Related Experiment Video
Updated: Apr 26, 2026
Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography
Published on: March 12, 2021
MRI of the knee and shoulder performed before radiography
Elizabeth George1, Stavros Tsipas2, Gregory Wozniak2
1Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachussetts.
Purpose:
Available data are limited on the level of adherence to established guidelines for appropriate utilization of MR in musculoskeletal imaging. This study estimates the percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography, which thus may fall outside the ACR Appropriateness Criteria for the Medicare and commercially insured populations.
Methods:
The percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography was estimated among patients in the Medicare 5% carrier claims limited data set and among commercially insured patients in the Truven Marketscan Treatment Pathways database in 2010.
Results:
Approximately 28% of all knee MRIs, and 35%-37% of all shoulder MRIs were performed without recent prior radiographs. The extrapolated expense of these potentially unwarranted MRIs in the entire fee-for-service Medicare population was between $20 and $35 million. Between 20% and 23% of patients undergoing knee MRI, and 27%-32% undergoing shoulder MRI, did not have radiographic examination at any point before the MRI in the same calendar year.
Conclusions:
MRI performed without prior radiography represents a potential gap in care and should be considered as an area for establishment of performance measures.
Insights
Many knee and shoulder MRIs are performed without prior radiography, potentially indicating a gap in care. This suggests a need for performance measures to ensure appropriate utilization of advanced imaging techniques.
Area of Science:
- Radiology
- Musculoskeletal Imaging
- Healthcare Utilization
Background:
- Adherence to established guidelines for Magnetic Resonance Imaging (MRI) in musculoskeletal imaging is not well-documented.
- Assessing the appropriate use of MRI is crucial for patient care and resource management.
Purpose of the Study:
- To estimate the percentage of knee and shoulder MRIs for pain or tendonitis performed without prior radiography.
- To identify potential deviations from the American College of Radiology (ACR) Appropriateness Criteria.
Main Methods:
- Utilized Medicare 5% carrier claims data and Truven Marketscan data for commercially insured patients in 2010.
- Estimated the proportion of knee and shoulder MRIs conducted without preceding radiographic examinations.
Main Results:
- Around 28% of knee MRIs and 35-37% of shoulder MRIs lacked recent prior radiographs.
- The extrapolated cost of potentially unwarranted MRIs in the Medicare population ranged from $20 to $35 million.
- 20-32% of patients receiving knee or shoulder MRIs had no prior radiography in the same calendar year.
Conclusions:
- MRI utilization without prior radiography highlights a potential gap in patient care.
- This practice warrants consideration for developing performance measures to improve imaging appropriateness.
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