International Journal of General Medicine (Jul 2022)
Agreement Between International Radiologists on the Appropriateness and Urgency in Lumbar Spine MRI Referrals
Abstract
Ali Hasayan Alanazi,1 Andrea Cradock,1 Rachel Toomey,1 Marie Galligan,2 John Ryan,3 John Stowe1 ,† Louise Rainford1 1Radiography and Diagnostic Imaging, University College Dublin, Dublin, Ireland; 2School of Medicine, University College Dublin, Dublin, Ireland; 3Ziltron LTD, Dublin, Ireland†John Stowe passed away on July 27, 2021Correspondence: Ali Hasayan Alanazi, South Central Buildings, APT 29, Sandyford, Dublin, Air Code D18 RW02, Ireland, Tel +35 3833782878, Email [email protected]: To determine how radiologists across health-care jurisdictions internationally assess the appropriateness and urgency levels of lumbar spine Magnetic Resonance Imaging MRI referrals.Patients and Methods: Clinical information was extracted from 203 lumbar spine MRI referrals. Texts were divided into 10 datasets and embedded into a software to facilitate the classification process. Participant radiologists were recruited at the Image Perception Lab, at the Radiological Society of North America Congress, 2019 and through the institution radiology network. Radiologists were asked if they use referral guidelines in their practices. Radiologists assigned appropriateness and urgency levels based on the referral text. Appropriateness level descriptors were: indicated, indicated but needs more information or not indicated. Urgency levels were categorized: urgent, semi-urgent, or not urgent. All cases containing neurological symptoms with/without red flags were extracted and exact agreement between radiologists’ responses on the indication status was calculated.Results: Seventy radiologists from 25 countries participated; 42% of participants indicated non-use of referral guidelines. Poor-moderate radiology agreements were recorded for appropriateness and referral urgency level decisions. 79.6% of responses indicated that cases containing neurological symptoms with/without red flags were indicated for scanning.Conclusion: Despite referral guidelines promotion, nearly half of participants stated non-usage. Subsequently, a varied agreement levels were found in assigning the appropriateness of the referrals. Appropriateness of referrals with neurological symptoms (with/without red flags) recorded good agreement.Keywords: back pain, lumbar spine referral, magnetic resonance imaging, examination appropriateness
