When is MRI appropriate?

1. When is MRI appropriate? B. McClarty Dept. of Radiology

2. MRI Utilization

3. Methods • 1.American College of Radiology Appropriateness Criteria • 2.CAR Medicalis Pilots • 3. BSCG project

4. ACR Appropriateness Criteria • Recommendation of which examination is most useful for investigation of a clinical symptom or condition • MRI is the preferred method for investigation of the CNS and musculo skeletal complaints and is complimentary examination for the chest, abdomen, and cardiovascular conditions.

5. ACR con’t • Shortened ACR criteria for CNS complaints • If you are ordering an infused CT of the brain or spinal cord, consider MRI • Do uninfused CT in preference to MRI for assessment of bone fractures or hemorrhage including SAH • Do CT for mastoids, sinuses due to high bone air contrast and better spatial resolution of CT

6. CT vs. MRI Mastoids

7. ACR con’t • Infused CT is the primary modality for the assessment of neck lesions /cervical lymphadenopathy • CT angiography has higher spatial resolution and better image quality than MRA • Consider local availability, patient’s ability to tolerate long MRI examination time

8. Medicalis projects • Evidence based order entry system piloted in pediatrics and more recently SE Manitoba • Dr.Martin Reed /Canadian Association of Radiologists • British Society of Radiology criteria modified to Canadian environment and placed in an electronic order entry system

9. BGSG Project • Bridging the generalist to specialist gap-Luis Oppenheimer • Initial project for assessment of low back pain. • Advantage for having patient and physician engagement in process

11. Thank you