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Is MRI Overutilized for Evaluation of Knee Pain in Veterans?
Scott Koenig1, George Morcos1, Rohan Gopinath1
1University of Maryland School of Medicine, Orthopaedics, Baltimore, Maryland.
Abstract:
MRI is an essential diagnostic imaging modality for many knee conditions; however, it is not indicated in the setting of advanced knee arthritis. Inappropriate MRI imaging adds to health care costs and may delay definitive management for many patients. The primary purpose of this study was to ascertain the frequency of inappropriate MRI scans performed at one Veterans' Administration Medical Center (VAMC). We performed a retrospective chart review of all knee MRIs ordered over a 6-month period. Inappropriate MRI was defined as MRI performed prior to radiographs (XRs), or in the presence of XRs demonstrating severe osteoarthritis, without leading to a nonarthroplasty procedure of the knee. Of the 304 cases reviewed, 36.8% (112) of the MRIs were deemed inappropriate, 33 were ordered by orthopedists, and 79 were ordered by other health care providers. Of the 33 ordered by orthopedists, 25 were ordered by retired/nonsurgical orthopedists. Obtaining an MRI delayed care by an average of 29.2 days. Of the 252 cases that had XR prior to MRI, none included all four views in the standard knee XR series and only four had weightbearing images. Over a third of knee MRIs performed at this VAMC were inappropriate and delayed care. Additionally, no XRs in our study contained all the necessary views to properly assess knee arthritis. These concerning findings signify a potential opportunity for education in diagnostic strategies, to better patient care and resource utilization in the VAMC.
Insights
Over a third of knee MRIs at this VAMC were inappropriate, leading to delayed care for patients with advanced knee arthritis. This highlights a need for improved diagnostic strategies and resource utilization.
Area of Science:
- Radiology
- Orthopedics
- Health Services Research
Background:
- Magnetic Resonance Imaging (MRI) is crucial for diagnosing knee conditions but is often overutilized in cases of advanced knee arthritis.
- Inappropriate MRI scans contribute to increased healthcare costs and can delay necessary patient treatment.
Purpose of the Study:
- To determine the frequency of inappropriate knee MRI scans at a Veterans' Administration Medical Center (VAMC).
- To assess the impact of inappropriate MRI scans on patient care timelines and resource allocation.
Main Methods:
- A retrospective chart review of 304 knee MRI orders over a six-month period at a VAMC.
- Defined inappropriate MRI as scans performed before radiographs (XRs) or with severe osteoarthritis on XRs, not leading to knee arthroplasty.
Main Results:
- 36.8% (112) of knee MRIs were deemed inappropriate.
- Inappropriate MRIs resulted in an average delay of 29.2 days in patient care.
- Radiographs (XRs) used in the study lacked standard views for assessing knee arthritis.
Conclusions:
- A significant proportion of knee MRIs at this VAMC are inappropriate, leading to delayed care.
- There is a clear need for enhanced education on diagnostic imaging strategies for knee conditions within the VAMC.
- Optimizing MRI utilization can improve patient outcomes and healthcare resource management.
