As rates of advanced imaging for lower back pain continue to increase, there is a need to ensure appropriateness of imaging. The goal of this project was to reduce the number of inappropriate MRI and CT requests for lower back pain patients and facilitate appropriate imaging by developing a combined imaging appropriateness checklist for lumbar spine MRI and CT.
In prior work, we developed and adopted individual evidence-based lumbar spine MRI and CT checklists into the radiology requisition process. In the current project, a combined checklist was developed and trialed in one of the former Saskatchewan health regions (Five Hills) beginning in May 2018. Using statistical process control (SPC), control charts compared monthly number of imaging requests pre- and post-checklist implementation from May 2017 to February 2020. Monthly number of lumbar spine MRI and CT requisitions in the nearby former Saskatchewan Regina Qu’Appelle Health Region, in which the combined checklist was not trialed, were also plotted and compared as a balancing measure.
In Five Hills, a shift (decrease) was observed in the monthly number of lumbar spine MRI requisitions seven months following the implementation of the combined checklist. However, the monthly number of lumbar spine CT requisitions did not change significantly. In the Regina Qu’Appelle Health Region, there was a shift (increase) in the monthly number of lumbar spine MRI requisitions, while the monthly number of lumbar spine CT requests decreased after the implementation of the combined checklist.
The combined checklist with evidence-based indications for lumbar spine MRI and CT imaging in lower back pain patients appeared to reduce the complexity associated with two previous individual checklists and facilitate imaging appropriateness. Accountable benefits may include the reduction of radiation exposure as a result of unnecessary and repeated imaging and reduction in wait times for CT and/or MRI.