Dr Panagiotopoulos raised the issue of unnecessary musculoskeletal MRIs in the November 2021 issue of the BCMJ. This problem of unnecessary imaging studies is not isolated to MRIs. I can corroborate his experience with receiving referrals that are frequently accompanied by unnecessary and clinically unhelpful MRIs and, indeed, other advanced imaging studies (nuclear medicine scans, ultrasounds, CTs, etc.). These studies can at times also be harmful by delaying referral and creating unnecessary patient anxiety through misleading interpretations.
Causative factors appear to include (1) misguided patient demand, (2) a lack of knowledge of indications for advanced imaging on the part of the ordering clinicians, (3) an absence of appropriateness screening by radiology, and (4) the frequent suggestion by radiology to perform advanced imaging that is clinically unhelpful and that primary care clinicians feel obliged to order.
With high demand and long waits, the response from governments and some health authorities was to increase the number of MRI scanners and their hours of use rather than to focus on appropriate use. This has led to a worsening of the problem. In the Northern Health Authority (NHA), between 2018 and 2019 this policy led to an 86.9% increase in the number of MRIs. Estimates put the number of MRIs done in BC annually at 1 per 21 people, and 1 per 18.5 nationally.
Within the central NHA catchment area, we have piloted implementation of strict criteria for musculoskeletal MRIs with some early success in reducing their numbers. This hopefully will be expanded across the whole region.
I have found it frustrating and ironic that ideas and efforts to curb the wasteful spending of health care money are not met with more acceptance from health administration and policy personnel. It seems the mantra is “more is better,” even when it is misguided and wasteful.
—Roger Purnell, MBChB, FRCSC
This letter was submitted in response to “Unnecessary musculoskeletal MRIs.”
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