- Rabab Abdalla Mohamed* & Yara Mohamed Abdalmoneem
- *Sohag Health Insurance Organization, Head of clinical research department
- DOI: 10.5281/zenodo.17926672
Background: Musculoskeletal
(MSK) imaging is essential for diagnosing bone, joint, and soft tissue
disorders, but inappropriate referrals remain a widespread challenge. Excessive
and unnecessary MRI requests increase healthcare costs and offer limited
clinical benefit. This study aimed to assess current MSK imaging referral
patterns, identify areas of inappropriate imaging, and implement evidence-based
guidelines adapted to the local context.
Methods: A prospective audit and
intervention development study was conducted at the Sohag Health Insurance
Organization over five months (Phase 1: four months; Phase 2: one month). Adult
patients referred for MSK imaging and their referring clinicians in
orthopedics, family medicine, rheumatology, and emergency medicine were
included. Referral appropriateness was evaluated using international imaging
guidelines, and data on imaging findings, clinical benefit, and follow-up were
analyzed before and after guideline implementation.
Results: Among 199 referrals, 43.2% originated from orthopedics,
26.1% from neurology, and 24.6% from neurosurgery. Low back pain (33.7%) was
the most common indication, and 49.7% of MRIs showed abnormal findings.
However, only 28.1% were clinically useful, while 46.8% were unnecessary. A
significant relationship was found between referring specialty and MRI
usefulness (p = 0.010) and between MRI findings and follow-up availability (p
< 0.001). Following the implementation of local referral guidelines, the
rate of appropriate imaging requests improved, particularly among orthopedic
clinicians.
Conclusion: A large proportion of MSK MRI referrals were found to
be inappropriate, especially for non-specific back pain. The introduction of
evidence-based, locally tailored referral guidelines improved imaging
appropriateness and clinical efficiency.
