Revolutionizing Brain Injury Diagnoses: The Power of DTI Imaging

0:00:07 - Shane Smith Hey, I'm Shane Smith from Shane Smith Law. I'm here with Thomas, one of our attorneys for the Brain and Concussion Group here at Shane Smith Law. Thomas deals with a ton of brain injury cases, ranging from concussions to more serious, mild traumatic brain injuries and even moderate traumatic brain injuries or more severe brain injuries. Thomas, now we were going to talk about DTIs today, which is this fancy new test they're doing that we hear a lot about. I thought it was exciting when I learned about it, so let's just start out in the beginning. What is DTI?

0:00:37 - Thomas Ozbolt Yeah, DTI is an advanced imaging technology and it's really revolutionized the way that providers, medical doctors, are diagnosing and identifying traumatic brain injuries. It's a non-invasive method that allows us to visualize, actually see with our eyes the white matter tracks in the brain which are often affected in traumatic brain injury cases.

0:00:59 - Shane Smith Now why do we need that? Because if I get a concussion, when regular doctors diagnose concussions all the time without any fancy tests, right so they shine it my pupils are dilated, you know I describe the symptoms. They're like you've got a concussion. What is the difference in diagnosing a concussion and maybe diagnosing a TBI or mild traumatic brain injury, which can be a concussion, with the DTI? I mean, what's the difference here? What's the benefit?

0:01:29 - Thomas Ozbolt I think the biggest issue is that if you say you have a concussion or a doctor says you have a concussion, it's like well, how do you prove that? Because anyone can say their head hurts. Anyone can say that they have a ringing in their ears. Anyone can say they're having migraines. Anyone can say a lot of things. But now we can actually show the areas inside your brain that have been damaged. It's not just oh well, this patient is reporting, you know, x, y and z symptoms and because of that we're going to diagnose them with concussions. No, it's not just that, we can actually see it for the first time, objective evidence with our eyes, for the first time.

0:01:54 - Shane Smith Wow, okay, so that's the real benefit. I mean, it takes away any doubt and I know I've had clients in the past where, you know, as cases go on and sometimes they talk to the defense doctors or the other side they start to doubt themselves, am I really having these symptoms or am I making it all up? When the other side alleges- this puts all of that to rest right?

0:02:12 - Thomas Ozbolt Yeah, yeah, you think so, and you know you have to have the imaging study, which is done using an advanced MRI kind of calibration. You have to have the image study done in conjunction with a clinical correlation. So you have to see a doctor and look at what's going on with the particular person, certain to the symptoms that they're presenting, but then you can match up the symptoms that they're presenting with what you can actually see on the DTI imaging. That shows essentially what's going on inside the brain, and what that shows is, you know, our brains, billions of nerve cells that are called neurons, those communicate with each other through these long thin fibers, those are called axons. These axons, they're bundled together and that forms the white matter of your brain, and that creates a complex network for transmitting information between different regions of your brain. When someone gets a TBI, these axons can become damaged and that disrupts the brain's ability to send and receive information. What DTI does, it allows doctors to examine the structure and the health of those axons, to see if there's any damage caused by the injury.

0:03:18 - Shane Smith Alright, so it'll actually see the damaged pathways in the brain, basically. Is that what it is? The stuff that's not working anymore?

0:03:27 - Thomas Ozbolt Yeah, it's almost like if you imagine a Christmas tree lighting up. You know you plug in the cords, you know you've got your old, you know 30-year-old lights that your mom and dad have been plugging in forever and you'll see like a strand of them doesn't come on. You know it doesn't light up and you're like, oh well, this, you know we might have to replace this. Obviously, you can't replace your brain, but you can tell, you know it's a similar kind of thing, where certain areas of the brain light up, and if they don't light up, then you can tell that there's been brain damage.

0:03:52 - Shane Smith Alright, now you mentioned clinical correlation. What does that mean?

0:03:54 - Thomas Ozbolt Yeah, that means it's actually having a doctor talk to you, review your medical records, review your medical history to see if there wasn't something that happened a long time ago that could explain what has happened here. DTI can essentially show things that are more recent versus things that happened a long time ago, really, of the damage. But, you know, having a doctor actually talk with the person is important too, because it's not just an image and then we draw our own conclusions from that. You need a doctor who can, you know, get the patient in the clinic and come to some determinations based on what they're able to observe with the client and determine using, you know, testing.

0:04:34 - Shane Smith How does the DTI work? What is it? You know, whenever we talk about imaging and stuff, I think of like a CT or an MRI. You know, you go into a little machine and it spins around and out pops your MRI, basically. How does the DTI work?

0:04:47 - Thomas Ozbolt Yeah, DTI is really, it's really neat. It's a really neat concept and really interesting, brilliant. It's essentially measuring the movement of water molecules along those axons that we just talked about. You know, in healthy brain tissue water molecules will move smoothly and consistently along the direction of those axons. So smooth, consistent flow. Now, if there's damage to those axons, the movement of the water molecules becomes disrupted and less organized. So during the actual scan you have a powerful magnet and radio waves and these are used to track the movement of water molecules in your brain.

0:05:21 - Shane Smith Now am I drinking like water or soda, like when the test is going on? Or is it just water in your brain normally?

0:05:27 - Thomas Ozbolt Normally it's just water in your brain normally, and so that water in the brain will be tracked by this you know, magnet and radio waves and it'll process that information, the scanner will, and then that'll produce these detailed images. You know, lighting up like a colorful strand of broccoli. That's basically kind of what it looks like, and they'll show the direction and the organization of the water movement. And then doctors can then identify where the structure of the axon has been disrupted due to the injury.

0:05:56 - Shane Smith One, that's just kind of cool. It's amazing that the science has gotten there to prove what we've been dealing with for- I mean what we've been dealing with for decades, but other people have been dealing with for you know thousands of years, you know concussions and things like that, and have to rely on people. What do we use a DTI for?

0:06:12 - Thomas Ozbolt You know, when we look at a case that involves a mild traumatic brain injury, brain injury, concussion, all of those different words you know, we often come up with the challenge of you know, this is a silent injury, it's the injury that you can't really see, because you know a lot of what's going on, is happening inside of the person's body. You know you're not bleeding, you're not, you know, showing your injury in a lot of ways. What this does is it gives us concrete scientific evidence. Objective evidence that nobody can dispute. And that type of evidence, as you know, that always bolsters your case. These imaging advancements, they help us demonstrate, as I would say beyond a reasonable doubt, the extent of a client's injuries. It's not just more likely than not. It's, hey, there's absolute proof of an injury.

0:06:52 - Shane Smith When you talk about it I mean you said it's a monster to prove that the injury occurred. How subjective is that? Can I look at it and say, well, I disagree with you here, it doesn't look like you had a brain injury. Or is it pretty cut and dry like a broken bone?

0:07:03 - Thomas Ozbolt Yeah, I think it's pretty cut and dry. There's always going to be ways to- that, you know, people can come up with to try to challenge these, whether it's the sample group and how they're looking at fractional anisotropy. And you know, just diving into the control groups that are used to get these measures, that sometimes they'll use standard deviation, that's probably a little bit too much. You know there's things in terms of looking at the control group, because a lot of what happens with DTI, or some of what happens with DTI, is they're looking at the flow and disbursement of the water and how it differs from the mean, you know. Okay, a regular person, right, and so you know defense might look at that and say well, who is your actual sample group? Did you use a sample group of a bunch of healthy 25, 26 year olds, or did you get people who are in their 50s or 60s, like this person who's involved here with this sample has been done of, so there's ways that they can look at it and challenge it.

0:07:56 - Shane Smith But my guess is all that's going to- as DTIs are used more and more, those arguments are basically getting weaker and weaker because they're going to have more sample size for all this stuff. Is that right?

0:08:07 - Thomas Ozbolt I think so. I think what we're seeing around the country is DTI becoming more and more accepted and being found to be admissible in courts all over this country, and there's a list that's come out about this. It just came out on one of the lists the other day.

0:08:22 - Shane Smith But it's pretty much, I mean it's growing every, I would say every year, but I mean it's actually growing a lot more rapidly than that, as other brain and concussion lawyers are fighting this fight basically.

0:08:36 - Thomas Ozbolt Yeah, once we're realizing the resources that we have available to our clients, that we can actually get them answers, let them know that it's not all just in your head, you know. No pun intended.

0:08:44 - Shane Smith I never want to take away from that aspect of it. I think that's a huge thing for our clients and doctors, patients is to know it's not just in their head, it's a legitimate injury, it can be proven. It's not just oh, you're a psychopath, you know, or that you're just acting out and can't control your emotions. I mean it proves the reasons why you're struggling with these issues.

0:09:07 - Thomas Ozbolt You start to understand why you're having the issues that you have, and it's not just something snapped one day. It's like no, you were injured and your brain was damaged in a way that's gonna affect you for the rest of your life. Yeah, and we can say that. We know that now, as we can see it right.

0:09:18 - Shane Smith No differently than if you crush somebody's knee and they're limping along. But you can physically see that. Brain stuff you can't.

0:09:25 - Thomas Ozbolt Yeah, yeah, and now, now you can, though with with this type of imaging, and I'm sure, as time passes, we're only gonna get better sort of technology and be able to look at these things even, even clearer than we do now.

0:09:41 - Shane Smith And I think back to when MRIs were brand new. You know I mean everybody didn't- you know they were a new thing and anytime there's a new procedure, nobody wants, you know the defense side is, always argues that it's new or it's untested, everything else. And it takes a while to get over that hurdle where everybody's like alright, it's really that- you know, we can't dispute the sciences there. Now we got to find other ways to attack it, right?

0:10:00 - Thomas Ozbolt Right, exactly, and you know there's always those battles at the beginning and you know, having a good team on your side to fight those for you, I think, is this the most important thing, especially in a state like North Carolina where, you know, these technologies, they haven't really been used that much compared to some other places around the country, so we're gonna be at the forefront of pushing those and making sure our clients to get treated the way that they should by insurance companies.

0:10:22 - Shane Smith All right. Well, Thomas, that's great, and thanks for being on the show. We appreciate it. And discussing DTIs and and everything that goes into that, I'll say new technology is what I'll say because I- and I think new is probably the wrong word, I think it's been around like 10, 15 years, but takes a while to trickle out and get, get handed out to everybody and it just makes me think of heck, even some of the new surgical things you know, the first time somebody did what is it laparoscopic with the really tiny tiny holes in it you know that was new too. And even now we have the defense say sometimes we think you should have done it differently. We don't like that procedure. I know that fights gonna be fought, but I know that the DTIs puts a lot of clients fears to rest and helps them with it. So, yeah, thanks for coming on talking about it and we look forward to our next time here on the show. Yeah, thanks for having me. And remember listeners if you like and follow. Subscribe so you can see more TBI updates from the brain and concussion group here at Shane Smith Law.