A panel of experts recently collaborated in a study which analyzed orders for MRI scans in two large hospitals. They found that more than half the cases in which a lumbar spine MRI scan were done should not have been ordered in the first place. The panel deemed 29% of the MRI referrals inappropriate, and another 27% of “uncertain value”.
It was also discovered that family physicians were the biggest culprits in ordering unnecessary low-back MRI scans. Only 34% of family doctors’ orders were considered appropriate, compared to 58% of orders by physicians of other specialties.
The research team, lead by Dr. Derek Emery, wrote, “Eliminating inappropriate scans and some uncertain value could reduce the harm that accrues from unneeded investigations and result in significant cost savings.”
The use of lumbar spine scans has risen drastically, even though there is a weak correlation between their findings and clinical signs and symptoms. The study noted the possible reasons for their overuse, including patient expectations, doctors’ concerns about litigation, and lack of physician accountability in regards to cost. The expert panel recommended strict guidelines for doctors and better patient education.
The only orders where the MRI scans were routinely deemed appropriate was in cases of post-operative leg or back pain. However, these accounted for only 17% of the low back MRI orders.
The findings of the study confirmed what many doctors already understand about MRI overuse. Imaging for low-back pain is one of the top five overused tests and treatments listed by both the American Academy of Family Physicians and the American College of Physicians.
Other studies have pointed out overuse of MRI for other patient conditions, including headache and sciatica.
Emery D, et al. Overuse of magnetic resonance imaging. JAMA Internal Medicine 2013; online first 25 March: doi 10.1001/jamainternmed.2013.3804.