Over my many years of being a Worker’s Compensation Attorney, there isn’t a week in which I don’t have an Injured Worker tell me that they really need to get an MRI. For many, they do not know why they need a MRI. They, however, strongly feel they need to get one. For many, MRIs are viewed by as the state-of- the-art way of finding out what is physically wrong with them. They want answers. They want to get better. There is no blame for wanting that!
This article is will discuss Injured Workers’ concerns about the need for the diagnostic test of Magnetic Resonance Imaging. This article will discuss the nature of MRIs and how they can help Injured Workers with respect to their workers’ compensation claims.
Diagnostic Testing: What is It?
In the field of medicine, scientists have employed various technologies to develop testing which can assist medical practitioners with respect to determining the proper diagnosis of medical conditions.
Technologies have allowed for the creating of various instruments to allow for testing. These tests include such items as blood tests, urine tests, x-rays, sonograms, and MRIs.
Diagnostic Testing: Why Is It Done?
Sometimes, testing is done when a medical practitioner is not sure as to a diagnosis or wishes to confirm their diagnosis. In those circumstances, they will order a test or tests to “rule out” a condition.
In sum, testing is not merely meant to find problems. Sometimes, it is also used to find that there “is not” a problem. MRIs are part of the arsenal of diagnostic tools that medical practitioners employ for those purposes.
What Is an MRI?
The abbreviation MRI stands for Magnetic Resonance Imaging. An MRI is a diagnostic test that uses magnets and radio waves to take pictures of internal organs and tissues. MRIs are different from X-Rays. Unlike X-Rays, there is no radiation employed.
The MRI studies are usually placed on a computer disk. Many clients are provided copies of the disk by the MRI facility. Treating or Evaluating Doctors view the imaging on the disk to interpret it. Sometimes, a Radiologist, a doctor who specializes on the reading of such tests, issues a report describing the MRI imaging studies. This report is their interpretation of the MRI itself.
In sum, after a patient has had an MRI, there should be the actual MRI study available. Also, if a Radiologist has been provided the study, a MRI report should be available as well. Doctors frequently review the MRI Radiology Reports. If they have concerns about the report, they will then review the actual study to confirm the findings.
Are Findings on an MRI Proof of an Injury?
Yes and No. If you speak to a doctor, they will often tell you that they will not diagnose a patient based upon a MRI. A diagnosis is usually achieved by a review of testing, a physical evaluation, a medical history, and a review of records. Thus, a MRI alone is not sufficient to render an opinion.
There was a study that was done with respect to MRIs that were done on individuals who did not have back pain. See Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain, Maureen C. Jensen, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross July 14, 1994 N Engl J Med 1994; 331:69-73 DOI: 10.1056/NEJM199407143310201.
In the study, the conclusion was “[o]n MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”
In sum, MRIs for the back with certain findings do not necessarily represent evidence of a work injury. Further, the study shows that a MRI alone will not be a basis for showing a labor-disabling back condition. In order to prove a work injury, there should be findings on physical examinations as well as additional testing such as x-rays and nerve studies. Further, there should be a history supporting injury.
What Body Parts Can MRIs Be Taken On?
MRIs can be done on many body parts and organs. These include almost every body part from the head to toe. There are Brain MRIs, Neck MRIs, Shoulder MRIs, Thoracic MRIs, Lumbar MRIs, Elbow MRIs, Wrist MRIs, etc. There are Hip MRIs, Knee MRIs, and Ankle MRIs. There are Organ MRIs as well. These include MRIs of the Heart, Breast, Liver, Kidney, Ovary. Pancreas and Prostate.
What is an MRI Report? Why is that Important?
MRI Reports are important in workers’ compensation. The reason being that many of the individuals in the workers’ compensation system rely on these reports in lieu of the actual MRI study. This includes the adjusters, the attorneys, and the judges. Also, it can include medical practitioners and evaluators who are either not trained or interested in reviewing the actual study.
Are There Different Types of MRIs?
Yes. There are different types of MRIs. Also, there are different ways of doing MRIs. A generic MRI is simply having the patient placed in the machine and they are imaged. The length of time that the individual has to be in the machine can vary. Other MRIs are done with contrast. A contrast is intended to take a better imaging study to view certain items. It generally will require that the individual is provided some chemicals within their body to allow for the enhanced imaging. One reason for doing it is that it can allow for better distinction between disc bulges and scar tissue. There are also Functional MRIs which measure brain activity.
What Is a MRI with Contrast?
An MRI with contrast is one in which the patient receives a contrast dye prior to the scan. This dye makes certain tissues or blood vessels to show up more clearly and with greater detail in the imaging study. For example, scar tissue, without contrast, may appear to be something else. There are problems with using contrast dye, however. Some individuals can suffer from side effects such as feeling sick, developing a skin rash, headaches, and dizziness. Some contrast dyes can cause damage to tissue and organ damage to individuals with severe kidney damage.
In sum, MRIs with contrast must be approached with great caution and concern with respect to side effects. There may be individuals who will not be able to have this type of test. Medical Practitioners, in this circumstance, will have to find some other means to obtain diagnostic information.
Are All MRIs the Same? Are MRI Reports the Same?
No. MRIs are not all the same. There are different MRI machines which produce different qualities of MRI studies. There are MRI machines that are older or are poorly maintained. These machines may produce poorer quality imaging. Also, there are Open MRIs which are used for larger individuals or those who are claustrophobic. The imaging studies from these machines can produce lesser quality imaging.
Likewise. Not all MRI Reports are the same. Sometimes, Radiologists differ on their interpretations of the MRI imaging study. Therefore, sometimes, Medical Practitioners insist on personally reading the MRI study rather than merely relying on the Radiologist’s report.
What is The Language of MRI Reports?
The language of MRI Reports is important. Within MRI Reporting, there are “terms of art.” By “terms of art,” I mean that there is language that is used by Radiologists to describe certain phenomena. For example, disc or disc material which protrudes from the spinal column can be described in a variety of terms. These terms include bulge, herniation or extrusion. These terms are well understood by Medical Practitioners. These terms will be used by Medical Practitioners to assess diagnosis, course of treatment, and assessment of permanent disability.
As noted in an article, “[t]he term “herniation” can be used to describe a wide spectrum of abnormalities involving disk extension beyond the interspace, from a bulge to a frank extrusion; therefore, the reported data on the prevalence of herniation can be misleading. Well-defined morphologic terms may be more useful in describing this abnormality and may correlate better with symptoms.” See Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain, Maureen C. Jensen, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross July 14, 1994 N Engl J Med 1994; 331:69-73 DOI: 10.1056/NEJM199407143310201.
How Are MRIs Used In Workers’ Compensation? How Are They Obtained?
In Workers’ Compensation, Diagnostic Testing is done for two reasons: medical treatment or medical-legal assessment.
If someone is treating for their claim, and their treating doctor, in the course of the treatment, orders an MRI, the MRI is to be considered as medical treatment. By treatment, the MRI is meant to be used to cure or relieve from the effects of the injury. Therefore, to obtain that MRI, the Medical Practitioner will have to place in a “Request for Authorization” for the testing. It will then be subject to “Utilization Review” and “Independent Medical Review.”
If an Injured Worker sees a Qualified Medical Evaluator and Agreed Medical Evaluator and they order an MRI, it is to be considered to be a medical-legal test. Medical-Legal testing is not subject to “review.” Therefore, it should not have to go through a “Utilization Review” process to get approved.
What Can MRI Tests Reveal?
MRI tests can reveal such things as blood vessel damage, injuries to the brain, cancer, multiple sclerosis, spinal cord injuries, and strokes. They can reveal blocked blood vessels, damage from a heart attack, heart disease, and problems with the structure of the heart.
With respect to bones and joints, MRIs can be used to detect bone infections, cancer, damage to joints, disc problems in the spine, and neck or lower back problems with nerve signs.
Are There People Who Cannot Have MRIs Done?
Yes. There are certain individuals who cannot have MRI studies.
There may be health reasons why someone may not be able to have an MRI taken. This can include health problems, recent surgery, allergies to medication or pregnancy.
Also, because of the use of a magnetic field, there is no metal allowed in the room. In light of this, there are a number of individuals who may not be able to have a MRI study. This applies to a variety of reasons which include the patient having artificial heart valves, body piercings, cochlear implants, drug pumps, fillings and other dental work, implanted nerve stimulator, insulin pump, metal fragments (i.e. from a bullet or shrapnel), metal joints or limbs, pacemakers or implantable cardioverter-defibrillator, and either pins or screws.
What is It Like to Have an MRI?
It is a strange experience. I have had a number of MRIs to various body parts. The machines make a loud noise. Also, certain MRI studies will ask you to maintain a fixed position for a prolonged period of time. Also, if you are doing certain MRIs, they may ask for you to do certain things such as hold your breath for a certain period of time. Usually, the MRIs have lasted 15 to 30 minutes in length. Personally, I found maintaining a fixed position to be the worst part of a MRI test. It can be painful. Some people are claustrophobic and do not like to be placed within the tube.
What if I Need Advice?
If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.