Public health

MBS review fails to address excessive imaging in primary care

Recommendations from the MBS Review of diagnostic imaging for low back pain lack sufficient details and do not adequately address the problem of excessive imaging in primary practice, Members of the Working Group say.

According to some members of the Low Back Pain Imaging Working Group, the 300-page report is incomplete without more details such as defined indications or strategies for ensuring appropriate imaging requests by clinicians.

Professor Chris Maher, director of the George Institute for Global Health’s musculoskeletal division and Australian Physiotherapy Association representative on the working group, said the recommendation to consider GP‐requested MRI of the lumbar‐sacral spine was a case in point.

“I have no problems replacing the appropriate use of CT with the appropriate use of MRI but unless we have those defined indications and strategies to limit unnecessary requests, then we are simply reducing patient exposure to radiation and replacing CT with a more expensive imaging technique.”

Australian Rheumatology Association president and representative on the working group Professor Rachelle Buchbinder said the recommendations were well intentioned but needed more safeguards.

“I’m very worried that without strict indications for use, we will see a similar situation to what we saw with MRI of the knee.

Requests for imaging from specialists fell a bit but there was a substantially larger increase in requests from GPs,” she told the limbic.

Professor Maher said other recommendations were also left surprisingly lean.

“We know for example that about 25% of patients with low back pain are referred for imaging at their first visit yet the prevalence of conditions that might warrant imaging is less than 1% in primary care.”

“Yet in Recommendation 3 to clarify the indications for low back imaging for each modality, the committee weren’t willing to specify those conditions such as fractures, infection, or inflammatory arthritis.”

He said the report also failed to highlight strategies that might encourage appropriate use of imaging.

“Other recommendations such as the development of clinical tools to inform decision-making make a great deal of sense but are lost in this huge report,” he said.

The Diagnostic Imaging Clinical Committee’s recommendations have been released for public consultation until 7 October. You can access the full report here. 

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