title: Inappropriate requests for magnetic resonance scans of the shoulder.
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) scans are a useful investigation for some shoulder pathology. They are costly however and a significant burden on radiology departments. In most cases clinical examination, plain radiography or ultrasound scan (USS) are sufficient for a diagnosis. There are no current UK guidelines regarding MRI shoulder scan requests.
  
  
  METHODS
  We reviewed 100 consecutive MRI shoulder scan requests and the associated formal reports; other investigations were also assessed.
  
  
  RESULTS
  Overall, 56% of MRI scans were ordered inappropriately. Shoulder consultant's requests were more appropriate than other groups (70% vs. 38%. p = 0.04). Excluding shoulder consultants 63 % of scans were inappropriately ordered. Shoulder consultants were more likely to order a preceding X-ray (80% vs. 53% respectively, p = 0.03). Of those with a clinical diagnosis of cuff pathology only 29% had an USS.
  
  
  CONCLUSIONS
  A high percentage of MRI shoulder scans are performed inappropriately. Shoulder consultants are more appropriate in their ordering than other groups. If all groups performed as well 50 % less MRI scans would need to be performed.
authors.affiliation: Royal Sussex County Hospital, Brighton & Sussex University Hospital Trust, Eastern Road, Brighton, BN2 5BE, UK, richardfreeman@doctors.net.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Freeman
authors.forename: Sanjay
authors.initials: S
authors.lastname: Khanna
authors.forename: David
authors.initials: D
authors.lastname: Ricketts
mesh_terms: D001175:Arthrography / Q000191:economics; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D017408:Guidelines as Topic; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography / Q000191:economics; D006113:United Kingdom