Through a process called radiographic digitization and utilizing the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, 2001, Chapter 15, (the AMA Guides) it is possible for you, the Doctor of Chiropractic, to prove a patient’s injury and have a report ready for court that is second to none. This is the significance of X-ray digitization. The Doctor of Chiropractic that treats personal injury cases MUST OBJECTIFY ALL FINDINGS, so that the body of evidence is not the doctor’s opinion. By practicing an evidence-based approach, the Doctor of Chiropractic can then utilize the best evidence available and be hrough a process called radiographic digitization and utilizing the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, 2001, Chapter 15, (the AMA Guides) it is possible for you, the Doctor of Chiropractic, to prove a patient’s injury and have a report ready for court that is second to none. This is the significance of X-ray digitization. The Doctor of Chiropractic that treats personal injury cases MUST OBJECTIFY ALL FINDINGS, so that the body of evidence is not the doctor’s opinion. By practicing an evidence-based approach, the Doctor of Chiropractic can then utilize the best evidence available and be able to practice with confidence and not have to settle bills out of fear that they over treated the patient.
Radiographic digitization is an integral part of determining whether or not a patient has been injured and to what degree they have been injured in an auto accident. The Doctor of Chiropractic must gather all of the subjective evidence during the initial examination and then decide which diagnostic tests to order to provide the objective evidence to enable the data to be based on fact rather than opinion. I would not like to get in front of a seasoned defense attorney with a mound of opinions; I would rather be armed with facts.
How does X-ray digitization prove that someone has been injured? The AMA Guides, pages 378-379, outlines the procedure to evaluate the flexion/extension films for motion segment integrity loss. Motion segment integrity loss is defined as either the loss of motion segment integrity (increased translation or angular motion) or decreased motion resulting mainly from developmental changes, fusion, fracture healing, healed infection, or surgical arthrodesis. Translation and angulation are biomechanical terms used to describe specific movements. Translational motion is the movement of a body along a straight line. Angular motion is rotation of a body about a point. Translation cannot be more than 3.5mm and angular variation cannot be more than 11o in the cervical spine.
The Doctor of Chiropractic may perform this evaluation by hand as outlined in the AMA Guides, but they will have a 26% error rate. Once again, if I am sitting on the witness stand and a seasoned defense attorney knows that I have evaluated the radiographs by hand, I am now sitting on a very hot seat and in a very uncomfortable position. This is exactly why the radiographs MUST be examined digitally. The computer will evaluate the X-rays the same way every time and make the evaluation truly objective.
If it has been determined that the patient has motion segment integrity loss, the Guides state that the patient is now in a category IV impairment and that means they have a 25-28% whole body impairment of the cervical spine. This is a pretty significant figure because some amputations are 40% impairment; therefore, having only a 12% difference between not being able to move your neck properly and certain amputations is quite significant. The significance extends beyond the fact that the patient has been injured. According to Foremen and Croft, the patient may have a prolonged recovery period due to these ligamentous injuries and, therefore, may take seventy-six or more treatments to heal. Foreman and Croft also provide an objective scale of prognosis, and ligamentous injuries show a poorer prognosis.
When should the digitization evaluation be performed? The AMA Guides state that the radiographs should be examined when the patient has reached maximum medical improvement. In other words, when the patient has reached normal function or when the patient has shown a plateau in improvement over several re-examinations, the doctor retakes the flexion/extension, AP/LAT views and sends them to be digitized.
Using X-ray digitization also allows the Doctor of Chiropractic to prove medical necessity behind care provided, because the biomechanical report details which motion segments have abnormal function. The insurance company doesn’t care about the pain level of a patient, only if the patient has a decrease in function. It is this decrease in function that the doctor should be providing evidence of and treating the patient for. Once this decrease in function has reached maximum medical improvement, the patient is then discharged from care.
In summary, X-ray digitization should be performed to:
1)Provide objective data about the injury and the amount of injury,
2)Determine impairment rating,
3)Provide objective evidence to determine treatment strategy,
4)Provide objective evidence to determine prognosis, and
5)Provide evidence to prove medical necessity.
Dr. Dwight C. Whynot is in fulltime practice in Johnson City, Tennessee. Dr. Whynot gives license-renewal lectures on Evidence-Based Chiropractic Practices which are promoted by the International Chiropractors Association and sponsored by Myologic and Spinal-logic Diagnostics. For questions regarding evidence-based practice procedures, email questions to [email protected]. For 12-hours CCE license renewal lecture dates and places call the ICA at 1-800-423-4690. For more information on Myologic or Spinal-logic, go to www.myologic.com or www.spinallogic.com