MRI is not beneficial in patients with joint pain and concomitant osteoarthritis (OA). We attempt to determine if evaluation of OA via X-rays can reduce inappropriate MRI and CT arthrogram use. In our jurisdiction, CT arthrograms are used as surrogate tests because of MRI wait times.

Our intervention required recent, weight bearing X-rays (within one year) for patients ≥ 55 years of age who were scheduled for outpatient MRI of the knee/hip/shoulder at an urban hospital. Red flags (i.e. neoplasm, infection) were identified for which MRI would be indicated regardless. Through review of radiographs on PACS/digital media and use of the validated Kellgren-Lawrence (KL) OA scale, radiologists assessed the presence and degree of OA. A finding of significant OA (KL > 2) without red flags would preclude MRI. Monthly averages of MRI and CT arthrogram exams were measured 33 months before and 23 months following introduction of the intervention.

The proportion of protocoled MRI requisitions that were avoided was 21%. If extrapolated to the province of British Columbia, 2419/11700 exams could have been prevented in the past year. The average monthly number of knee/hip/shoulder MRI exams as a percentage of total MRI exams decreased from 4.9% to 4.3% (P < 0.02) following the intervention. The average monthly number of knee/hip/shoulder CT arthrogram exams decreased from 20.6 to 12.1 (P < 0.0001).

We were able to decrease the number of MRI and CT arthrogram exams in patients ≥ 55 years of age with joint pain by implementing an evaluation for OA via recent X-ray imaging.

Reducing the Volume of Low-Value Outpatient MRI Joint Exams in Patients ≥ 55 Years of Age