According to director of clinical policy for the American College of Physicians, Amir Qaseem, MD, “Low back pain is one of the most common reasons for a patient to see a physician and many patients with low back pain receive routine imaging that is not beneficial and may not even be harmful. Unnecessary imaging can lead to a series of unnecessary additional tests, interventions, follow ups, and referrals that do not improve patient outcomes.”
The American College of Physician’s recommendations are based on a systematic review conducted for the Diagnosis and Treatment of Low Back Pain and the American Pain Society, and a subsequent meta-analysis. The resulting conclusions detail that decisions for repeat imaging should be based on the development of new symptoms or changes in current symptoms. Patient’s should be educated about the current and effective standards of care and the benefits and harms of radiological testing.
An MRI machine utilizes a strong magnetic field to align the magnetization of some atoms in the body, and radio frequency fields to alter their alignment. This results in nuclei producing a rotating magnetic field that can be detected by the scanner. The gathered information is then recorded to construct an image of the scanned area of the body.
A CAT scan is a medical imaging tool that employs tomography created by computer processing. Digital geometry is employed to generate a three dimensional image of the inside of an object using a large number of two-dimensional X-ray images taken around a single axis of rotation.
The guidelines claim that for doctors, it is critical to assess the benefits, harms, and costs of an intervention to determine if it presents a good value. It is essential to reduce the implementation of interventions that provide no benefit. Assessment of the cost of an intervention should also take into account any costs that might incur as a result of the original intervention.
Paul Shekelle, MD, of the Clinical Guidelines Committee concludes, “Efforts to control expenditures should not focus solely on the costs, but rather on the value of health-care interventions. The best way to maintain effective and efficient care is to identify and eliminate wasteful practices, and to demonstrate which interventions provide high-value, which means their benefit is sufficient to justify their harms and costs.”