Evaluation of history taking status and diagnostic and therapeutic measures before applying spine MRI

Mohammad Bagher Owlia, Fatemeh Jaferi


According to increasing use of clinical facilities such as MRI to diagnose diseases around the world, it is important to know that to what extent these facilities are used based on the existing indications. Accurate history taking and physical examination are essential and first step in requesting para-clinical measures. It is also very important in interpreting the spine MRI findings in patients with back pain. Therefore, it seems necessary to examine physicians' attention to history taking and physical examination before applying MRI to enact rules for optimal use of existing facilities. A total of 195 outpatients referred to the Imaging Center of Shahid Sadoughi Hospital in Yazd for spine MRI were selected by easily and convenience sampling method. The data were collected using a structured interview. Of 195 patients referred, 17.5% (n = 31) and 8.2% (n = 16) reported that the physician was not aware of the main complaint duration and the exact pain localization, respectively, and 31% of patients had not been examined by the physician. Based on the results of this research, inattention of some physicians to accurate history taking and physical examination is one of the reasons for aberrant spine MRI. Accordingly, lack of attention to the absence of clinical signs consistent with the results of MRI can create a chain of futile diagnostic and therapeutic measures as well as financial and psychological burden on the patients.The results showed that solving the problem of aberrant requests for MRI requires fundamental and comprehensive planning to develop national guidelines, inclusion of these guidelines in educational system of medical students and doctors, encouraging patients to ask physicians about the reason for applying MRI and its impact on diagnostic and therapeutic processes, and finally national legislation and insurance to monitor and reduce requests without indications.


Medical History Taking, Physical Examination, Magnetic Resonance Imaging, Yazd

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Deyo RA, Tsui-Wu Y-J. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine 12:264-268, 1987.

David CJ, Carroll LJ, Côté P. The Saskatchewan health and back pain survey: the prevalence of low back pain and related disability in Saskatchewan adults. Spine 23:1860-1866, 1998.

US Department of Health and Human Services. Acute low back problems in adults: Assessment and treatment. 1994.

Use of imaging studies for low back pain: Percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain x-ray, MRI, CT scan) within 28 days of the diagnosis. National Committee for Quality Assurance (NCQA). HEDIS 2014: Healthcare Effectiveness Data and Information Set. Vol. 1. Washington (DC): National Committee for Quality Assurance (NCQA); 2013.

Lehnert BE, Bree RL. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? J Am Coll Radiol 7:192-197, 2010.

Saadat S, Ghodsi SM, Firouznia K, Etminan M, Goudarzi K, Naieni KH. Overuse or underuse of MRI scanners in private radiology centers in Tehran. Int J Technol Assess Health Care 24:277-281, 2008.

Mayo JR, Peter LM. Towards clarity: what does inappropriate imaging really mean? Canadian Assoc Radiologists J 5:250-251, 2010.

Pennsylvania Health Care Cost Containment Council. The growth in diagnostic imaging utilization. Accessed 2007 July.

Salari H, Ostovar R, Esfandiari A, et al. Evidence for policy making: clinical appropriateness study of lumbar spine MRI prescriptions using RAND appropriateness method. Int J Health Policy Manag 1:17-21, 2013.

Palesh M, Fredrikson S, Jamshidi H, Jonsson PM, Tomson G. Diffusion of magnetic resonance imaging in Iran. Int J Technol Assess Health Care 23:278-285, 2007.

Rao JK, Kroenke K, Mihaliak KA, Eckert GJ, Weinberger M. Can guidelines impact the ordering of magnetic resonance imaging studies by primary care providers for low back pain? Am J Managed Care 8.1:27-36, 2002.

Davis PC(1), Wippold FJ 2nd, Brunberg JA, et al. ACR Appropriateness criteria on low back pain. J Am Coll Radiol 6:401-407, 2009.

Ramirez N, Flynn JM, Hill BW, et al. Evaluation of a systematic approach to pediatric back pain: the utility of magnetic resonance imaging. J Pediatric Orthoped 35:

-32, 2005.

Kim HJ, Suh BG, Lee DB, et al. The influence of pain sensitivity on the symptom severity in patients with lumbar spinal stenosis. Pain Physician 16: 135-144, 2013.

Hall H. Effective spine triage: patterns of pain. Ochsner J 14: 88-95, 2014.

Spanjer J, Krol B, Popping R, Groothoff JW, Brouwer S. Disability assessment interview: the role of detailed information on functioning in addition to medical history-taking. J Rehab Med 41:267-272, 2009.

Avoundjian T, Gidwani R, Yao D et al. Evaluating Two Measures of Lumbar Spine MRI Overuse: Administrative data versus chart review. J American Col Radiol 13:1057-1066, 2016.

Palesh M(1), Fredrikson S, Jamshidi H, Tomson G, Petzold M. How is magnetic resonance imaging used in Iran? Int J Technol Assess Health Care 24:452-458, 2008.

Emery DJ, Shojania KG, Forster AJ, Mojaverian N, Feasby TE. Overuse of magnetic resonance imaging. JAMA Int Med 25:1-3, 2013

Robinson JD, Hippe DS, Hiatt MD. The Effect of a No-denial policy on imaging utilization. J Am Col Radiol 10:501-506, 2013.

Blackmore CC, Mecklenburg RS, Kaplan GS. Effectiveness of clinical decision support in controlling inappropriate imaging. J Am Col Radiol 8: 19-25, 2011.


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