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Increased use of MRI as a ‘gold standard’ raises access issues
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 Per Kjaersgaard-Andersen |
As the quality of MRI technology has improved, MRI scans are increasingly being ordered, sometimes leading to major bottlenecks in the timely diagnosis of musculoskeletal conditions. Such demand for MRI as an orthopaedic and trauma diagnostic tool stems from it having become the “gold standard” for several differential diagnoses and from educated patients seeing it as a tool to have their injuries and pain better understood. In fact, some patients now directly request MRI studies and I know several patients who have contacted imaging clinics on their own to have an MRI performed.
Due to this demand, MRI scanning is now offered in many private clinics, making it a business tool as well as a clinical one. However, this raises questions about whether unnecessary MRI examinations are being done, if access to MRI facilities should be controlled and if MRI access should be limited to patients who need it most, such as for cancer diagnosis and treatment.
A newly presented paper by Paxton and colleagues showed MRI scanning to be overused if the doctors who ordered the MRIs had financial interest in either the clinic or equipment used. Also, the doctors studied with a financial interest in MRIs were associated with a significantly lower number of positive scans for spinal disorders. Are we, as clinicians, overusing MRI, using it to avoid making a differential diagnosis, or relying on it simply to confirm our diagnosis prior to surgery?
In orthopaedics, we stress that the basic clinical examination should be part of a patient’s final evaluation. MRI is a tool that can help produce an accurate diagnosis that will ultimately help the patient and surgeon select an optimal treatment. The goal, therefore, should be free and unlimited access to MRI — an approach many physicians and patients would likely support since there is currently a lack of free access to MRI. However, this situation will also likely result in more private MRI clinics. Now is when a relevant debate is most needed about how MRI should be used, who can order it, and under what conditions patients can have scans done.
Reference:
- Paxton BE, Lungren MP, Jung S, et al. A case study in lumbar spine MRI and physician self-referral imaging. Paper SSK08-07. Presented at the 2011 Annual Meeting of the Radiological Society of North America. Nov. 27-Dec. 2. Chicago.