Why is a Digital Motion X-ray more expensive than a regular x-ray? A Digital Motion X-ray or DMX is an advanced form of imaging, such as MRI's CT scans, Fluoroscopy, etcetera. As with all specialized imaging, the equipment required and the time needed to produce a DMX evaluation is more costly to purchase and maintain than standard x-rays.
I heard a DMX is good for evaluating ligament damage, but x-rays don't show ligaments. Wouldn't an MRI be better to see ligaments? MRIs are superior for seeing soft tissue such as ligaments. The MRI ability to see the various tissues makes it a great resource for determining soft tissue pathology. If a ligament is torn, an MRI has the ability to see just how torn that ligament is. What an MRI cannot do, is determine how well that ligament is stabilizing
The primary function of ligaments, is to maintain the stability of a joint while the joint moves. Just as a torn ligament found on an MRI could still be maintaining stability to the joint, an overstretched ligament will appear normal on an MRI, yet be completely failing. Unless the person, that is evaluating the MRI, can see the joint move, they must make an education assumption if a ligament is doing its job or not. They can only see one moment in time and the patient must stay still. For this reason, MRIs are unreliable for finding instability from overstretched ligaments. One specific benefit of a DMX, over all other forms of imaging, the patient moves through their full range of motion while the DMX images are captured!
Regular X-rays and MRIs have found joints that have slipped over another joints, Isn't this ligament instability? If it is, why would I need a DMX? It is true that regular x-rays and MRIs have found slippages, which are assumed to be instability. With out seeing that joint in full motion, we don't really know if that, found instability, is actually a partially dislocated joint that is "jammed" into that translated position ( not actually unstable) or if we are seeing the full severity of instability that was displayed.
A DMX will show exactly when, during the motion, a joint becomes unstable. Additionally, The DMX will show the most degree of instability that occurs. This means we will know which ligament is faulty and just how faulty. Instability can occur at any point in time, during the joints range of motion. With all forms of static imaging only one moment in time is captured. Even if you were to do a stress x-ray (which is usually painful in instability cases), the time it takes to get the patient positioned and take the picture, the patient likely already guarded to prevent pain. With a DMX, we will usually catch the instability before the patient starts any protective measures to prevent pain. Our picture in picture technology will show the patient's facial expression at the point of pain. It hurts when I move. I found similar imaging to DMX that offers passive motion, wouldn't that be better than a DMX? While its nice to have a comfortable evaluation, the question to consider is this; Do you want to see what your joints are doing when they are supported mechanically by an external mechanism or would you like to see what your joints are doing when you are not supported by any other means other than your own supporting tissues? I am sure there are benefits to a passive range of motion joint assessment, however when it comes to assessing ligament integrity, the best way is to see it in action, without external support. Others claimed to offer Motion studies, what makes your service unique? Don't be fooled. Digital motion X-ray has been tried and true for over 20 years. Some claim to be offering a DMX, service,but are not actually using a DMX system. A DMX system captures real time evaluations. The DMX system is trusted by many top instability providers and has been used as the gold standard in a 10 year instability study. Additionally, our system uses a fraction of the radiation required by other imaging. In fact, a full cervical DMX study which has close to 3000 images in real time, uses no more radiation that a standard 7 view cervical x-ray. Is a DMX only for the neck? While the DMX is heavily used for cervical studies of the neck, many have used the DMX to evaluate TMJ syndrome, shoulders, knees, ankles, hips, elbows, wrist and hands. Due to the low radiation nature of the DMX, Lumbar studies maybe limited based on the size of the patient.
How long is a DMX evaluation? Usually, it is about 1/2 hour per evaluation. Allow an hour for any possible complications that may occur. Due to pain or other various circumstances, Some sections may have to be repeated. Also, we review the captured video with you to assure we have captured the required images as well as to answer any questions you may have. You can save time by downloading or requesting a copy of the paperwork to be filled out, complete the forms and send it back before your visit. Will I receive a copy of my DMX and report? Yes! This is always included. We will automatically send you a copy as well as those you have authorized to receive a copy. Please keep your copy to share with additional providers you may encounter to avoid an additional record retrieval and submitting fee.
Do your reports include a mensuration analysis? All cervical x-rays will include a mensuration analysis. While this is an additional charge by other providers, we feel this report is essential to the cervical DMX. We do not charge extra for this level of reporting. Extremity reports do not include a mensuration report as mensuration in these areas are not usually required.
My Doctor is wanting to receive the DMX in DICOM format, can you do this? Unfortunately no. This is because DICOM does not support true video. DICOM has a simulated video which is more of a slide show. As the most important image frames are selected, measured and added to your report, Those that only want a DICOM can use the report. Most of the time providers want DICOM is because its easy to integrate into their EHR system. A full DMX video converted to DICOM would require enormous file size and processing to view. Most instability providers that use our services, create a separate patient file outside their EHR system, then make reference to that file in their EHR. This way, they can use the report found in the EHR, while still have the ability to see the full motion DMX.
By the way, this is a good way to tell, if a provider is not using a true DMX system. No DMX system can convert to DICOM as there is simply to many images to convert.
Is DMX an old technology? In some ways yes, and in other ways no. The original X-ray was motion. They used the X-ray for fun at the fair grounds. They used them to see how well your shoes fit your foot. It was all fun and games until they discovered that to much radiation was a serious health risk. Hospital grade fluoroscopic imaging is still used, but sparingly as it still uses a lot of radiation. Under these circumstances, the patient stays still and the machine moves around them. Regular flouroscopy causes a wash out as the patient moves. This causes frequent obliteration of the image. While this can occur with a DMX too, because of the extremely low radiation emitted, the reverse contrast design and the collimation methods, this is very rare and limited. DMX is still top of its class for instability studies. The software used and the image capturing devices may change over time, but the heart of a digital motion x-ray is still the same as all other radiation type diagnostic imaging. X-rays are sent through your body. You body absorbs some of the x-rays, while most pass right through. The absorbed part caused the inside images to show up on a screen that is then captured. The DMX fluoroscopic screen is able to capture all motion with no need of any refresh rate.
Will my insurance cover this? This is probably the most asked, yet toughest questions to answer. While patient's are hopeful of the answer, most already know the likelihood of coverage. With all the benefit manipulations by the insurance industry, it is truly difficult to know this answer. The easy answer is, very few do, most don't. We will provide you with a statement that you can send to your insurance company for reimbursement. It is best to assume you will have to pay out of pocket than to assume your insurance will re-reimburse you. It's better to get a happy surprise that they reimbursed something, than to get an unexpected disappointment that your insurance denied the claim. I had an IME provider review my DMX. The IME said that the DMX is of no diagnostic benefit and is excessively radiating me. Is this true? Absolutely not true. This statement is either being made for one of two reasons. The IME is not as independent as they are supposed to be, or they are unknowledgeable as to what a DMX actually is. Most IMEs I have encountered are well meaning. Generally speaking, I have found that they were unfamiliar with DMX and assumed it to be the same thing as video fluoroscopy. I have participated in litigation and in counter arguments against IMEs a few times. This is generally an easy to win argument. They are hoping the patient, the provider, or the attorney wont call their bluff. Don't let them convince you otherwise.
Across the nation, DMX has helped win very large settlements. In many cases, the DMX was the only evidence that the patient suffered a true permanent injury, based on the AMA guidelines. Insurance companies already know this to be true, but they are hoping you, and your attorney wont know or challenge them on this. It doesn't matter how credentialed and experienced your IME is. This should be an easy argument in court as precedence has already been set many times across the country. Any experienced IME will know this. The truth is, the DMX is the gold standard to evaluating ligamentous instability! ( see report under the heading, "for the doctor").
If you have questions, not answered here, feel free to reach out to me. If I run into more common questions, I will add them here.
Improved diagnosis with better imaging - That's Arizona Digital Motion X-Ray