It’s not uncommon for doctors to order magnetic resonance imaging (MRI) tests for patients complaining of back pain, headaches and other health problems.
But according to a study by Canadian researchers published in the journal JAMA Internal Medicine, most MRI’s ordered by doctors for lower back pain are inappropriate or of questionable value. Family doctors are more likely to order unnecessary MRI tests than other specialists.
Research teams in Alberta and Ontario looked at a total of 2,000 requests for MRI’s at four Canadian hospitals. Half were for MRI’s of the head and half were for the spine.
They determined that over half of the lumbar spine or lower-back MRIs had questionable value or were inappropriate. The findings are important because in some parts of Canada, MRI tests for the lower back account for about a third of all MRI requests — further stretching limited resources in a country where wait times for MRIs are long and patient access is limited.
“It is commonly believed that MRI is overused and this is the first time its use has been rigorously measured,” said lead author Derek Emery, a University of Alberta researcher in the Faculty of Medicine & Dentistry.
Only about a third of the lower back MRI’s ordered by family doctors were considered appropriate. MRI’s ordered by neurologists and orthopedic surgeons had value in less than 50% of the cases. Neurosurgeons had highest rate of success at 75%.
“MRI is a limited resource in Alberta, so if the number of inappropriate MRI’s can be reduced, there will be more capacity to perform MRI’s on patients who really need them This is all about improving patient care, imaging those patients who will benefit and not imaging those who will not,” said Emery. “There are many patients who would benefit from MRI’s who are not being imaged due to lack of access.”
The study did find that requests for MRI’s of the head in patients with headaches were appropriate 83% of the time. That, researchers say, may be due to the fact that most of the patients in the study had already been prescreened with a computed tomography (CT) scan, likely explaining the high rate of appropriate head MRI’s.
“The results tell us that we should not assume there is overuse in any given area without measuring,” said Emery. “We were surprised by the results about head MRI’s – we thought the rate of inappropriate use would have been much higher but the results showed otherwise.”
Researchers say the findings demonstrate doctors need to be better educated about when
it’s appropriate to order an MRI. One solution might be creating a tool that could give doctors instant feedback when submitting a request for an MRI on behalf of a patient
“Overuse of medical interventions, such as MRI, is a considerable problem, leading to excess costs and adverse outcome,” the authors wrote. ”Overuse is driven by many factors, including patient expectations, physician concerns about litigation, and lack of physician accountability for cost.”