CT/MRI scan study suggests some tests are overprescribed



    TORONTO, June 26 /CNW/ - Ontario wait times have improved and this is
attributed to the tens of millions of dollars pumped into health care by the
province. But Ontarians continue to face long lineups for MRI and CT scans. We
now have a much clearer picture on why people are waiting in some instances -
doctors may be ordering tests when they are not really necessary.
    Based on findings from Ontario's Institute for Clinical Evaluative
Sciences (ICES), scientists conclude that CT / MRI tests could be performed
less often for some patients. "The focus of the Ontario Wait Times Strategy
has been to spend nearly $100 million in the province to increase the supply
of CT and MRI, yet despite this, wait times for MRI are still way above
target. An obvious question is whether the scans are being ordered for the
right and appropriate reasons," says principal investigator and ICES
Scientist, John You. "For the first time, this study puts a spotlight on why
tests are ordered and how often they find abnormalities that will influence
patient management. For many patients, CT and MRI scans are a crucial part of
their care and they are waiting too long to get their tests. One way of
reducing wait times is to not order scans in patients who are unlikely to
benefit from them. If we can reduce inappropriate use, then we can improve
access to CT and MRI scans for those who will benefit."

    
    The study of 11,824 outpatient CT scans and 11,867 outpatient MRI scans
from randomly selected Ontario hospitals performed after January 1, 2005
found:

    -   Headache was the most frequent indication for CT scans of the brain:
        less than two percent of these scans found treatable abnormalities
        that could explain the headache.

    -   Back pain was the most common indication for MRI scans of the spine:
        80% of these scans were abnormal, but the clinical importance of the
        abnormalities was unclear.

    -   Over half of MRI scans of the extremities were for knee pain or
        suspected cartilage tear: 90% of these scans were abnormal, but the
        clinical importance of the abnormalities was unclear.

    -   1 in 4 CT abdomen/pelvis and CT chest reports recommend more
        testing.

    -   More MRI scans were performed on patients living in high-income
        neighbourhoods than in low-income neighbourhoods, suggesting that
        access to MRI may be influenced by factors other than clinical need
        alone. No neighbourhood income trend seen for CT scans.

    -   Family physicians ordered the greatest number of scans, compared to
        other physician types.

    -   Cancer-related indications accounted for over 50% of CT's of the
        abdomen/pelvis and chest.
    

    "As doctors, we sometimes get a bit defensive about the appropriateness
of our own ordering patterns," says You, Staff Physician at McMaster
University. "One group of physicians will tend to point fingers at another as
the source of the problem. But in reality, the onus doesn't fall on one single
group, and all of us - physicians, patients, researchers and government - must
each play a role in improving the system."
    In the province of Ontario the number of CT scans increased 4-fold and
the number of MRI scans increased 12-fold between 1993 and 2006. Currently,
the reported wait times are 5.5 weeks for a CT scan and 14 weeks for an MRI
scan, defined as the time by which 90% of patients have had their scans.

    
    Possible ways of decreasing inappropriate use:

    -   Better decision support using e-health solutions, developing
        web-based systems of ordering CT and MRI that incorporate current
        practice guidelines.

    -   Tracking ordering patterns in real-time would allow feedback to
        clinicians, their peers and practice guidelines.

    -   Educating physcians and the public about the pros and cons of
        diagnostic imaging is crucial. They must understand that diagnostic
        imaging tests are not perfect, they do not always provide a final
        diagnosis, can cause unnecessary anxiety and complications from
        biopsies when abnormalities turn out to be false alarm positives or
        'red herrings', and CT scans expose patients to radiation.
    

    The study "Indications for and results of outpatient computed tomography
and magnetic resonance imaging in Ontario" is in the June issue of Association
of Radiologists Journal.

    More detailed study findings on the ICES website:
http://intool.ices.on.ca

    To view study, please visit: http://files.newswire.ca/650/ICES_Study.pdf

    Author affiliations: ICES
(Dr.You,Laupacis,Ms.Rothwell,Mr.Purdy,Przybysz,Fang); McMaster
University(Dr.You); Keenan Research Centre,Li Ka Shing Knowledge Institute of
St.Michael's Hospital (Dr.Laupacis), Ontario.

    ICES is an independent, non-profit organization that uses
population-based health information to produce knowledge on a broad range of
health care issues. Our unbiased evidence provides measures of health system
performance, a clearer understanding of the shifting health care needs of
Ontarians, and a stimulus for discussion of practical solutions to optimize
scarce resources. ICES knowledge is highly regarded in Canada and abroad, and
is widely used by government, hospitals, planners, and practitioners to make
decisions about care delivery and to develop policy.





For further information:

For further information: Kristine Galka, Media Advisor, ICES, (416)
480-4780, (416) 629-8493

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