"Solutions will require strict adherence to appropriate guidelines and better education of patients," such as the Choosing Wisely campaign, an effort by numerous medical specialist organizations to reduce overuse of healthcare services.
On the other hand, researchers found that 82.8% of MRI scans of the head when patients complained of headache were seen appropriate, a much more reasonable percentage, Emery says. Reasons listed for the head MRI included migraine headache, suspect brain tumor or aneurysm, or a headache in a patient with cancer.
Emery and colleagues used the RAND-University of California Los Angeles appropriateness method to define appropriate care for just these two indications, lumbar spine pain and headaches.
The project required a thorough literature review to come up with all reasons that evidence suggests justify such a test, and for lumbar spine MRI, the research came up with hundreds of scenarios. They then convened two expert panels composed of orthopedists, neurologists, family medicine specialists, podiatrists, neuroradiologists, and others to review the cases.
When the requisitions for these imaging tests didn't specify why the test was being requested, the researchers contacted the patients directly, which they received human subject research approval to do.
"To my knowledge, this is the first time this has been looked at really rigorously, although lots of papers will quote that up to 30% of images are inappropriate," he says.
Emery says that if research on the use of MRI for both indications had each revealed large amounts of inappropriateness and overuse, one might conclude similar rates for other types of MRIs.
But because there wasn't a high rate of inappropriate for head MRI, Emery believes that overutilization rates may vary depending on the region, the symptom and body site. More research is needed to investigate appropriateness of MRI testing for other types of patients.