title: MRI of the knee and shoulder performed before radiography.
abstract: OBJECTIVE
  Available data are limited on the level of adherence to established guidelines for appropriate utilization of MR in musculoskeletal imaging. This study estimates the percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography, which thus may fall outside the ACR Appropriateness Criteria for the Medicare and commercially insured populations.
  
  
  METHODS
  The percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography was estimated among patients in the Medicare 5% carrier claims limited data set and among commercially insured patients in the Truven Marketscan Treatment Pathways database in 2010.
  
  
  RESULTS
  Approximately 28% of all knee MRIs, and 35%-37% of all shoulder MRIs were performed without recent prior radiographs. The extrapolated expense of these potentially unwarranted MRIs in the entire fee-for-service Medicare population was between $20 and $35 million. Between 20% and 23% of patients undergoing knee MRI, and 27%-32% undergoing shoulder MRI, did not have radiographic examination at any point before the MRI in the same calendar year.
  
  
  CONCLUSIONS
  MRI performed without prior radiography represents a potential gap in care and should be considered as an area for establishment of performance measures.
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachussetts.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: George
authors.affiliation: AMA, Chicago, Illinois.
authors.forename: Stavros
authors.initials: S
authors.lastname: Tsipas
authors.affiliation: AMA, Chicago, Illinois.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wozniak
authors.affiliation: Musculoskeletal Radiology Section, Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: David A
authors.initials: DA
authors.lastname: Rubin
authors.affiliation: Sutter Medical Group, Sacramento, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Seidenwurm
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachussetts.
authors.forename: Kesav
authors.initials: K
authors.lastname: Raghavan
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: William
authors.initials: W
authors.lastname: Golden
authors.affiliation: American College of Radiology, Reston, Virginia.
authors.forename: Colleen
authors.initials: C
authors.lastname: Tallant
authors.affiliation: American College of Radiology, Reston, Virginia.
authors.forename: Mythreyi
authors.initials: M
authors.lastname: Bhargavan-Chatfield
authors.affiliation: American College of Radiology, Reston, Virginia.
authors.forename: Judy
authors.initials: J
authors.lastname: Burleson
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachussetts. Electronic address: frybicki@partners.org.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007717:Knee; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000175:diagnosis*; D052256:Tendinopathy / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014481:United States
keywords: Appropriateness criteria; decision support; overutilization; performance measure; radiology