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The diagnostic value of MRI in foot and ankle surgery. Foot Ankle Int. 2007 Feb;28(2):166-8
Tocci SL, Madom IA, Bradley MP, Langer PR, Digiovanni CW
Quote:
BACKGROUND: MRI is being used with increasing frequency and seems to have become more popular as a screening tool rather than as an adjunct to narrow specific diagnoses or plan operative interventions. Our hypothesis was that the rising accessibility of this test may be resulting in its overuse.
METHODS: We retrospectively reviewed 221 consecutive patients referred over a 3-month period for treatment of a lower extremity problem to determine: (1) the number of patients who presented with an MRI already obtained from an outside source, (2) the number of patients who obtained an MRI from the foot and ankle specialist after referral, and (3) the number of times the foot and ankle specialist used these studies or found them helpful in the care of the patient. Fractures (20) were excluded.
RESULTS: Of the 201 patients without fractures included in the study, 19.9% (40 of 201) had MRI scans during the course of their treatment; 15.4% (31 of 201) presented to their initial visit with an MRI scan from an outside source, and 4.5% (9 of 201) received MRI scans as ordered by the foot and ankle specialist. Eighty-seven percent (27 of 31) of the pre-referral MRI scans were thought to be unnecessary, and 48.4% (15 of 31) had radiographic interpretations that were considered either immaterial to the patient's pertinent clinical diagnosis or inconsistent with the specialist's interpretations. All nine MRI scans ordered by the specialist were useful in the care of the patient. Therefore, of the 221 consecutive patients, the foot and ankle specialist would have ordered MRI scans in only 5.9% (13 of 221).
CONCLUSIONS: This study suggests that many of the pre-referral foot or ankle MRI scans obtained before evaluation by a foot and ankle specialist are not necessary. Further studies need to be performed to determine the role of MRI in the screening of foot and ankle disorders.
Interesting conclusion to this study. Most likely true for any specialty.
It's my humble opinion that the combination of "ease" of diagnosis, the threat of legal ramifications for mis or missed diagnosis and time constraints of in office examinations are responsible for the over utilization of tests in general, including MRI's.
In addition, I feel patients almost expect to get an MRI.
I have found many insurance's limiting the ordering of MRIs to certain diagnoses......i.e., will not pay for things like "rule out stress fracture" or "Morton's neuroma" - etc...
Which I more or less agree with.
DO we need to get back in touch with our clinical diagnostic skills? Are newly trained practitioners taught to depend on these tests rather than their own clinical interpretations?
Dr. Steve
Is MRI necessary?
Linear Mode
