Inappropriate ordering of magnetic resonance images of the shoulder
Freeman R, Khanna S, Ricketts D
Royal Sussex County Hospital Brighton
Introduction: Magnetic Resonance Imaging (MRI) scans are a useful investigation for some shoulder pathology. They are however costly and a significant burden on radiology departments. In most cases clinical examination, plain radiography or ultrasound scan (USS) are sufficient for a diagnosis. There are no current UK guidelines regarding MRI shoulder scan requesting.
Methods: We reviewed 100 consecutive patients who had undergone MRI shoulder scan, the associated request forms, formal reports and other investigations were assessed.
Results: Overall 57% of MRI scans were ordered inappropriately. Shoulder consultants requests were more appropriate than other groups (70% vs. 36%. p=0.006). Excluding shoulder consultants 64% of scans were inappropriately ordered. Shoulder consultants were more likely to order a preceding x-ray (80% vs. 53% respectively, p=0.03). Of those with a clinical diagnosis of cuff pathology only 29% had an USS.
Conclusion: A high percentage of MRI shoulder scans are performed inappropriately. Shoulder consultants are more appropriate in their ordering than other groups. If all groups performed as well 50% less MRI scans would need to be performed.