How one Canadian health center reduced inappropriate MRI knee exams
Performing more value-based imaging exams has been a long-standing goal for radiology. And one Canadian center has found that checklists helped reduce inappropriate MRI knee exams at its institutions.
Researchers from St. Joseph Health Care Center’s Department of Medical Imaging created a checklist based on American College of Radiology (ACR) criteria to help justify ordering knee MRI studies. They found the reference criteria significantly decreased unnecessary exams and may ultimately help break over-ordering habits.
“To the best of our knowledge, this is the first study to evaluate the effectiveness of an appropriateness checklist that has been applied to a large patient population referral base,” G. Garvin, with St. Joseph in Ontario, Canada, and colleagues wrote. “Our study provides hope that these checklists can have a material impact on MRI ordering practices and the improve availability of MRI for patients with good indications for MRI,” the researchers added.
ACR Appropriateness Criteria says that knee MRIs should not be ordered in patients with severe osteoarthritis (OA), a common occurrence among people over 60 years old—a population that is only expected to grow. Despite this, MRIs are commonly performed for preoperative guidance while radiographs, which are cheaper and quicker, provide enough information for clinicians, the authors noted.
With this is mind, the team created a simple checklist to reduce MRI referrals for patients with moderate or worse OA. If a referring physician found the patient fell under the checklist criteria, they called the provider to explain that MR imaging wasn’t recommended and shouldn’t be performed.
To determine the effectiveness of the checklist, the researchers compared 200 consecutive knee MRI studies ordered one year before implementing the new guidance to 200 MRIs performed after using the checklist.
Garvin et al. reported an overall decrease in the number of knee MRIs ordered after implementing the checklist, dropping from 36.5% to 20.5% in moderate or greater OA cases. In those with severe OA—which calls for a radiograph—the team saw an 80% decrease.
Using a checklist may also help address the “excessive” wait times for MRIs across the Canadian healthcare system, the researchers wrote. Based on their study, wait times for the modality did not drop, but they were trending downward, which, according Garvin et al., indicates at least the possibility checklists can improve MRI’s availability.
The results, while “provocative” are early and incomplete, the team wrote. But they believe with more research, enforcing checklists could improve other areas of MRI ordering.
“Our results raise the possibility that a host of other, as yet uninvestigated, MRI studies could potentially benefit from this approach. This may increase the availability of MRI for patients with valid indications,” the team concluded in their study, published Dec. 10 in the European Journal of Radiology.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.