Send the study
Provide the DICOM study, preferably from the source facility, along with any available documentation of how the images were obtained.
Medical image authenticity
A signed forensic opinion on whether the images are authentic.
From the Greek τεκμήριον, “conclusive proof.”
Tekmerion reviews CT, MRI, and X-ray studies submitted in insurance claims or litigation and reports whether the images were altered, reused, or synthetically generated. Each opinion is signed by a board-certified diagnostic radiologist and written to meet Daubert and Frye admissibility standards.
The problem
A clinical read does not answer whether the images themselves are genuine.
Insurance claims and litigation often rest on CT, MRI, or X-ray studies. Those files can be altered, copied from another case, or generated by AI. A standard radiology interpretation describes what the pictures show. It does not establish that the pictures are the original, unaltered study they claim to be.
-
Altered images
Edits, splices, or copy-moved regions can change what a study appears to show.
-
Reused studies
A scan from another patient, date, or claim may be submitted as if it belongs to the case at hand.
-
Synthetic images
AI-generated or composited studies can look clinically plausible while having no real acquisition behind them.
How it works
Send the study. Receive a signed report.
Clients submit imaging the usual way: a CD or USB of the study, or a secure file-transfer link. The strongest chain of custody comes from obtaining the files directly from the imaging facility.
Analysis
The study is examined across five evidence layers, from chain of custody and metadata to pixel forensics and radiologist review.
Signed report
You receive a written forensic opinion with a verdict of Authentic, Inconclusive, Manipulated, or Synthetic, signed by the reviewing radiologist.
Five evidence layers
Each opinion is built from more than a visual impression.
Tekmerion examines a study in layers, then a radiologist reviews the findings and signs the report.
Chain of custody
The submitted study is compared with the source PACS, when those originals can be obtained, to confirm the files are the ones acquired for the case.
DICOM metadata consistency
Headers are checked for internal consistency and for signs that identifiers, dates, equipment tags, or edit history do not agree with a genuine acquisition.
Physics and pixel forensics
Pixel data are examined for noise patterns, Hounsfield unit (HU) plausibility, and artifacts of copy-move, splice, or other manipulation.
Anatomic plausibility
A diagnostic radiologist reviews whether the anatomy, pathology, and imaging physics are consistent with a real study of the claimed examination.
Provenance and sealing
Cryptographic hashes, and where applicable C2PA provenance and digital signatures, are used to seal what was reviewed and preserve the work product.
Authentic
Inconclusive
Manipulated
Synthetic
Reports state a verdict on this scale. They are expert opinions, not legal determinations.
Who it is for
Built for the people who have to stand behind a claim file.
No-fault and auto insurers
When a claim depends on imaging, an independent authenticity opinion can be requested before benefits are paid or a dispute proceeds.
Special investigative units
SIUs can refer studies that appear reused, inconsistent, or otherwise suspicious for a documented forensic review.
Defense law firms
Counsel can obtain a radiologist’s signed opinion, written with Daubert and Frye admissibility standards in mind, for use in litigation.
Michael Karachalios, MD
Diagnostic Radiologist
About the physician
A board-certified diagnostic radiologist signs every opinion.
Michael Karachalios, MD, is a board-certified diagnostic radiologist with more than 15 years in medicine. Tekmerion is operated by Michael Karachalios MD Diagnostic Radiology PC, in Manhasset, New York.
-
Certification
Board certified, American Board of Radiology (Diagnostic Radiology)
-
Fellowship
Body Imaging / Cross-Sectional Imaging / MRI, Icahn School of Medicine at Mount Sinai 2014–2015
-
Residency
Diagnostic radiology, Zucker School of Medicine at Hofstra/Northwell at Lenox Hill Hospital 2010–2014
-
Internship
Surgical internship, Mount Sinai Beth Israel 2009–2010
-
Medical degree
MD, Stony Brook University School of Medicine 2009
-
Subspecialties
Abdominal, gastrointestinal, genitourinary, and emergency imaging
-
Licensure
Medical licensure held in 25+ states
Current and past
- AL
- AR
- AZ
- CA
- CO
- FL
- HI
- IN
- KS
- KY
- LA
- MD
- MI
- MO
- MS
- MT
- NE
- NJ
- NV
- NY
- OH
- OK
- OR
- SC
- TX
- VA
- VT
- WA
-
Memberships
Radiological Society of North America (RSNA); American College of Radiology (ACR)
Confidentiality
Patient studies are handled as protected health information.
HIPAA business associate agreements are available for clients who need them. Cases are handled with encryption, and reports are prepared for the requesting insurer or counsel—not posted to this site.
What this site is not
This page is an introduction to the service. It is not a portal for uploading studies that contain patient information, and it is not a place to submit a claim.
To request a case review, contact Dr. Karachalios directly. Transfer instructions will be arranged in a way that protects the study.
Contact
Request a case review.
Insurers, SIUs, and defense counsel may write or call to discuss a study. Please do not email image files that contain patient identifiers until a business associate agreement and a secure transfer method are in place.
- Email mike@tekmerion.health
- Phone 516-263-9379
- Location Manhasset, New York
- Practice Michael Karachalios MD Diagnostic Radiology PC