thus, manually-traced lesions are still the gold standard, but require a large amount of work from a trained neuroanatomy expert.

 

USC’s dataset attempts to bridge the gap between human tracers and machines. By providing 304 T1-weighted MRIs with lesions segmented by a human, the study’s authors hope computer programmers can develop an accurate lesion segmentation algorithm. The dataset is available for download free of charge here.

 

Strokes are a leading cause of death and disability in the United States.

 

Mortality rates from strokes have steadily declined worldwide, but around two thirds of stroke survivors suffer long-term disabilities that affect their daily activities. This situation has led scientists to focus on what interventions provide the best outcomes for stroke survivors.

 

Doctors have opportunities for intervention at both the acute and chronic stages. In the former, intervention can save neural tissue and promote functional recovery. In the latter, rehabilitation can help long-term recovery.

 

Magnetic resonance imaging can aid doctors in making intervention decisions.

 

Clinical brain images taken within 24 hours of a stroke help doctors determine whether to administer thrombolytic drugs or perform surgery to save neural tissue. Because clinical scans are taken for almost all stroke victims, there have been great strides in using large-scale datasets of these acute scans for predictive modeling.

 

Unfortunately, sub-acute and chronic scans are given less and therefore harder to obtain, making predictions at these levels less advanced. That’s one thing the study’s co-author Sook-Lei Liew would like to change.

 

“The goal of ATLAS is to generate a dataset that machine learning and computer scientists could use to develop better automated algorithms to identify the lesions,” Liew told Health Data Management.

 

Machine learning requires large, accurate datasets to train and to test.

 

Liew hopes that computers will eventually be able to identify biomarkers in stroke patients, making it easier to prescribe the appropriate rehabilitation therapy and treatment. Her next step is to create a separate dataset used to test the algorithms developed using the current dataset.

 

“In machine learning, you always need a training dataset and a testing dataset.” Liew noted. “Even if people aren’t interested in stroke, it’s also an interesting dataset to train any sort of computer vision algorithm because it’s a challenging problem.”

 

References:

 

Slabodkin, G. USC Releases MRI Stroke Dataset To Spur AI Research. Health Data Management. Available here. Accessed February 22, 2018.  

  

Liew, S et al. A Large, Open Source Dataset of Stroke Anatomical Brain Images and Manual Lesion Segmentations. Scientific Data. February 20;(5):180011. doi:10.1038/sdata.2018.11

Accessed February 22, 2018.   

 

Feigin, VL et al. Global and regional Burden of Stroke During 1990-2010: Findings From the Global Burden of Disease study 2010. The Lancet. January 2014;(383)9913:245-255. doi:10.1016/S0140-6736(13)61953-4 Accessed February 22, 2018.

 

mri-pacemaker

MRI Scans, Pacemakers, and Implantable Cardioverter-Defibrillators: New Safety Evidence

Patients with pacemakers and implantable cardioverter-defibrillators (ICDs) may safely receive magnetic resonance imaging (MRI) testing according to a study from the New England Journal of Medicine. Currently, implanted devices must meet the Food and Drug Administration’s criteria to be considered MRI-conditional. The pacemakers and ICDs that do not meet these requirements are considered legacy devices, and the federal government considers them unsafe for MRI scans. However, the new study proves that, with adherence to protocols, patients with legacy devices can safely receive MRI scans.

 

The study followed over 1500 patients with implanted devices.

 

The prospective, nonrandomized study followed 875 patients with pacemakers and 634 with ICDs. All patients had implanted devices that were considered legacy devices —  that is, they did not meet the requirements of the Centers for Medicare & Medicaid Services (CMS). Researchers from the University of Pennsylvania performed MRIs on the patients only when it was deemed clinically necessary.

 

The scans were done under strict protocols with physicians on hand to monitor patients. Tachyarrhythmia functions were disabled on the machines and pacing modes were appropriately adjusted on the devices.

 

“We found MRI examinations to be safe in the setting of legacy cardiac pacemakers or ICD systems, when using a safety protocol,” lead study author and University of Pennsylvania professor Saman Nazarian told Cardiovascular Business. “The scans were safely performed even when performing thoracic or cardiac MRI and with patients that were dependent on cardiac pacing for every heartbeat.”

 

A previous study from MagnaSafe found similar results for non-thoracic scans.

 

The MagnaSafe Registry is a multi-center study attempting to determine how safe MRIs are for patients with pacemakers and ICDs. They published findings several years ago that upended the traditional view that MRIs were too dangerous for patients with legacy devices. With similar results to Nazarian’s study, MagnaSafe found that there were almost no clinically relevant problems caused by the scan.

 

This is hugely important because many people with legacy implants are denied MRI scans by Medicare and Medicaid. While doctors may then order computed tomography (CT) scans, MRIs are better at diagnosing certain diseases, particularly in the brain and spinal cord. Nazarian said that if a patient with a legacy device needs an MRI, they should contact a medical center that can safely conduct the scan.

 

“Many centers across the U.S. are capable of performing safe imaging despite your device,” Nazarian said to Cardiovascular Business. “MRI can be instrumental in providing the right data for appropriate treatment planning in the setting of many neurologic, cardiac and musculoskeletal disorders as well as malignancies.”

 

The results from the two studies offer compelling evidence that MR technology is safe for those with implanted legacy devices.

 

According to Robert Russo, a doctor in the MagnaSafe study, more than half of patients with implanted devices will eventually need an MRI. Replacement with an MRI-conditional device is not an option, as the complication risks are too high. Therefore, it’s important to determine the safety of MRI scanning for patients with these legacy devices.

 

The above studies show how MRIs pose minimal risks while bestowing life-saving advantages for those who need scans. The FDA and CMS have not changed their regulations in light of the findings, but the evidence is mounting that they should consider doing so.

 

References:

 

Getting an MRI if you have a pacemaker. Harvard Health Publishing. August 2015;Web. Available from: https://www.health.harvard.edu/heart-health/getting-an-mri-if-you-have-a-pacemaker

 

Nazarian S et. al. Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices. The New England Journal of Medicine. December 2017;377:2555-2564. doi:10.1056/NEJMoa1604267

 

Slachta A. MRIs proven safe for patients with with FDA-unapproved implantable devices. Cardiovascular Business. January 2018;Web. Available from: http://www.cardiovascularbusiness.com/topics/electrophysiology-arrhythmia/mris-proven-safe-patients-fda-unapproved-implantable-devices

 

The MRI Procedure in 10 Steps: Managing Patient Anxiety Through Information

10 Jan 2018 Health Care, Medical, MRI

 

A first-time MRI procedure can make patients nervous, even to the point of ending the scan. That can lead to higher costs for imaging centers, and even affect patient outcomes if the anxiety interferes with the quality of the radiology report. Research shows one simple way to help nervous patients get through their scans without interruption: Communication.

 

A 2015 study in the journal Magnetic Resonance Imaging tested an intervention in which imaging staff explained the MRI process to one group of patients. They took blood samples during the scans, later testing them for the stress hormones prolactin and cortisol. Additionally, they took both the experimental and control groups through the 40-questions State-Trait Anxiety Inventory to measure patient nervousness.

 

The patients who had the intervention in which staff verbally shared information about the scan showed a 6-percent drop in cortisol after the scan. The control group’s cortisol levels increased by 18 percent. The authors of the study conclude that “MRI anxiety can be reduced by information and communication. This combined method is shown to be effective and should be used during daily radiology routine.”

 

So what can physicians do to prepare their patients for a first MRI scan in advance? It’s never too early to start educating patients about what they can expect during a health procedure. And the MRI process can be boiled down into 10, easy-to-grasp steps. Share these steps with patients to help limit anxiety during an MRI scan:

 

  1. First, radiology staff will walk the patient through a detailed screening process. Because of the strong magnetic field generated during an MRI, patients must report any medical implants or metal particles in their bodies. These may preclude the use of MRI imaging. 
  2. Once the patient clears the screening, staff will lead them into the MRI suite. Some imaging facilities offer hospital robes, to ensure there’s no metal in the patient’s clothing. Others allow patients to wear their own metal-free clothes, such as sweat pants and a T-shirt. The technologist will proceed to position the patient on the table; most commonly, patients lie on their backs. If the scan requires an additional radiofrequency coil, the technologist will place that on the patient’s body at this time.

  3. The patient enters the bore. Meanwhile, technologists cycle through a list of pre-programmed settings called “protocols.” They’ll choose the protocol that corresponds with the body part they are imaging; this will tell the MRI machine which angles, targets, and pulse sequences to use in this particular procedure.

  4. Before the scan proper begins, technologists run a “scout” or “localizer” scan. This is a low-quality image, and it won’t be used in reporting. However, localizer scans obtain visual and placement information that the computer will used to plan the angles of its imaging later in the process.

  5. Parallel imaging is a process designed to speed up scan time. It collects less raw data during the scan, and patches missing information using special algorithms to generate the final image. Parallel imaging requires specifically calibrated coils, and may call for a calibration scan at this point.

  6. One of the great strengths of MRI scans is that they create 3D images that can be viewed from any angle. The next step is to program in the angle of images for the radiologist. Technologists can change the “thickness” of the image at this point, as well.

  7. Before the scanner can begin collecting valuable images, it must calibrate all systems through the use of a prescan. This shouldn’t take much more than 10 or 20 seconds.

  8. It is only at this relatively late stage in the process that the technologist actually runs the scan. They will make necessary adjustments and continue scanning according to the chosen protocol. In the end, they’ll have clear, accurate images that radiologists will use in their reporting.

  9. Some types of images require extra work in post-production, but this can be done after the patient has left the MRI suite.

  10. Scanning complete, the technologist pulls the patient from the bore. Different types of scans take varying lengths of time, but most range between 20 and 60 minutes.      

 

When patients understand more about their medical procedures, and know what to expect, they’re less likely to experience significant anxiety. That’s both a value in itself — as patient-centered caregivers, staff at Precise Imaging works to keep patients comfortable, both physically and emotionally — and an element of better diagnoses, which lead to better patient outcomes.

 

To learn more about an MRI procedure from Precise Imaging, or to refer a patient, call us at 800-558-2223.  

 

References:

 

Deshmane A, Gulani V, Griswold MA, Seiberlich N. Parallel MR imaging. Journal of Magnetic Resonance Imaging: JMRI. 2012;36(1):55-72. doi:10.1002/jmri.23639

 

Elster AD. “Performing an MR Scan.” MRIQuestions.com. 2017. Web. Jan. 8 2018.

 

Tazegul G, Etcioglu E, Yildiz F, Tuney D. Can MRI related patient anxiety be prevented? Magnetic Resonance Imaging. 2015;33(1):180-3. doi:10.1016/j.mri.2014.08.024

 

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