Audit of MRI protocol, referral pattern and appropriateness of clinical indications for lumbar spine MRI use for adult low back pain: A single- centre study in Ghana.

Abstract

A guideline for MRI request is nonexistent in Ghana. This study is to evaluate the local lumbar spine MRI protocol, clinical indications, referral sources, imaging findings and the appropriateness of the request using the Appropriateness Criteria (AC) of the American College of Radiology (ACR) for MRI of Lower Back Pain (LBP) patients. Using a Ghanaian tertiary hospital’s MRI centre, we evaluated the local MRI protocol used for lumbar spine imaging, reviewed the referral sources of adult patients (18 years and above) within a six-month period. The age, gender, clinical indication, imaging findings and the appropriateness of lumbar spine MRI for low back pain (LBP) was descriptively analyzed using Excel 2013. A total of 242 patients (females 140, males 102) underwent MRI for LBP within a six-month period. The existing MRI protocol was justified. Using the AC of ACR, about 39% of MRI requests were “ usually appropriate ” , 36% “ may be appropriate ” , and 25% were “ usually not appropriate”. Most referrals were from the OPD (58%). Most common indication was LBP/sciatica (52.1%); the most common imaging finding was degenerative changes (65.0%). The local MRI protocol for LBP was justified. Judicious request for MRI is very necessary to avoid wastefulness. MRI centers must prioritize requests coming from Orthopedic Specialists and not the OPD. The main imaging finding was degenerative bone disease which plain radiography can diagnose. This study may serve as a reference for local lumbar spine MRI practice, and inform local practice.