Which imaging option to choose

Imaging plays a vital role in modern medicine; however there are concerns that its benefits may be overshadowed by its risks in certain situations.1

How much is too much?

Over the last decade requests for imaging services have increased in Australia with the greatest rise in requests for MRI and nuclear medicine.2 GPs are the largest users of imaging services and requested over 12 million imaging procedures in the 2011/12 financial year. This accounts for over 70% of total imaging referrals for that period.3

Choose carefully

Careful selection of imaging modalities is needed for clinically meaningful outcomes and to reduce imaging overuse, unnecessary radiation exposure and waiting lists. Appropriate use of imaging technologies can benefit patients and the community.

Encounters commonly seen in general practice when imaging may be considered include:

  • headache
  • back pain
  • other musculoskeletal conditions.4,5
glucose monitoring
Figure 2: Guidelines on requests for MRI, CT, X-ray or ultrasound
(Based on radiological standards and guidelines. Not a complete list of indications or situations due to the continuously evolving variety of equipment, modalities and indications.6)

Before you request

Before requesting imaging:

  • Ensure the expected benefits of imaging outweigh the potential harms.
  • Inform patient of benefits and potential harms of imaging technique.
  • Refer people with symptoms of a specific disease for imaging using an appropriate technology.
  • Only re-image if symptoms change or new ones present.

Find out more

The Medicinewise News: magnetic resonance imaging in primary care discusses the role of MRI in primary care and how ordering has evolved over the last decade.

References
  1. Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013;346:f2360. [PubMed]
  2. Australian Diagnostic Imaging Association. What patients need: accesible, accurate, affordable and early diagnosis through quality diagnostic imaging. Federal Budget Submission 2012-2013. 2012. http://www.adia.asn.au/sites/default/files/020211%20ADIA%20Federal%20Budget%20Submission%202011-12.pdf (accessed 7 June 2013).
  3. Medical Benefits Reviews Task Group, Diagnostic Imaging Review Team, Department of Health and Ageing. Review of funding for diagnostic imaging services: final report. 2011. http://chiropractors.asn.au/AM/Template.cfm?Section=Submissions4&Template=/CM/ContentDisplay.cfm&ContentID=14530 (accessed 21 March 2013).
  4. Gough-Palmer AL, Burnett C, Gedroyc WM. Open access to MRI for general practitioners: 12 years' experience at one institution – a retrospective analysis. Br J Radiol 2009;82:687–90. [PubMed]
  5. Miller G, Valenti L, Charles J. Use of diagnostic imaging in Australian general practice. Aust Fam Physician 2006;35:280–1. [PubMed]
  6. The Canadian Association of Radiologists. CAR Standard for MRI Imaging. Ottawa, 2011. http://www.car.ca/uploads/standards%20guidelines/20110428_en_standard_magnetic_resonance.pdf (accessed 9 August 2012).