When is MRI appropriate?
B. McClarty
Dept. of Radiology
MRI Utilization
MRI Exams performed in Winnipeg - 2003/04 to 2008/09
17,825
20,860
24,443
32,234
35,721
39,523
-
10,000
20,000
30,000
40,000
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
Exa
ms
Methods
1.American College of Radiology Appropriateness Criteria
2.CAR Medicalis Pilots3. BSCG project
ACR Appropriateness Criteria
Recommendation of which examination is most useful for investigation of a clinical symptom or conditionMRI is the preferred method for
investigation of the CNS and musculo skeletal complaints and is complimentary examination for the chest, abdomen, and cardiovascular conditions.
ACR con’t
Shortened ACR criteria for CNS complaints If you are ordering an infused CT of the
brain or spinal cord, consider MRIDo uninfused CT in preference to MRI for
assessment of bone fractures or hemorrhage including SAH
Do CT for mastoids, sinuses due to high bone air contrast and better spatial resolution of CT
CT vs. MRI Mastoids
ACR con’t
Infused CT is the primary modality for the assessment of neck lesions /cervical lymphadenopathy
CT angiography has higher spatial resolution and better image quality than MRA
Consider local availability, patient’s ability to tolerate long MRI examination time
Medicalis projects
Evidence based order entry system piloted in pediatrics and more recently SE Manitoba
Dr.Martin Reed /Canadian Association of Radiologists
British Society of Radiology criteria modified to Canadian environment and placed in an electronic order entry system
BGSG Project
Bridging the generalist to specialist gap-Luis Oppenheimer
Initial project for assessment of low back pain.Advantage for having patient and physician
engagement in process
Thank you