General Guideline Principles for Follow-Up Diagnostic Imaging

and Testing Procedures for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Follow-Up Diagnostic Imaging and Testing Procedures.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Follow-Up Diagnostic Imaging and Testing Procedures

The choice of diagnostic imaging studies is based on both clinical judgement and the case-specific clinical presentation, which is covered in depth in General Principles section A-13. Additionally, repeat or alternative diagnostic imaging may occasionally be clinically necessary.

The clinical situation changes (e.g., due to new or worsening symptoms, getting ready for surgery or receiving therapeutic injections, etc.), a preceding test was of poor quality and/or was nondiagnostic, or it was essential to track clinical improvement (e.g., postoperatively) or decline over time.

Maximizing diagnostic accuracy, reducing negative patient effects, and promoting clinical efficiency can all be achieved by selecting the right procedure(s) or doing numerous procedures in the right order. The cumulative radiation exposure and related dangers rise as a result of repeated procedures.

The sensitivity and specificity of diagnostic imaging procedures for any diagnosis can vary. The selection and interpretation of imaging studies should be based on the clinical history, physical examination, and clinical judgement.

Plain X-rays are typically a good place to start, but they are not always sufficient. Numerous spinal problems may benefit from information from magnetic resonance imaging (MRI), myelography, or computed axial tomography (CT) scanning performed after myelography.

It is important to understand that repetitive CT exams result in a higher cumulative radiation dosage and associated dangers. Repeat imaging or alternative imaging may be necessary in some situations, as mentioned above. Choosing one method over another typically involves a number of considerations.

Imaging is typically not clinically indicated until after conservative therapy has been tried and failed, even after initial imaging is performed, as may be indicated by clinical presentation, history of significant trauma, or other clinical “red flags” that raise suspicions for serious underlying conditions.

In the absence of a significant neurologic deficit or abnormality, myelopathy, or progressive neurological changes, imaging is typically not clinically indicated. Prior to ordering an imaging procedure, a patient should typically get treatment for a minimum of four weeks and as long as six to eight weeks.

However, the doctor may use discretion in this situation. Objective clinical findings should be given more weight when the results of diagnostic imaging and testing techniques do not agree with the findings of the clinical examination.

There is strong evidence that disc degeneration is more common than 50% among those over 40 who are asymptomatic. Loss of signal intensity on an MRI scan indicates disc degeneration, which may be caused by age-related changes that cause biochemical and structural changes apart from traumatic injury and may not be pathologically significant.

Although not uncommon, disc bulging and posterior disc protrusion are symptoms that are more frequently seen in the cervical spine than the lumbar spine because of the narrower cervical spinal canal. Clinical correlation is necessary since people over 40 may experience mild reduction in the spinal cord’s cross-sectional area without myelopathy.

What our office can do if you need Follow-Up Diagnostic Imaging and Testing Procedures

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

Disclaimer

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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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