title: Two-tiered approach to MRI for headache: a cost-effective way to use an expensive technology.
abstract: OBJECTIVE
  The purpose of this study was to compare the diagnostic efficacy and cost implications of a proposed two-tiered approach to MRI in patients with headache.
  
  
  METHODS
  We identified 245 consecutive patients with headache using MRI studies performed at a tertiary care facility between October 2009 and July 2011. Three radiologists prospectively used FLAIR sequences from these MR studies to diagnose underlying abnormality or to identify the need for a comprehensive MRI study. We compared the diagnostic efficacy and the cost implications of such a two-tiered approach with those of conventional MRI from the perspectives of the payer, the patient, and the imaging facility.
  
  
  RESULTS
  The sensitivity and specificity for two-tiered (83.3% and 100%, respectively) and conventional (91% and 97.8%, respectively) MRI approaches were not significantly different. Assuming a 50% reduction in the payment for the initial limited MRI performed as a first step of the two-tiered approach, this approach would have resulted in 44.8% savings to the payer. A substantial reduction in the scanner utilization time from 4168 minutes to 1249 minutes for the two-tiered approach would have enabled increased throughput at the imaging facility. Although 27 (11%) patients would have been recalled for a comprehensive MRI study in the two-tiered approach, the average time spent in the scanner by each patient would have been less for the two-tiered approach (5.1 minutes vs 17.0 minutes).
  
  
  CONCLUSIONS
  A two-tiered approach to MRI can serve as a viable cost-effective alternative to the conventional approach.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 510 S Kingshighway Blvd, St. Louis, MO 63110, USA. sharmaa@mir.wustl.edu
authors.forename: Aseem
authors.initials: A
authors.lastname: Sharma
authors.forename: Martin
authors.initials: M
authors.lastname: Reis
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Parsons
authors.forename: Franz J
authors.initials: FJ
authors.lastname: Wippold
authors.forename: John
authors.initials: J
authors.lastname: Chrisinger
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Schwedt
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Pilgram
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D017408:Guidelines as Topic; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019233:Retreatment / Q000191:economics; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D003287:Contrast Media