In recent years, SPECT (Single-photon emission computerized tomography) scans have become prominent, although somewhat controversial, in the medical field for assisting in the diagnosis of a traumatic brain injury (TBI).
SPECT scans are a type of imaging that depict how blood flows to organs and tissues. Prior to the scan, a radioactive “tracer” is injected into your bloodstream. As the tracer moves through your body, it collects in the body’s organs and tissues. The scan records the location of the tracer, producing a 3-D picture. The colours of the imaging demonstrate the level of blood perfusion in any given area.
A SPECT scan is different than other types of imaging, such as an MRI, because it evaluates function as opposed to structure. Areas where blood flow is altered can be detected, even where there is no noticeable difference in the anatomy of the area. For this reason, SPECT scans are now largely recognized in the medical community as a tool to aid in the diagnosis of traumatic brain injuries, particularly where damage to the brain cannot be seen on traditional imaging.
As SPECT scan have increased in popularity for diagnosing brain injuries, Ontario courts have grappled with how to handle this new type of evidence.
Relevant history: Meade v. Hussein
In November of 2021, the Ontario Superior Court of Justice released the decision Meade v. Hussein. That decision held that SPECT scans were inadmissible at trial for the purpose of proving a traumatic brain injury, as they failed to satisfy the “reliable foundation test” for novel scientific evidence. Specifically, the judge stated that SPECT scans were not reliable since they cannot distinguish brain injuries from anxiety or depression. The 3-D image of a brain created by a SPECT scan when a person is suffering from a psychological condition such as anxiety or depression looks indistinguishable from that created when a person is suffering from a traumatic brain injury.
This decision raised concern amongst plaintiff counsel, as it disallowed an important piece of medical evidence from being put forward at trial.
New development: Wabie v. Wilson
A recent decision of the Ontario Superior Court, Wabie. v. Wilson[1], revisits this issue. The action related to a 2014 motor vehicle accident. The plaintiff, a 50-year-old woman, was rear-ended at a low speed. Her injuries initially appeared to be limited to whiplash injuries but over time her physical and cognitive abilities changed. She developed symptoms including light sensitivity, speech impairments, severe headaches, reduced concentration, dizziness, difficulty sleeping, and fatigue. Her family doctor diagnosed her with a concussion and took her off work. An MRI was conducted, which was normal.
The family doctor then referred her for a SPECT scan. Coincidentally, the radiologist who conducted the imaging, Dr. Yin-Hui Siow, is the radiologist who conducted the SPECT imaging in the Meade case. The results were abnormal in the areas of the brain that are the most common locations for traumatic brain injury to be seen.
At trial, Dr. Siow argued that SPECT imaging is one of the tools that can be used to show a TBI. He opined that the medical history of the Plaintiff in conjunction with the abnormal SPECT imaging results leads to the conclusion that the Plaintiff had suffered a TBI. The defendant asked the Court to disregard the evidence entirely, relying on Meade.
Ultimately, the Court held that the SPECT scan evidence could be admitted in this case. The judge differentiated this case from Meade, stating that the SPECT scan evidence in Meade was being used to diagnose a brain injury whereas the SPECT scan evidence in Wabie was being used to support a diagnosis of a brain injury that already existed. In other words, in Meade the SPECT scan was being used as a primary diagnostic tool, whereas in Wabie it was being used as a secondary diagnostic tool. Importantly, the court also noted that the SPECT scan evidence in Wabie was not being relied upon to differentiate a brain injury from anxiety or depression.
Summary
This decision opens up the doors for a limited use of SPECT scans at trial. The bottom line is that a SPECT scan is a secondary tool, to be used in concert with other medical techniques and observational tools. So long as the SPECT scan evidence is being presented as one factor to consider in support a brain injury diagnosis, and not as a diagnosis unto itself, it appears that that it may be admissible at trial.
Lauren Cullen practices with the Siskinds Personal Injury Law department. If you have questions about the information contained within this article or any other personal injury questions, please write to [email protected] or call 519-660-7826.
[1] 2022 ONSC 4296