Rate of Recommendation for Follow-up MRI Post-shoulder Ultrasound: An Initial Benchmarking Study

Area of Science:

• Radiology
• Musculoskeletal Imaging

Background:

• Ultrasound (US) demonstrates accuracy comparable to magnetic resonance imaging (MRI) for diagnosing common shoulder pathologies.
• Despite US accuracy, a significant number of patients undergo follow-up MRI after shoulder US examinations.

Purpose of the Study:

• To establish an initial benchmark for an acceptable rate of MRI recommendation following shoulder US.
• To analyze indications for additional MRI after shoulder US.

Main Methods:

• A review of 350 diagnostic shoulder ultrasound reports from a community radiology site over two months.
• Manual review of reports mentioning MRI to identify and characterize recommendations for follow-up MRI.

Main Results:

• Additional MRI was recommended in 6.0% of cases overall (8.2% by staff radiologists).
• Indications included rotator cuff evaluation, poor visualization, internal derangement, post-vaccination pain, soft tissue mass, non-rotator cuff injury, and fracture evaluation.

Conclusions:

• A benchmark rate of less than 9% for MRI recommendation after shoulder US is proposed for experienced musculoskeletal ultrasound (MSKUS) practitioners.
• This benchmark applies to settings with mixed patient referrals.