IntroductionTo compare the cost‐effectiveness and patient impact between acute magnetic resonance imaging (MRI) management and conventional management in the diagnosis of occult scaphoid fractures in a rural setting.MethodsConsecutive patients presenting to a rural emergency department (ED) with a suspected scaphoid fracture were randomly assigned to either conventional management (6) or acute MRI management (10) (3 patients were excluded from the study analysis). All healthcare costs were compared between the two management groups and potential impacts on the patients’ pain, mobility and lifestyle were also measured.ResultsThere were no significant differences between the two groups at baseline. There was one (10%) scaphoid fracture in the MRI group and none in the conventional group (P = 0.42). A larger proportion of other fractures were diagnosed in the MRI group (20% (2) vs. 16.7% (1), P = 0.87), as well as less clinic attendances (1 (0–2.25) vs. 4 (2.25–5)) and diagnostic services (1 (1–1.25) vs. 2 (1–3)). Median management costs were $485.05 (AUD) (MRI) and $486.90 (AUD) (conventional). The MRI group had better pain and satisfaction scores as well as less time of immobilisation, treatment and time off work.Conclusion MRI dramatically reduces the amount of unnecessary immobilisation, time of treatment and healthcare usage in a rural setting. The two protocols are suggested to be equivalent financially. When potential societal costs, the amount of unnecessary immobilisation, low prevalence of true fractures and patient satisfaction are considered, acute MRI should be the management technique of choice. Further studies are still required to assess the best method for managing bone bruise within the scaphoid.

Introduction: When radiologists are not available, sonographers may be able to provide an interim report, especially for patients referred from emergency or in remote clinics. The aim of this study was to compare the agreement of diagnostic findings between sonographers and radiologists for patients referred from the emergency department for pelvic ultrasound. Methods: Sonographer findings and corresponding radiologists' reports of consecutive pelvic ultrasound examinations referred from the emergency department were compared prospectively over a 7-month period. Paediatric cases were excluded. Diagnostic agreement was scored by an independent investigator into the following: grade 1-agree with radiologist report; grade 2-minor discrepancy, unlikely to impact patient management; grade 3-major discrepancy, likely to impact patient management but does not lead to adverse outcomes for the patient; and grade 4-major discrepancy, findings likely to result in significantly adverse outcome for the patient.