Academy of Chiropractic’s

Lawyers PI Program 267

From the Desk of :

"Requesting an MRI to be Amended From the Radiologist"

If you either have taken the MRI Spine Interpretation course or understand disc definitions as published by the American Society of Neuroradiology, you would understand the difference between a bulge and a herniation and the nomenclature. That language is critical in being able to create an accurate diagnosis, prognosis and diagnosis for your patient. In addition, it is critical in a medical-legal case with lawyers and the findings MUST be consistent, when allowable. 
There are times when it is impossible to get the radiologist to amend their reports, however if you realized how much leverage you have (your referrals are the leverage) and understood how to use it, reports would get amended. That leverage is not to get the radiologist to do something unethical, it is simply to consider your request that is backed up by currently accepted literature in the medical community. 
It was reported by Luri (see Educational Flyer #69) in 2009 that “…the specific morphology of the herniation was not reported by the radiologist in 42.2% of cases.”  Simply put, 42.2% of all MRI Interpretations by general radiologists have been confirmed to be wrong 42.2% of the time. This is scary stuff and compels each of us to be proficient in MRI interpretation to ensure we are getting an accurate MRI read. 
I am not suggesting at any level to not consider the MRI report by any radiologist. Radiologists will see pathology that you are not trained to see and they have a lifetime of being trained in seeing abnormal's. However most general radiologists have not looked at spine for too many years and you are the second set of eyes to confirm their findings regarding spine  and disc first, and other pathology second. It is here where you will confirm their findings and best serve your patients and the lawyers you have to report to secondarily. 
Should you disagree with the radiologist, you cannot just state they are wrong, you must give a reference as to the foundation of your opinion and it has to be backed up by the literature. That is the easy part. The American Society of Neuroradiology published their definitions and what I and many consider to be the most reliable source of disc definitions currently. they can be found at:
Once you have determined that there is an inconsistency with the literature, you need to address the subject and I suggest a letter so that you have a record of the correspondence that can be used to give more weight to your opinion should the radiologist not consider your request to amend the report. 
Dr. David Reich, from Queens NYC is one of many doctors nationally writing great requests for amendments, however we just completing editing what I feel is a very respectful way of requesting an amendment in a report. 
His letter:

David R. Reich DC
86-10 117th St
Richmond Hill, N.Y. 11040
TEL: 718-xxx-xxxx
FAX: 718-xxx-xxxx

April 5, 2012
Medical Center
322 West 10th St
New York, NY 10000
Att: Radiology Department 
        Dr. Michael Radiologist
Fax: 212-xxx-xxxx
Patient: Smith, John
Date of Birth:  06/00/1987
Request for Review of L-MRI dated 04/03/2011

Dear Dr. Radiologist:
The above mentioned patient recently underwent a lumbar MRI evaluation (without contrast) dated 04/03/2012. In addition to reviewing the written report I also studied the images provided for me on the accompanying CD-ROM.
I very much appreciate your thoroughness when reviewing this imagining study.
Based on the current accepted terminology by the American Society of Neuroradiology, the left eccentric L4/5 disc bulge mentioned in your report is by definition a herniation. A disc bulge, again by definition, is a degenerative condition which is circumferential and non eccentric, encompassing a minimum of 50% of the total circumference of the disc. Since the lesion favors only the left side, by definition it is a disc herniation and of traumatic origin. This is best seen on the T2 axial slice #24.
It takes a minimum of 6 months before osteophytes become visible on imaging studies, and therefore the herniation must be acute and causally related to the motor vehicle accident occurring on September 30, 2011.
Could you please amend the report as it is consistent with the literature and the tenants of the American Society of Neuroradiology 's definition of disc bulge vs. herniation, and fax the amended report to my office at 718-xxx-xxxx.
David R. Reich D.C.