Qualität und Sicherheit in der Gesundheitsversorgung / Quality and Safety in Health Care| Volume 137, P20-26, November 01, 2018

Methods to detect inappropriate use of MRI and CT for musculoskeletal conditions: A scoping review

Published:November 06, 2018DOI:https://doi.org/10.1016/j.zefq.2018.09.002



      Identify and evaluate methods suitable for detecting inappropriate use of MRI or CT in the musculoskeletal system.


      Systematic review of studies that described methods to measure inappropriate use of MRI or CT in the musculoskeletal system. We used a multi-step strategy to classify identified methods into categories. These categories were then analyzed according to the data needed and their limitations.

      Eligibility criteria for selecting studies

      English or German language studies that measured inappropriate use of MRI or CT in the musculoskeletal system. Articles were also included if they reported a general approach to the measurement of inappropriate imaging regardless of body region. Expert opinions, unsystematic reviews, commentaries, articles without abstracts, and studies on cancer were excluded.


      47 studies met the inclusion criteria. The categorization of the studies resulted in seven individual approaches to measure inappropriate use: (1) availability of meaningful diagnostic information; (2) predictors associated with imaging use; (3) comparison with guideline recommendations; (4) assessment by experts; (5) comparison or analysis of patients’ paths; (6) comparison with surgery findings; (7) geographic variation. All these approaches have specific data requirements and individual advantages and disadvantages regarding risk of bias and needed data.


      We could not find a single method of choice to detect inappropriate use of MRI or CT in the musculoskeletal system. A combination of different approaches is the preferred strategy to deal with the advantages and disadvantages of the individual methods.



      Identifikation und Evaluation von Methoden zur Feststellung von unangemessener MRT- oder CT-Nutzung im Muskel-Skelett-System.


      Systematische Übersichtsarbeit von Studien, die Methoden zur Feststellung von unangemessener MRT- oder CT-Nutzung beschrieben haben. Studien wurden in einem mehrstufigen Verfahren ausgewählt und strukturiert. Methodenkategorien wurden anhand der benötigten Daten und ihrer Limitationen analysiert.

      Auswahlkriterien für Studien

      Englisch- oder deutschsprachige Artikel, die unangemessene CT- oder MRT-Nutzung im Muskel-Skelett-System gemessen haben. Studien wurden auch eingeschlossen, wenn ein allgemeiner Ansatz, unabhängig von der Körperregion, beschrieben wurde. Expertenmeinungen, unsystematische Reviews, Kommentare, Artikel ohne Abstract und Studien mit Schwerpunkt Krebs wurden ausgeschlossen.


      47 Studien erfüllten die Einschlusskriterien. Die Kategorisierung der Methoden ergab 7 verschiedene Ansätze: (1) Verwendbare diagnostische Information; (2) Prädiktoren in Verbindung mit der Nutzung bildgebender Verfahren; (3) Vergleich mit Leitlinienempfehlungen; (4) Expertenurteile; (5) Vergleiche oder Analyse verschiedener Behandlungsverläufe; (6) Vergleich mit Operationsbefunden; (7) Regionale Unterschiede. Alle Ansätze waren mit individuellen Vorteilen und Schwächen verbunden und wiesen bestimmte Anforderungen an die Daten auf.


      Wir konnten keine einzelne Methode der Wahl zur Identifikation von unangemessener MRT- oder CT-Nutzung im Muskel-Skelett-System finden. Eine Kombination unterschiedlicher Verfahren kann Nachteile der einzelnen Methoden ausgleichen und Vorteile kombinieren.



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