Evaluation of Imaging Utilization Prior to Referral of Musculoskeletal Tumors

Nystrom, Lukas M.; Reimer, Nickolas B.; Dean, Cooper W.; Bush, Charles H.; Scarborough, Mark T.; Gibbs, Charles P.

doi:10.2106/jbjs.n.00186

Cited by 18 publications

(10 citation statements)

References 17 publications

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“…The results are presented in Fig. 2 [ 20 – 23 , 26 – 29 , 35 , 40 – 42 , 54 , 64 , 68 , 69 , 122 , 123 , 125 , 127 – 130 , 140 , 141 , 143 , 145 – 147 , 157 – 159 , 172 – 174 , 176 , 177 , 179 , 182 , 190 , 210 , 211 , 213 , 215 , 216 , 229 , 242 , 252 , 277 , 284 , 353 – 387 ]. From these studies, imaging examinations with a high proportion of low-value examinations (more than 50% inappropriate use reported) was: Head CT (routine and repeat), routine trauma scan, MRI in musculoskeletal pain, dual-energy x-ray absorptiometry (DEXA) in low risk patients or low interval DEXA follow-ups, echocardiography, carotid imaging, chest X-ray, X-ray in acute rhinosinusitis, CTA in pulmonary embolism, early-stage breast cancer staging, acute pancreatitis, and special imaging for pre-op templar bone CT in cochlear implantation, and CT/MRI in long bone cartilaginous lesions.…”

Section: The Quantity In Use Of Low-value Examinationsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: The Quantity In Use Of Low-value Examinationsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…One study noted a 32.4% prevalence of inappropriate advanced imaging ordered before referral for musculoskeletal tumors when resources were not limited. 21 For the surgeon who does not specialize in oncology, consultation with a musculoskeletal radiologist or orthopaedic oncologist is a vital link in making a diagnosis or deciding whether a biopsy is necessary. An image of the radiograph sent by e-mail can be accomplished in many circumstances.…”

Section: Diagnosis: Imagingmentioning

confidence: 99%

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

2020

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Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.

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“…1 Three prospective case series over the last 2 decades have attempted to comment on the most appropriate imaging modalities to be done by referring practitioners before evaluation by a specialist in orthopaedic tumors. [6][7][8] This question is important to avoid over-imaging tumors of low-risk and quiescent biology, as well as recognizing tumors that are inherently aggressive and a threat to the survival of the afflicted. These previous reports demonstrated general agreement in the overuse of advanced imaging in orthopaedic tumors (MRI, CT, bone scan, and positron emission tomography [PET]), with benign bone tumors as the most common entity over-imaged.…”

Section: Overview and Rationalementioning

confidence: 99%

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist

Miller

2019

J Am Acad Orthop Surg

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The Musculoskeletal Tumor Society and American Academy of Orthopaedic Surgeons recently collaborated on a clinical practice guideline Use of Imaging Prior to Referral to an Orthopaedic Oncologist. The complete manuscript is available on OrthoGuidelines (www.orthoguidelines.org) and the Musculoskeletal Tumor Society website (www.msts.org). This clinical practice guideline is designed to assist practitioners without specialization in musculoskeletal tumors to determine the most efficacious imaging modalities for establishing an accurate diagnosis and treatment plan when confronted with a bone or soft-tissue lesion of unknown etiology. A panel of experts with interest and expertise in orthopaedic surgery, orthopaedic oncology, and musculoskeletal radiology created relevant questions and synthesized existing literature into 12 topics and 27 recommendations. The group considered several common clinical and radiographic features often seen at the initial presentation of a bone or soft-tissue tumor of the pelvis or extremities. This guideline is intended to inform front-line practitioners to give insight into imaging modalities that are of minimal clinical utility, as well as those that are critical to establishing an accurate diagnosis and assessing the urgency of referral to an oncologic specialist. In addition to a summary of the primary findings of the report, we included three cases that illustrate clinical scenarios in which the guidelines can assist in determining the most appropriate first-line management. The strengths of the relevant guidelines are noted.

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Evaluation of Imaging Utilization Prior to Referral of Musculoskeletal Tumors

Cited by 18 publications

References 17 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist

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