Combined Lumbar Spine MRI and CT Appropriateness Checklist: A Quality Improvement Project in Saskatchewan, Canada

Abstract Background As rates of advanced imaging for lower back pain continue to increase, there is a need to ensure appropriateness of imaging. The goal of this project was to reduce the number of inappropriate MRI and CT requests for lower back pain patients and facilitate appropriate imaging by developing a combined imaging appropriateness checklist for lumbar spine MRI and CT. Methods In prior work, we developed and adopted individual evidence-based lumbar spine MRI and CT checklists into the radiology requisition process. In the current project, a combined checklist was developed and trialed in one of the former Saskatchewan health regions (Five Hills) beginning in May 2018. Using statistical process control (SPC), control charts compared monthly number of imaging requests pre- and post-checklist implementation from May 2017 to February 2020. Monthly number of lumbar spine MRI and CT requisitions in the nearby former Saskatchewan Regina Qu’Appelle Health Region, in which the combined checklist was not trialed, were also plotted and compared as a balancing measure. Results In Five Hills, a shift (decrease) was observed in the monthly number of lumbar spine MRI requisitions seven months following the implementation of the combined checklist. However, the monthly number of lumbar spine CT requisitions did not change significantly. In the Regina Qu’Appelle Health Region, there was a shift (increase) in the monthly number of lumbar spine MRI requisitions, while the monthly number of lumbar spine CT requests decreased after the implementation of the combined checklist. Conclusions The combined checklist with evidence-based indications for lumbar spine MRI and CT imaging in lower back pain patients appeared to reduce the complexity associated with two previous individual checklists and facilitate imaging appropriateness. Accountable benefits may include the reduction of radiation exposure as a result of unnecessary and repeated imaging and reduction in wait times for CT and/or MRI.

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JUSTIFICATION OF RADIOLOGICAL PROCEDURES ALGORITHM ADJUSTMENT IN DIAGNOSIS OF LOWER BACK PAIN CAUSE AT UNIVERSITY CLINICAL CENTER TUZLA

Acta Medica Saliniana ◽

10.5457/ams.v49i1.489 ◽

2019 ◽

Vol 49 (1) ◽

Author(s):

Aida Denjagić

Keyword(s):

Back Pain ◽

Lumbar Spine ◽

Radiation Dose ◽

Lower Back Pain ◽

Lower Back ◽

Clinical Center ◽

Spine Ct ◽

Diagnostic Key ◽

Magnetic Resonance Imaging Mri ◽

Radiological Procedures

Introduction: Lower Back Pain (LBP) is one of the most frequent reasons for visiting physican. Authors of guidelines scrutinizing use of radiography and Computed tomography (CT) or Magnetic resonance imaging (MRI) in LBP diagnostic. Method of choice in the LBP diagnostic should be MRI except in cases where we should get diagnostic informations as soon as possible (traumas etc.) and in strict indications in bone structures where CT should be a method of choice. Increase of CT use and following icrease CT derived radiation dose in patients are very serious problems of last decades. Aim: To show the nessesary of procedure algorithm adjusment in LBP diagnostic. Reasons are: danger of overdiagnosis leading to chronifications, loosing time and money to get exact diagnose and leading to cumulate very high ionizing doses (10 mSv per person with average body weight from lumbar spine CT) that could couse a cancer if it is over 100 mSv (in some studies if it is over 50 mSv). Patients and methods: Sixty-nine patients, average age of 51.35 years, were included in the study. Lumbar spine CT was performed and repeated procedure at MRI in a very short time in Clinic for Radiology and Nuclear Medicine of University Clinical Centre Tuzla from January 1 2017 to February 9 2018. The sample of patients was formed consecutively. Referral diagnosis for CT procedures were: M51 in 36 patients (52.17%), N/A in 13 (18.84%), M05 in 4 (5.8%), G83.4 in 3 (4.35%) and other in 13 (18.84%). Results: 30 (83.33%) of patients were referred from CT to MRI procedure in time under 42 days (during acute phase). Relation of justified and unjustified undertaken CT procedures were: 71% unjustified, 10% justified and 19% N/A.Conclusion: Performed study showed unjustified undertaken CT procedures and high unnecessary radiation dose in 71% patients. There are justified reasons for procedure algorithm adjusment in LBP diagnostic. Key words: lower back pain, diagnostic procedure algorithm, CT, MRI

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Emotional and Neurobehavioural Status in Chronic Pain Patients

Pain Research and Management ◽

10.1155/2011/825636 ◽

2011 ◽

Vol 16 (1) ◽

pp. 41-43 ◽

Cited By ~ 5

Author(s):

He Shuchang ◽

He Mingwei ◽

Jia Hongxiao ◽

Wu Si ◽

Yang Xing ◽

...

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Lower Back Pain ◽

Mood State ◽

Control Group ◽

Chronic Lower Back Pain ◽

Control Subjects ◽

Lower Back ◽

Chronic Pain Patients ◽

Pain Patients

OBJECTIVE: To investigate the emotional and neurobehavioural status of patients suffering from chronic pain.METHODS: Fifteen male patients with chronic lower back pain and 15 healthy control subjects were studied for approximately six months. Pain was measured using a visual analogue scale. The WHO Neurobehavioral Core Test Battery (NCTB) was used to assess neurobehavioural effects of environmental and occupational exposures.RESULTS: Visual analogue scale results demonstrated a modest range of reported pain (mean [± SD] 62.0±10.8) in chronic pain patients, whereas control subjects reported no measurable pain. With the NCTB, it was found that scores of negative mood state, including anger-hostility, depression-dejection, fatigue-inertia and tension-anxiety in pain patients were significantly higher than scores in the control subjects. By contrast, scores of positive mood state (vigour-activity) in chronic pain patients were lower than those in the control group. The NCTB scores of the Santa Ana Dexterity and Pursuit Aiming II tests in chronic lower back pain patients were lower than those of the control group. Scores for other NCTB sub-tests, including the Digit Span, Benton Visual Retention and Digit Symbol tests, were not significantly different compared with controls.CONCLUSIONS: Chronic lower back pain patients had more negative mood and less positive mood than controls. These patients also demonstrated neuromotor deficits in coordination and reaction time. Further studies are required to examine possible neurological mechanisms and research potential intervention strategies for patients suffering from chronic pain.

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