title: Developing Criteria for Lumbar Spine Magnetic Resonance Imaging (MRI) Using RAND Appropriateness Method (RAM).
abstract: BACKGROUND
  Studies show that a large proportion of healthcare offered may be inappropriate or unnecessary. Magnetic resonance imaging (MRI) is a new and expensive diagnostic technology which has been increasingly used all over the world. Moreover, this trend has been more rapidly increasing in Iran. Low back pain is a common disorder all over the world and MRI technique is one of the several ways to assess its cause.
  
  
  OBJECTIVE
  The present study aims to develop scenarios for lumbar spine MRI.
  
  
  METHODS
  In the present study, the RAND Appropriateness Method (RAM) was used in order to reach consensus regarding developing scenarios for lumbar spine MRI. We generated scenarios from valid clinical guidelines as well as the experts' opinion. The panel members included nine specialists from various medical specialties that had scored scenarios in two rounds, the first of which was without interaction, while the second one was with interaction.
  
  
  RESULTS
  We extracted 97 scenarios for the lumbar spine MRI in the scenario extracting phase of the study and the panel members added 18 scenarios. After implementation of two rounds, the scenarios were categorized into three ranges. Sixty seven (58%) of the scenarios were considered as appropriate, 45 (39%) as uncertain, and three (2.6%) as inappropriate.
  
  
  CONCLUSIONS
  RAM is useful for identifying stakeholder views in settings with limited resources. Since RAM has precise instructions for consensus developing, a large number of scenarios were considered as uncertain. Therefore, more research has to be conducted on the issue.
authors: Department of Medical Informatics and Management, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Ali
authors: A
authors: Keshtkaran
authors: Mohammad Hadi
authors: MH
authors: Bagheri
authors: Rahim
authors: R
authors: Ostovar
authors: Hedayat
authors: H
authors: Salari
authors: Majid Reza
authors: MR
authors: Farokhi
authors: Atefeh
authors: A
authors: Esfandiari
authors: Hossein
authors: H
authors: Yousefimanesh
keywords: Clinical Scenario; Lumbar Vertebrae; Magnetic Resonance Imaging; RAND, RAM