Radiology studies play a huge role in the world of third party claims.  As a result of the radiological studies performed in third party claims, acute, degenerative and chronic conditions can be seen, results which are then evaluated within the context of the event in question.  At this point in the claims process, it’s possible for trained physicians to discern whether there are new or acute findings, whether the studies note something unexpected and, most importantly, whether there is an injury cause for the claim or radiological findings. Do the radiological findings align with the mechanism of injury?

But in the insurance and legal arena –­­ where non-medical players are tasked with reviewing and analyzing the radiology study reports ­–­ things can get problematic.

This brief overview can help clarify the basics that medical professionals apply when they consider a claim-related radiology study.  It’s simple information about some of the more prominent radiological modalities we see in our practice…not an exhaustive or in depth explanation.

Areas of radiology

There are three main areas of radiology:  Diagnostic, Interventional and Therapeutic. While the specific studies can be interchangeable, how they are used determines the differences of the specialties.

  • Interventional is used as an image guiding (CT or fluoroscopy) procedure or surgery and, thus, would be considered minimally invasive.
  • Therapeutic radiology uses radiation or techniques in the treatment of conditions such as cancer.
  • Diagnostic is a radiological study for the detection of a disease or injury and is typically noninvasive.

A CT scan is used frequently in emergency situations as it is a quick, fairly cheap diagnostic tool giving excellent detail for bone.

Eight, common radiological modalities

Here’s a closer look at the types of radiological studies MKC has dealt with over the years:

  • Plain X-ray.  Themost common diagnostic radiological modality.  It is a 2D, superimposed view used to evaluate bone, organs and soft tissue such as muscle and fat. Because of the 2D view, multiple “views” or x-rays may be needed to fully evaluate an area, such as bone fracture.  Advantages include lower dose of radiation, cost and time to complete.
  • CT scan.  Uses a series of x-rays as the patient is moved through a scanner  to capture pictures from different angles.  The process involves a “reconstruction” of the information creating a close representation that is used for diagnosis. Radio-fluorescent contrast can be used to evaluate certain areas or suspected diagnoses, such as with an aneurysm.  A disadvantage is that it uses doses of radiation that can be harmful to younger patients.  So, benefits vs. risks need to be weighed.
  • MRI scan.  Simply put, MRI uses a strong magnet and radio waves to produce very detailed images of the body.  There is no radiation involved.  It is excellent for scanning all types of soft tissues and can detect blood flow and cryptic vascular malformations.  While the costs of the study have come down, it is still relatively expensive when compared to other diagnostics. Additionally, the study is time consuming compared to CT or plain films and, therefore, can limit its use in emergent or trauma situations.
  • Diffusion-weighted imaging (DWI).  Very simply stated, a DWI is a type of MRI that uses the motion of water molecules to generate contrasting images.  The level of detail secondary to the sensitivity of the study is greater, and visualization of structures can be accomplished earlier than that of a traditional MRI.  This is especially true (and important) with small and early infarcts, some of which would not be seen on a traditional MRI for several hours post infarct, but which  can be seen on DWI within minutes.
  • Diffusion-Tensor Imaging (DTI).  The DTI is a form of MRI which uses the rate of water diffusion between cells to document information. This study is being used as a prognostic tool for traumatic brain injury given its value in evaluating white matter of the brain.  Its value is that it evaluates microstructures and, as such, is more sensitive to cellular damage than traditional MRI or CT scan.  This is becoming a more widely used modality, as the images are very detailed and in color.  Plus, abnormalities can be visualized with a DTI and explained fairly easily to non-medical people.
  • Fluoroscopy.  A continuous X-ray beam or image is projected on a monitor screen in real time and is used for diagnostic and therapeutic purposes, such as with a swallowing study, cardiac catheterization or during surgery. An X-ray  “movie” of sorts is created.  In certain circumstances, a contrast dye is used.
  • Nuclear Medicine Imaging or radionuclide scanning.  A diagnostic study that uses small amounts of radiation to evaluate the physiology of cells, molecules, chemical reactions, etc.  With nuclear medicine, imaging and treatment are often married.   Information about the anatomy as well as function is provided. With these studies, a radiopharmaceutical substance (or tracer) via injection is used.  PET scan and bone scans are some of the more common nuclear medicine studies.
  • Ultrasound.  This is a diagnostic tool that uses sound waves to capture live imaging from inside the body.  It is often used to check fetal development and can be used during surgery or certain medical procedures.  There is essentially no risk, and ultrasounds do not use radiation.

A cautionary note.  When assessing a claim, consider the timing of a scan or other test.  In our experience, we raise a red flag when, for example, a whiplash claimant undergoes high-level diagnostics immediately post incident. An MRI, a CT scan and similar tests should be done to confirm or rule out a condition – not as part of a fishing expedition.

The bottom line

As with any study, abnormalities need to be understood within the clinical picture presented. Diagnostic studies have the ability to analyze and identify pre and post-DOL findings as well as acute, sub-acute and chronic pathologies.  Understanding overlapping abnormalities and pathologies is of utmost importance in determining relatedness to an event.

However, radiology study findings should not be taken out of context.  Moreover, correlation does not equal causation. A radiological finding should be viewed in conjunction with all injury/event information clinical documentation and medical data points. For example, ask…

  • Is there right side diagnostic pathology vs a left-sided complaint?
  • Does the information from clinical and radiological data tell a story that makes sense within the framework of the event or injury?

If unclear, then it may be time to turn to expert medical consultants for help.

KARI

PS:  Here’s some additional reading that can help you understand the basics of radiology studies ­­https://casemed.case.edu/clerkships/neurology/Web%20Neurorad/MRI%20Basics.htm, https://teachmeanatomy.info/, www.wisegeek.com/what-is-diffusion-tensor-imaging.htm, https://www.imaginis.com/nuclear-medicine and https://www.healthline.com/health/ultrasound#purpose.