title: The extent of inappropriate use of magnetic resonance imaging in low back pain and its contributory factors.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is an expensive and commonly used technology with a variety of indications in patient diagnosis and treatments. The aim of this study is to identify a comprehensive list of indications and contraindications for MRI in patients with low back pain (LBP) and to determine the appropriateness of using this technology in these patients on the basis of this list.
  
  
  METHODS
  A cross-sectional study was conducted in four radiographic centers in Tehran, Iran. A list of MRI indications and contraindications for LBP was developed by review of documents and expert panel. A pre structured checklist was designed and incorporated into a structured form. All 100 consecutive patients referring to four radiographic centers for performing MRI regarding LBP completed the questionnaire. Chi-square, Fisher's Exact Test and logistic Regression were used to assess statistical significance.
  
  
  RESULTS
  In this study, 187 patients (46.7%) had an indication for MRI, but 186 patients (46.5%) had no indication, 18 patients (4.5%) had indication and contraindication at the same time and nine patients (2.3%) had contraindication. Moreover, 71 patients (17.8%) underwent MRI for LBP during the past 2 years, of which 14 (19.7%) had normal results. Patients with complementary private insurance had a history of previous MRI about 20% more than other patients (P = 0.018). There was a statistically significant relationship between complementary private insurance coverage and number of MRI performed (P = 0.006).
  
  
  CONCLUSIONS
  About half of the patients referring to radiographic centers with LBP for MRI had no indication for this test.
authors.affiliation: Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sanaz Zargar Balaye
authors.initials: SZ
authors.lastname: Jame
authors.affiliation: Department of Health Management and Economics, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali Akbari
authors.initials: AA
authors.lastname: Sari
authors.affiliation: Department of Epidemiology and Biostatistics, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Majdzadeh
authors.affiliation: Department of Health Management and Economics, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arab
authors.affiliation: Department of Health Care Management, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hojjat
authors.initials: H
authors.lastname: Rahmani
keywords: Appropriate use; contraindication; indication; low back pain; magnetic resonance imaging