Finding the Truth in Medical Imaging: Painting the Picture of Appropriateness for Magnetic Resonance Imaging in Canada

Vanderby, Sonia; Peña-Sánchez, Juan Nicolás; Kalra, Neil; Babyn, Paul

doi:10.1016/j.carj.2015.05.002

Cited by 7 publications

(6 citation statements)

References 17 publications

(79 reference statements)

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“…Studies have shown that inappropriate MRI use exists for many indications [9]. Although MRI appropriateness guidelines exist, as shown in our results, they are not widely used in practice [14e17].…”

Section: Appropriatenessmentioning

confidence: 81%

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Variations in Magnetic Resonance Imaging Provision and Processes among Canadian Academic Centres

et al. 2017

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Our analysis showed great variation among facility-level factors such as hours of operation, request forms, and prioritization scales among institutions and facilities. Opportunities exist to create standardized processes and improve request forms to focus more on specific information required for appropriateness, increase consistency in patient care, and promote demand balancing, minimizing unnecessary exams and therefore reducing wait times.

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Section: Appropriatenessmentioning

confidence: 81%

“…Despite being a pressing concern for many years, it is still unclear what percentage of completed MRI exams across Canada are inappropriate. A recent review yielded estimates ranging from 2%-28.5% of all MRI exams obtained [9], with results varying based on study methods and the indications for imaging being studied.…”

Section: R Esum Ementioning

confidence: 99%

Variations in Magnetic Resonance Imaging Provision and Processes among Canadian Academic Centres

et al. 2017

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“…Rates of inappropriate imaging diagnostic procedure use in the primary care setting vary considerably (from 0.2 to 99.9%) [23], even for a single procedure within the same country (i.e. from 2 to 28.5% inappropriate MRI in Canada) [24]. Given the substantial heterogeneity of the methods applied, the observed variability could possibly reflect the appreciable variation in determinants of deviation from guidelines.…”

Section: Discussionmentioning

confidence: 99%

Using text analysis software to identify determinants of inappropriate clinical question reporting and diagnostic procedure referrals in Reggio Emilia, Italy

Venturelli

Ottone

Pignatti

et al. 2021

BMC Health Serv Res

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Background Inappropriate prescribing of diagnostic procedures leads to overdiagnosis, overtreatment and resource waste in healthcare systems. Effective strategies to measure and to overcome inappropriateness are essential to increasing the value and sustainability of care. We aimed to describe the determinants of inappropriate reporting of the clinical question and of inappropriate imaging and endoscopy referrals through an analysis of general practitioners’ (GP) referral forms in the province of Reggio Emilia, Italy. Methods A clinical audit was conducted on routinely collected referral forms of all GPs of Reggio Emilia province. All prescriptions for gastroscopy, colonoscopy, neurological and musculoskeletal computerised tomography (CT) and magnetic resonance imaging (MRI) from 2012 to 2017 were included. The appropriateness of referral forms was assessed using Clinika VAP software, which combines semantic analysis of clinical questions and available metadata. Local protocols agreed on by all physicians defined criteria of appropriateness. Two multilevel logistic models were used to identify multiple predictors of inappropriateness of referral forms and to analyse variability among GPs, primary care subdistricts and healthcare districts. Results Overall, 37% of referral forms were classified as inappropriate, gastroscopy and CT showed higher proportions of inappropriate referrals compared to colonoscopy and MRI. Inappropriateness increased with patient age for CT and MRI; for gastroscopy, it was lower for patients aged 65–84 compared to those younger, and for colonoscopy, it was higher for older patients. Fee exemptions were associated with inappropriateness in MRI referral forms. The effect of GPs’ practice organization was consistent across all tests, showing higher inappropriateness for primary care medical networks than in primary care medical groups. Male GPs were associated with inappropriateness in endoscopy, and older GPs were associated with inappropriateness in musculoskeletal CT. While there was moderate variability in the inappropriate prescribing among GPs, there was not among the healthcare districts or primary care subdistricts. Conclusions Routinely collected data and IT tools can be useful to identify and monitor diagnostic procedures at high risk of inappropriate prescribing. Assessing determinants of inappropriate referral makes it possible to tailor educational and organizational interventions to those who need them.

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“…Various research articles have been able to demonstrate the positive impact of using available guidelines to help decrease imaging use [4]. In Ottawa, the establishment of four decision rules: the Ottawa Ankle Rule, the Ottawa Knee Rule, the Canadian C-Spine Rule and the Canadian CT Head Rule resulted in a 20% -30% overall decrease in imaging [5].…”

Section: Introductionmentioning

confidence: 99%

Rate of Inappropriate Imaging Utilization by the Emergency Department in Community Hospitals

Robert¹,

Asch²,

Nijmeh³

2018

OJRad

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Objective: To retrospectively analyse the use of imaging studies in the Emergency Department of community hospitals using evidence based guidelines and clinical judgement. Methods: Medical records of 661 patients who visited the Emergency Department (ED) in 2015 and underwent imaging studies were reviewed. The Canadian Association of Radiologists, American College of Radiologists and Choosing Wisely Canada guidelines were used to determine the appropriateness of imaging studies. The use of prior patient imaging, the rate at which studies were repeated and the respective impacts on patient management of the imaging studies were also examined. Results: Of the 1056 imaging studies reviewed, 228 (22%) were found to be clinical situations where no imaging study was indicated while 168 (16%) were considered a suboptimal choice of imaging study or modality. When no study was recommended, a positive impact on the diagnosis was noted in 105 (46%) cases and on patient management 83 (36%) times. Notably, 219 (21%) patients had a relevant examination performed in the last 30 days, and 147 (14%) reports noted that the results of the prior study also concurred with the imaging study evaluated. Conclusion: In this study, 228 (22%) radiographs and CT studies, excluding MVC related imaging and extremity imaging, were not indicated based on appropriateness criteria and consequently had a limited impact on patient management. This supports the need for increased clinical decision support for ED physicians, regional health information exchanges and consideration of Computerized Physician Order Entry in the ED with embedded appropriateness criteria at the point of ordering.

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Finding the Truth in Medical Imaging: Painting the Picture of Appropriateness for Magnetic Resonance Imaging in Canada

Cited by 7 publications

References 17 publications

Variations in Magnetic Resonance Imaging Provision and Processes among Canadian Academic Centres

Variations in Magnetic Resonance Imaging Provision and Processes among Canadian Academic Centres

Using text analysis software to identify determinants of inappropriate clinical question reporting and diagnostic procedure referrals in Reggio Emilia, Italy

Rate of Inappropriate Imaging Utilization by the Emergency Department in Community Hospitals

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