Castillo S, Joodi R, Williams LE, Pezeshk P, Chhabra A. Sacrum magnetic resonance imaging for low back and tail bone pain: A quality initiative to evaluate and improve imaging utility. World J Methodol 2021; 11(4): 110-115 [PMID: 34322363 DOI: 10.5662/wjm.v11.i4.110]
Corresponding Author of This Article
Samantha Castillo, MD, Academic Fellow, Department of Radiology, UT Southwestern, 5303 Harry Hines Blvd, Dallas, TX 75390, United States. ssirignano@gmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Academic Activity Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Jul 20, 2021; 11(4): 110-115 Published online Jul 20, 2021. doi: 10.5662/wjm.v11.i4.110
Sacrum magnetic resonance imaging for low back and tail bone pain: A quality initiative to evaluate and improve imaging utility
Samantha Castillo, Robert Joodi, L Errett Williams, Parham Pezeshk, Avneesh Chhabra
Samantha Castillo, Robert Joodi, Parham Pezeshk, Avneesh Chhabra, Department of Radiology, UT Southwestern, Dallas, TX 75390, United States
L Errett Williams, Medical School, UT Southwestern, Dallas, TX 75390, United States
Author contributions: Chhabra A, Pezeshk P and Joodi R conceived of the project; Joodi R, Castillo S and Williams LE performed a retrospective chart review and data analysis under the guidance of Drs. Chhabra A and Pezeshk P. Chhabra A and Pezeshk P reviewed patient imaging; Castillo S and Pezeshk P prepared and performed clinician education; Castillo S, Pezeshk P and Chhabra A contributed to the final version of the manuscript.
Conflict-of-interest statement: Dr. Chhabra A receives payment as a consultant for Treace 3D Medical Inc. and Icon Medical and book royalties from Jaypee and Wolters. The remaining authors have no financial conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Samantha Castillo, MD, Academic Fellow, Department of Radiology, UT Southwestern, 5303 Harry Hines Blvd, Dallas, TX 75390, United States. ssirignano@gmail.com
Received: October 22, 2020 Peer-review started: October 22, 2020 First decision: November 25, 2020 Revised: December 20, 2020 Accepted: May 20, 2021 Article in press: May 20, 2021 Published online: July 20, 2021
Abstract
As quality and cost effectiveness become essential in clinical practice, an evidence-based evaluation of the utility of imaging orders becomes an important consideration for radiology’s value in patient care. We report an institutional quality improvement project including a retrospective review of utility of sacrum magnetic resonance (MR) imaging for low back pain at our institution over a four-year period and follow-up results after physician education intervention. Sacral MR imaging for low back pain and tailbone pain were only positive for major findings in 2/98 (2%) cases, and no major changes in patient management related to imaging findings occurred over this period, resulting in almost $500000 cost without significant patient benefit. We distributed these results to the Family Medicine department and clinics that frequently placed this order. An approximately 83% drop in ordering rate occurred over the ensuing 3 mo follow-up period. Sacrum MR imaging for low back pain and tail bone pain has not been a cost-effective diagnostic tool at our institution. Physician education was a useful tool in reducing overutilization of this study, with a remarkable drop in such studies after sharing these findings with primary care physicians at the institution. In conclusion, sacrum MR imaging rarely elucidates the cause of low back/tail pain diagnosed in a primary care setting and is even less likely to result in major changes in management. The practice can be adopted in other institutions for the benefit of their patients and improve cost efficiency.
Core Tip: Sacrum magnetic resonance studies ordered for low back pain were suspected to lack clinical utility at our institution. A literature review demonstrated a lack of evidence based practice in ordering of this study for low back/tail bone pain. A quality project was then pursued to first assess the clinical usefulness of the study. Over four years these studies had no major impacts on management. An educational component of the quality project was then pursued with a rapid decrease in the number of studies ordered by referring providers.
