Doctors requesting ‘unnecessary’ lower back MRIs: Canadian report

TORONTO – Doctors may be ordering unnecessary MRI tests for patients feeling lower back pain, a new Canadian study says.

More than half of lower-back MRIs requested in two hospitals – one in Calgary and one in Ottawa – didn’t offer much value to patients, according to the study published Monday in the journal JAMA Internal Medicine.

“It is commonly believed that MRI is overused and this is the first time its use has been rigorously measured,” said Dr. Derek Emery, a neuroradiologist and researcher at the University of Alberta.

“For the lower back, imaging is most often not useful,” Emery told Global News.

Emery and his team collaborated with the universities of Calgary, Toronto and Ottawa in the study.

Read more: By the numbers: Hospital wait times

An MRI – or magnetic resonance imaging – is a medical imaging technique that produces images of the internal body to help doctors determine if specific treatment, such as surgery for example, is needed. It offers a valuable glimpse into a patient’s condition.

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Emery says that across Canada though, MRI resources are limited and marred by lengthy wait times.

“We don’t have enough to cover the patients. Basically, if we eliminated some of the MRIs that were not likely helpful, we could have more capacity to do scans on patients who really need it,” Emery said.

Increase in ordering MRI scans for lower back

For their study, the researchers put together an expert panel composed of doctors, nurses, specialized surgeons and radiologists. They reviewed previous research on MRI use and put together an extensive list of reasons doctors or patients would request an MRI on their lower backs or a head scan. The experts then rated the reasons for request from one to nine.

They then scoured the data of 2,000 MRI scans – half each for brain and lower back – and compared their rankings to the reasons for request in these cases at the University of Alberta Hospital and the Ottawa Hospital.

Results showed that more than 50 per cent of the lumbar spine and lower back MRIs had “questionable value” or were deemed inappropriate by the panel.

On the other hand, MRIs for patients who reported headaches were useful 83 per cent of the time.

“Inappropriate meaning it was unlikely to benefit patient care. Generally, the lower back imaging doesn’t help in identifying lower back pain,” Emery said.

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Instead, discomfort in the back is typically mechanical and treatment could involve exercise.

Over the past few years, requests for lower back MRIs have “rocketed,” the report notes.

Family doctors were also most likely to request these tests compared to specialists – only 34 per cent of the time were their orders for an MRI deemed appropriate. Specialists had a higher rate of pegging a test’s value at 75 per cent.

“There’s tremendous pressure for the doctor to do something, to order a test that gives both the patient and doctor a reassurance. Sometimes patients go to a physician’s office wanting a test,” Emery said.

It’s also hard for some family doctors dealing with wide-ranging conditions to decipher when an imaging test will help them.

The report’s authors point to offering education and resources to family doctors to help them decide.

MRI wait times in Canada

Requests for MRIs are most common for the lower back, head, shoulders, knees and the neck.

Emery notes that its value also lies in helping doctors deal with the fear of a recurring disease, such as cancer.

Right now, wait times are weighing down access to MRI use, though.

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In Edmonton, where Emery practices for example, some 15,000 people are waiting for their MRI appointment. Some wait nearly six to seven months.

These numbers vary across the country.

An average lower back MRI costs Alberta about $400, but Emery notes that it isn’t just the price tag of these unnecessary procedures that’s hurting the health care system.

“The price is lost opportunity in scanning other patients and leaving others who need it on the wait list,” he said.

The team’s next steps are to look at the economic impact of these scans and offer insight in how to relieve the backlog.

The study was funded by a $400,000 grant from the Canadian Institutes of Health Research.


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