Unneeded CT, MRI scans down, AHS says

A provincial initiative to reduce unwarranted MRI and CT scans has met with some success, but more work needs to be done to curb rising wait times for the expensive diagnostic tests, Alberta Health Services says.

Efforts that began three years ago have so far resulted in a 12 per cent drop in magnetic resonance imaging scans for the lumbar spine and lower back, Mauro Chies, vicepresident of clinical support services, said Friday.

“We made a good gain in terms of reducing the number of orders … But I think it’s fair to say we were hoping for more,” Chies said.

Computed tomography tests for lumbar spine and lower back have also come down, although the effect is less significant because the vast majority of scans on this part of the body are done through an MRI.

Health officials decided to focus on lower back imaging following the development of new guidelines that suggested many such tests are unnecessary.

A study from Alberta researchers published in 2013 reviewed 2,000 requests for magnetic resonance imaging in Alberta and Ontario, finding more than 50 per cent of such scans for the lower back were inappropriate or had minimal value.

Among family doctors, just 34 per cent of the orders were found to be appropriate.

Some radiologists have disputed the research.

Regardless, lower back imaging comprises about 30 per cent of all MRI orders in the province, so it’s an obvious target to try to reduce both costs and wait times, Chies said.

The effort has largely centred on better educating doctors to avoid diagnostic scans unless specific red flags are present, such as a suspected infection, compression fracture or cancer.

For many patients with lower back pain, exercise and physiotherapy are often the recommended option.

To achieve further reductions in unnecessary tests, Chies said AHS leaders are hoping the development of the new Connect Care information technology platform will help.

The technology will include a tool called “clinical decision support,” which can guide physicians in determining the best use of particular tests.

As well, committees of experts are looking at other potential overuses of CTs and MRIs, including some scans for headaches or knee pain, Chies said.

“We try to go body part by body part.”

The effort comes during a period when wait times for MRIs and CTs have climbed significantly in Alberta and other parts of Canada.

Statistics from the Canadian Institute for Health Information showed that in 2017, half of Alberta patients waiting for an MRI were accommodated within 96 days — up from 84 days the year before.

To scan 90 per cent of the patients on the list, the rate jumped to 277 days from 242 days over the same period.

Those waits were the worst in Canada among the six provinces that submitted data.

Waits for a CT scan were also among the longest in the country, with Alberta accommodating half its patients within 30 days last year.