Majority of Low Back MRI Scans Deemed Inappropriate

mri scanA significantly high number of lumbar spine MRI scans ordered by both family physicians and specialists were deemed inappropriate or of “uncertain value” after analysis by an expert panel, a result they reported as “unsurprising”. 

Analysts studied scenarios from 500 lumbar spine MRI requisitions and 500 head MRI requisitions at each of 2 sites –The University of Alberta Hospital in Edmonton, Alberta, Canada and The Ottawa Hospital in Ottawa, Ontario, Canada–  between May 2008 and March 2010, ranking each request on a 9-point scale. 
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Of the scans ordered by family physicians, only 34% were deemed appropriate, while 58% of those ordered by specialists were appropriate. 

MRI scans of the head fared much better, with 83% being considered appropriate, with little variation among specialties. 

Posteroperative leg or back pain made up 17% of lumbar spine MRI orders, and were the only segment routinely rated appropriate. 

"Eliminating inappropriate scans and some of uncertain value could reduce the harm that accrues from unneeded investigations and result in significant cost savings," researchers wrote.

"Overuse is driven by many factors, including patient expectations, physician concerns about litigation, and lack of physician accountability for cost," they concluded. "Solutions will require strict adherence to appropriate guidelines and better education of patients.

–Michael Potts

Reference

Emery D, Shojania K, Forster A, Mojaverian N, Feasby T. Overuse of magnetic resonance imaging [published online ahead of print March 25, 2013].  JAMA Intern Med. 2013;():1-3. doi:10.1001/jamainternmed.2013.3804.

 

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