When is MRI appropriate?

B. McClarty

Dept. of Radiology

MRI Utilization

MRI Exams performed in Winnipeg - 2003/04 to 2008/09

17,825

20,860

24,443

32,234

35,721

39,523

-

10,000

20,000

30,000

40,000

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

Exa

ms

Methods

1.American College of Radiology Appropriateness Criteria

2.CAR Medicalis Pilots3. BSCG project

ACR Appropriateness Criteria

Recommendation of which examination is most useful for investigation of a clinical symptom or conditionMRI is the preferred method for

investigation of the CNS and musculo skeletal complaints and is complimentary examination for the chest, abdomen, and cardiovascular conditions.

ACR con’t

Shortened ACR criteria for CNS complaints If you are ordering an infused CT of the

brain or spinal cord, consider MRIDo uninfused CT in preference to MRI for

assessment of bone fractures or hemorrhage including SAH

Do CT for mastoids, sinuses due to high bone air contrast and better spatial resolution of CT

CT vs. MRI Mastoids

ACR con’t

Infused CT is the primary modality for the assessment of neck lesions /cervical lymphadenopathy

CT angiography has higher spatial resolution and better image quality than MRA

Consider local availability, patient’s ability to tolerate long MRI examination time

Medicalis projects

Evidence based order entry system piloted in pediatrics and more recently SE Manitoba

Dr.Martin Reed /Canadian Association of Radiologists

British Society of Radiology criteria modified to Canadian environment and placed in an electronic order entry system

BGSG Project

Bridging the generalist to specialist gap-Luis Oppenheimer

Initial project for assessment of low back pain.Advantage for having patient and physician

engagement in process

Thank you