A new study found that ACR’s Radiology Support, Communication and Alignment Network (R-SCAN) web portal, could decrease the total of inappropriate magnetic resonance imaging (MRI) studies for uncomplicated low back pain. The study was published in the Journal of the American College of Radiology.

To investigate, Dr. Christie Mary Lincoln and associates registered a project on the ACR’s Radiology Support, Communication and Alignment Network (R-SCAN) web portal, and collected lumbar spine MRI order-entry records from three family medicine clinics.

The number of orders placed/month at the clinics was assessed during a 10-month period. R-SCAN content and highlighting the American College of Physicians and Choosing Wisely campaign imaging guidelines gave educational presentations at those clinics. The number of MRI orders placed was reassessed during another ten months.

Additionally, subsets of scans collected from 90 patients in three of the ten months before the educational period and 79 patients in four of the ten months after the educational period were randomly selected. Charts and medical data for those patients were retrospectively studied. MRIs were then assessed according to the ACR Appropriateness Criteria and compared between the pre- and post-education periods.

The study reported that the average number of monthly MRIs ordered from all three clinics combined was considerably more during the pre-education period (6.3) than during the post-education period (10.0). Similarly, the combined average ACR Appropriateness Criteria rating at all three clinics was considerably higher during the post-education periods (5.8) than pre-education periods (4.7).

Dr. Lincoln said R-SCAN collaborated referring healthcare providers (physicians, nurse practitioners, or physician assistants) with radiologists to select the best imaging possible, even though that means no imaging.

“Providers ordering advanced imaging must first consult appropriate use criteria using a clinical decision-support tool. We hope the widespread integration of clinical decision support, like the one R-SCAN provides, into electronic medical record systems will be a definitive, long-term, structural solution for appropriateness of advanced imaging,” Dr. Lincoln added.

Dr. Jeffrey Goldstein said physician education assisted them to understand an advantage and disadvantages of MRI for their patient would help the MD to support clinical decision making based on evidence-based medicine. The patient’s request for an MRI also played a role in overuse. Thus, patients should also be educating.

Dr. Goldstein added, “Physicians are judged in part on how their patients perceive their experience and interaction with the MD. If patients feel they are ‘denied’ care, they are more likely to feel that their MD is disinterested.”

The researchers concluded that clinician education, facilitated by R-SCAN, reduced MRI lumbar spine studies for uncomplicated low back pain, and improved the appropriateness of those studies according to ACR criteria.