Use of MRI in Primary Care for MSK conditions
The ICS is implementing a programme of transformation for community MSK services across North East London, investing in increased capacity to improve waiting times. One of the key enablers to invest more into community service capacity is reducing our MRI activity.
Each MRI costs the equivalent of the average patient being assessed and treated in an MSK physio led community service. Rates of Requests for MRIs (per 100,000) from Primary Care are increasing and in some areas are several times the expected levels.
It is important we use MRIs in accordance with guidance and specifically for Back and Neck pain we should remember GIRFT:
- Most back or radicular pain settles within 3 months.
- MRI is rarely indicated for back or neck pain and should only be organised after assessment by a musculoskeletal practitioner with spinal expertise.
- They cannot tell how someone feels and are not a diagnosis. Spinal MRI findings always need to be interpreted in the context of a clinical assessment. Findings described in MRI reports are very common in people with NO PAIN, such as disc degeneration (80%), disc bulges (60%), disc protrusion (36%), annular tear (23%)1 (aged 50 years). These findings increase with age and can be signs of a naturally maturing spine.
- Nine out of ten people with NO neck pain have disc bulges on MRI and most people in their 20s have bulging discs.
- There is good evidence to suggest that unwarranted MRI scans are detrimental to patient wellbeing and lead to poorer outcomes
References:
1. W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes and J.G. Jarvik. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Apr 2015, 36 (4) 811-816.
2. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine (Phila Pa 1976). 2015 Mar 15;40(6):392-8
3. Sajid IM, Parkunan A, Frost K. Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care BMJ Open Quality 2021;10:e001287.
Please also note the attached leaflet for patients concerning MRIs which clearly states that MRIs are rarely needed for people with back or neck pain and should be requested by an MSK specialist rather than a general practitioner. If you have any queries please contact shahnaz.begum5@nhs.net in the first instance.