CHANEY LAW FIRM BLOG

Subscribe to our Blog

MRIs in motion show what happens on the inside

I've previously written on the benefit of MRIs taken under real-world conditions, where the patient is sitting or standing upright during the MRI. These types of MRIs are invaluable for explaining why some patients experience certain types of pain patterns, even when recumbent (lying down) MRIs can't always explain pain.

Here's an interesting video compilation of MRIs images set to motion (warning — brief clip of sexually explicit content):

JAMA talks low back pain

Transient

The Journal of the American Medical Association (JAMA) recently published an article on low back pain on its Patient Page. This article contains a good discussion of the anatomy of the back, the sources of low back pain, and the range of treatments that should be considered.

JAMA notes that low back pain can result from problems with muscles, bones, or nerves, but muscle pain doesn't move down the legs. When the patient has had trauma, imaging studies such as x-rays, MRIs, and CT scans are appropriate. JAMA reports that treatment may include exercise, physical therapy, chiropractic, acupuncture, over-the-counter or prescription medication, and, in rare cases, surgery.

One of the things that we found interesting is that the JAMA article cited a clinical guideline by the American College of Radiology (ACR). This article discusses the appropriateness of several types of imaging studies under different clinical conditions. The ACR guideline states that most uncomplicated low back pain resolves on its own, but that intervention is needed for more complicated cases. The guideline considers low back pain to be "complicated" when it is accompanied by trauma, cumulative trauma, or lasts longer than 6 weeks. The ACR guideline confirms that x-rays are appropriate for evaluating alignment and instability in the low back.  

The ACR guideline was published by the National Guideline Clearinghouse (NGC). The NGC is a governmental organization created in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]). Its mission is to provide health professionals, health plans, and others a mechanism for obtaining objective information on clinical practice guidelines.

We are glad to see JAMA referencing the NGC's Guidelines. As lawyers who deal with health issues for our clients, we like to work with doctors who utilize the latest health guidelines in their practice. 

Chaney Law Firm fights for the use of objective medical technology tools in court

Our firm handles quite a few connective tissue injury cases. While some types of these injuries can be seen on some MRI machines, the extent to which connective tissue has been injured is usually assessed by how motion of joints is altered due to the injury. For example, the following analysis is performed for a cervical spine injury:

This is an excerpt from the American Medical Association's Guidelines to the Evaluation of Permanent Impairment ("AMA Guides"), which treating physicians usually follow in quantifying the extent of a connective tissue injury. The physician draws lines on x-rays and compares adjacent levels of the spine in a process known as radiographic mensuration analysis. Where the angles between adjacent levels exceed 11º, the AMA Guides state that the patient has a 25% permanent whole body impairment. Physicians have been performing these types of measurements and diagnoses for around a century, and the AMA Guides have required them since 1993.

Historically, this analysis took quite a bit of time and effort on the part of the physician. However, in the early- to mid-1990's, some physicians recognized that this process could be computerized and set to work creating software to perform the analysis. The resulting diagnostic procedure is called computerized radiographic mensuration analysis, or CRMA. The result is sometimes referred to as a "digitized x-ray," since plain film x-rays can be scanned and analyzed as well. Since the late 1990's, many scientific research articles, clinical practice guidelines, and healthcare associations have recognized that CRMA is easier, faster, more reliable, more repeatable, and more accurate than hand-derived measurements.

digitizing order.gif

Just before a scheduled trial date for one of our clients in early January, a trial judge in Texarkana ruled that CRMA was "a mere technological advancement of established, reliable mensuration procedures such as the one utilized by the AMA Guides." For that reason, the trial judge rejected a defense challenge to the use of impairment evidence based upon CRMA and the AMA Guides. We at the Chaney Law Firm are proud to be defending the right of injury victims in Arkansas to use objective, repeatable technology tools to quantify their injuries.