University of Calgary

Study suggests lower-back MRI scans often unnecessary

UToday HomeMarch 26, 2013

Lower-back PainDr. Tom Feasby is a University of Calgary neurologist who worked jointly on the study with the University of Alberta. Photo by Bruce PerraultResearchers investigating the appropriateness of lower-back and head MRIs and have concluded many requests for these scans are not needed.

In a joint study led by the University of Calgary and the University of Alberta, using methodology developed at the RAND Corporation, 2,000 requisitions for magnetic resonance imaging scans placed in Edmonton and Ottawa were examined to determine if they were appropriate.

“We had suspected that MRI scans might be overused, but we had to do the study to be sure,” says Dr. Tom Feasby, a neurologist at the University of Calgary, and a member of the Institute for Public Health and the Hotchkiss Brain Institute. “We wanted to gather evidence to help make the health system safer and more effective.”

Data published in the March 25 edition of JAMA Internal Medicine found evidence that in lower back scans, 56 per cent were either inappropriate or of uncertain value, and only 44 per cent were appropriate. In contrast, most MRI scans of the head for headache (83 per cent) were appropriate.

Investigators were not surprised by the high number of inappropriate low back scans as they are amongst the most frequently requested scans in the health system and are very often not helpful.

Dr. Derek Emery, a radiologist from the University of Alberta, says the study results indicate MRI use of the lower back may need to be reigned in since the requests for these tests have increased in recent years.

“MRI is a limited resource in Alberta so if the number of inappropriate MRIs can be reduced, there will be more capacity to perform MRIs on patients who really need them,” says Emery. “This is all about improving patient care; imaging those patients who will benefit and not imaging those who will not. It is important to note that we did not measure underuse of MRIs. There are many patients who would benefit from MRIs who are not being imaged due to lack of access.”

Researchers believe the high number of inappropriate requests is driven by many factors such as patient expectations, physician concerns about litigation, and lack of patient and physician accountability for cost.

Long waiting lists for procedures, including MRI scans, are a major issue in the Canadian health-care system. Reducing the use of tests and procedures that are not necessary could help alleviate this important problem.

The study was funded by the Canadian Institutes for Health Research (CIHR).

Alberta Health Services welcomes the research. “We’ve been working with Dr. Emery on this issue and our intent is to look at further studies to better understand MRI utilization,” says Mauro Chies, AHS vice-president of diagnostic imaging. “This will help inform new protocols that will guide how MR imaging can be used most efficiently in the province.”


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