title: Review of MRI wrist examination since introduction of Medicare item number.
abstract: BACKGROUND
  The Australian Health Department provided extended rebatable requesting rights to general practitioners in 2012 for magnetic resonance imaging (MRI) examinations in patients less than 16 years of age for a small set of clinically appropriate indications. Included item numbers 63522 and 63523 'referral by a medical practitioner (excluding a specialist and consultant physician) for a scan of wrist following radiographic examination where scaphoid fracture is suspected'. The aim of this study is to evaluate MRI examinations of suspected scaphoid fractures in the paediatric population following the Medicare item number introduction.
  
  
  METHODS
  Review of 60 consecutive MR wrist examinations requested by general practitioners and performed between 30 November 2012 and 16 July 2014 for a rebatable magnet in a private clinical setting. The indication for all studies was to exclude a clinically suspected fractured scaphoid following a normal radiograph. All patients were less than 16 years of age at time of examination.
  
  
  RESULTS
  Sixty examinations were performed; 51 revealed pathology (85% of cases) with nine normal examinations (15%). Twenty-nine studies revealed one of more fractures involving the carpals, metacarpals or distal radius. In total, 41 fractures were identified on MRI examination with 29 carpal bone fractures, six distal radius fractures and six metacarpal fractures.
  
  
  CONCLUSIONS
  The results highlight the sensitivity of MR wrist examination and its diagnostic benefit in clinically suspected paediatric scaphoid fractures. In addition, it reflects the prudent referral nature of general practitioners.
authors.affiliation: Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Jones
authors.affiliation: Sunshine Coast Radiology, Maroochydore, Queensland, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Sinnamon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000473:pathology*; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data*; D015995:Prevalence; D011793:Queensland / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States; D014600:Utilization Review; D014954:Wrist Injuries / Q000453:epidemiology* / Q000473:pathology*
keywords: MRI; carpal; fracture; microtrabecular; scaphoid