Inappropriate CT and MRI Referrals

Photo: A computer tomograph (CT)

26 percent of the studied CT and
MRI examinations were considered
inappropriate; © SXC

While overall imaging growth is in line with or below that of other physician services – two percent or less annually since 2006 – a significant amount of imaging ordered and carried out by non-radiologists may be inappropriate.

"Radiologists, hospitals, health plans, and policy makers have struggled with ways to improve the rate of appropriate utilization of imaging studies, particularly CT, MRI, and PET," said Robert L. Bree, lead author of the study. "Our study looked at a large group of CT and MRI examinations. Evidence-based appropriateness criteria developed by a radiology management company were used to determine if the examinations were appropriate," said Bree.

The study, performed at Harborview Medical Center in Seattle, included medical records from 459 elective outpatient CT and MRI examinations from primary care physicians that were reviewed. "Of the 459 reviewed, 74 percent were considered appropriate and 26 percent were considered inappropriate. 58 percent of the appropriate studies were positive and affected subsequent management while only 24 percent of inappropriate studies were positive affecting management," said Bree. Examples of inappropriate examinations include brain CT for chronic headache, lumbar spine MR for acute back pain, and knee or shoulder MRI in patients with osteoarthritis.

"Our study shows that CT and MRI examinations ordered in the outpatient primary care setting are frequently not appropriate based on the application of a national radiology benefit management company's evidence-based guidelines. A high percentage of examinations not meeting appropriateness criteria and subsequently yielding negative results suggest a need for tools to help primary care physicians improve the quality of their imaging decision requests," said Bree.; Source: American College of Radiology / American Roentgen Ray Society