LNCtips.com: Working with Radiographs

If you are a legal nurse consultant who reviews medical malpractice cases, you know that many cases involve x-rays, CT scans, MRIs and other types of radiographs. Failure to diagnose (oversights, and misinterpretations) and injuries from interventional radiology procedures are common allegations in medical malpractice cases.

As the LNC reviewing this type of case, it's important to get not only the radiology reports for the case but also the actual radiographs themselves. The legal nurse consultant needs to know how to request and obtain radiographs in specific formats.  While there are several different types of radiographs such as x-rays, fluoroscopy, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), and nuclear medicine, the radiographs come in only a couple of formats:

      1)  Hard copy films. These are the kind of films that you view using a light box. Chest x-rays, abdominal x-rays and limb x-rays can be produced as hard copy films. However, hard copy films are difficult to store, can degrade in quality when copied, and are bulky to send to experts.

      2)  DICOM (Digital Imaging and Communication in Medicine) format.  DICOM images are digital images used in CT, MRI, and other diagnostic tests. You can view DICOM images on your computer using a compact disk  (CD) provided by the hospital, radiology center, or litigation copy service. The CD has  images and a DICOM viewer to see the images on computer.

Which format is better in a medical malpractice case? The answer is, "It depends."

According to the American College of Radiology, expert radiology witnesses should review ORIGINAL images if possible.  Because DICOM images are created digitally, they don't deteriorate in quality when they are copied. Therefore, DICOM images are essentially the same as original images. In fact, they are called duplicate originals. Hard copy films lose quality each time they are copied.  So, if you obtain a copy of an x-ray, it will lose some quality.  If you then make a copy of your copy to send to an expert, this copy of a copy loses even more quality. In addition, DICOM is a file format that cannot be modified, unlike images that are produced in PDF, JPG, or other formats. Because non-DICOM images can be altered, they aren't appropriate to provide to an expert.  For these reasons, many expert radiologists prefer to receive images in DICOM format.

However, if you're working on a case in which films were originally produced in hard copy format, you may need to stick with hard copy films. Attempting to digitize the films by scanning them can result in poorer quality than making another hard copy unless certain equipment is used.  Most litigation copy firms have the ability to scan films but very few have the ability to create duplicate films of such good quality that they can be put in DICOM format because the scanning and printing equipment costs hundreds of thousands of dollars.  If you have a hard copy film that you want to put in DICOM format, ask your copy service if they can provide this service in-house.  If not, you should either get another hard copy film or send your film to another litigation copy service that can provide this service.

I thank CopyScan, a litigation copy service, which specializes in digitizing films, for assistance with information on this web page.

...Katy Jones