The Risks and Rewards of Medical Imaging

According to recent headlines, the answer is: maybe.

Advances in imaging technology in the last generation have made it possible to "see" inside the human body with extraordinary clarity and detail. With this insight, illnesses and injuries can be diagnosed faster, with greater accuracy than ever before, and without the use of invasive diagnostic procedures.

The two most widely known and used of these high-powered tests are the CT (Computed Tomography) scan and the MRI (Magnetic Resonance Imaging) test.

A CT scan is a noninvasive test that combines special X-ray equipment with sophisticated computers to produce multiple images or pictures inside the body. Its diagnostic strength is its ability to provide a superior evaluation of fine bone details. The MRI is a noninvasive test that uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of internal body structures. This type of scan provides a superior evaluation of soft tissue detail as well as good bone detail.

Of these two commonly used diagnostic tests, only the CT scan emits radiation.

Americans Are Getting More Scans and More Radiation

The invention and availability of the CT scan has increased the number of scans that people receive, and consequently, the amount of radiation. Americans received about 70 million CT scans in 2007, up from only 3 million in 1980. Because of the increasing use of CT scans for diagnosis, the average American's dose of radiation has grown six fold over the last couple of decades.

These scans emit a significantly greater amount of radiation than X-rays. A CT scan of the chest exposes the patient to more than 100 times the radiation of an X-ray, while an abdominal CT scan is roughly equivalent to 400 chest X-rays.

With higher radiation comes greater health risks. A study published by Columbia University researchers in 2007 estimated that in a few decades as many as two percent of all cancers in the U.S. might be due to radiation from CT scans.

These statistics and predictions must be balanced against the benefits that CT scans can give: fast, accurate diagnosis of the patient's condition due to an accident or illness, without costly and potentially dangerous invasive procedures. Today's sophisticated medical imagery is a powerful tool to help medical professionals arrive at an early diagnosis and proceed with fast, appropriate treatment. Many doctors point out that the danger of serious injury or death resulting from missing a potentially life-threatening diagnosis if no imaging is performed poses a much greater, more imminent risk than the radiation from the test itself.

The Implications for Workers' Compensation

The scenario in which a patient is subjected to multiple CT scans is most likely to happen with an illness that requires diagnosis, and then ongoing monitoring to manage that illness. The vast majority of these types of illnesses are covered under group health plans. Injured workers in the workers' compensation system are less likely to experience an excess of radiation for several reasons:

o Workers' compensation cases are episodic. In most instances, injured workers are diagnosed, treated, and returned to work as quickly as possible. Treatment is for a finite period of time and then the injury is resolved.

o Injuries in workers' compensation are most likely to occur to the back or the extremities. Consequently, the majority of scans for workers' compensation patients are MRIs, which provide the best detail for these types of injuries. The percentage of cases requiring heart, chest or abdominal CT scans -- which generate the most radiation -- is much smaller in workers' compensation than in the overall health-care system.

o Tests are usually pre-authorized by the adjuster or payer after a careful review of the injured worker's medical situation. Therefore, the "patient demand" factor is not present.

However, there are situations where a CT scan may be the better option -- or the only option -- for the injured worker. People who have older types of pacemakers, ear implants or other devices cannot have MRIs because of the impact of the magnets on their implants. Diagnosis of hernias in the abdomen is an example of one type of problem that may be best diagnosed with a CT scan. CT scans are also used to detect and delineate fractures.

What does all this mean for workers' compensation adjusters and case managers? They should be aware of and concerned that over-radiation and side effects from CT scans can occur in the course of treatment for a claim, and would be considered part of the liability for that claim. They should also consider:

o The patient's medical history. Someone with a history of previous injuries is more likely to have been exposed to CT scans. An effort should be made to find out what types of radiology tests were administered in the patient's past. This could be done by contacting the patient's primary care physician.

o Using CT scans only when they are especially effective for a particular diagnosis or when they are indicated due to other factors in the patient's situation.

o Working with physicians to be sure that the American College of Radiology's guidelines for the types of diagnostic tests to use in specific situations are followed.

Bill Colacurcio is director of marketing at One Call Medical, a specialized Preferred Provider Organization offering a nationwide, credentialed, and reduced-cost MRI / CT / EMG service for the workers' compensation, group health, and auto insurance industries. www.onecallmedical.com.