Diagnostic Imaging: Best Practice

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Original Editor - Melissa Coetsee

Top Contributors - Melissa Coetsee  

Introduction[edit | edit source]

Diagnostic imaging has evolved significantly over the past decades, and has become an important component of the health care system.

The use of diagnostic imaging has doubled in the United States over a 16 year period[1]

Inappropriate diagnostic imaging is a major contributor to unnecessary health care expenditure and overtreatment. Improved awareness of the risks, benefits and evidence-based recommendations can improve decision-making and avoid unnecessary imaging.[1]

Potential factors that influence unnecessary imaging[2][3]:

  • Patient expectations/requests, and the need to find proof that their pain is real
  • Clinician's fear of missing severe pathology
  • Lack of awareness of current guidelines
  • Lack of awareness of the harm of unnecessary imaging
  • Belief that imaging will reassure patients
  • A lack of access to conservative management options

These factors need to be managed with good communication and evidence based guidelines.[3]

Risks of Inappropriate Imaging[edit | edit source]

Radiation Exposure[edit | edit source]

Iatrogenic Effects[edit | edit source]

"Incidentalomas"[edit | edit source]

Incidental abnormal radiographic findings occur in 20-50% of imaging studies.[1]Discernment is required to determine when such findings require further investigation or pose no threat in the absence of symptoms.

Asymptomatic Imaging[edit | edit source]

The Evidence[edit | edit source]

Clinical Recommendations[edit | edit source]

Musculoskeletal Imaging[edit | edit source]

MRI Contra-indications[edit | edit source]

Conclusion[edit | edit source]

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 Ford B, Dore M, Moullet P. Diagnostic imaging: appropriate and safe use. American Family Physician. 2021 Jan 1;103(1):42-50.
  2. Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. bmj. 2021 Feb 12;372.
  3. 3.0 3.1 Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine. 2013 Oct 15;38(22):1939-46.