University of Oulu

Tahvonen, P., Oikarinen, H., & Tervonen, O. (2020). The effect of interventions on appropriate use of lumbar spine radiograph and CT examinations in young adults and children: a three-year follow-up. Acta Radiologica, 61(8), 1042–1049.

The effect of interventions on appropriate use of lumbar spine radiograph and CT examinations in young adults and children : a three-year follow-up

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Author: Tahvonen, Pirita1,2; Oikarinen, Heljä2; Tervonen, Osmo2
Organizations: 1Department of Radiology, Lapland Central Hospital, Rovaniemi, Finland
2Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: SAGE Publications, 2020
Publish Date: 2020-08-28


Background: According to international guidelines, radiological examinations of the lumbar spine are of limited value and do not improve clinical outcome unless there are clinical red flags present suggesting serious pathology. Nevertheless, the utilization of lumbar spine imaging remains high.

Purpose: To follow up the effects of active referral guideline implementation and education on the number and appropriateness of lumbar spine radiographs and computed tomography (CT) examinations in young patients and to evaluate whether the appropriate radiographs have more significant findings.

Materia and Methods: Referral guidelines for spine examinations and info pocket cards on radiation protection were distributed to referring practitioners. Educational lectures were provided annually. The number of lumbar spine radiographs and CT examinations on patients aged <35 years was analyzed before and three years after the interventions. Appropriateness and findings of 313 radiographs and appropriateness of 117 CT scans of the lumbar spine were assessed.

Results: The number of lumbar spine radiographs and CT scans decreased significantly after the interventions and the level remained unchanged during the follow-up (−33% and −72%, respectively, P < 0.001). Appropriateness improved significantly in radiographs from 2005 to 2009 (65% vs. 85%) and in CT scans already from 2005 to 2007 (23% vs. 63%). Radiographs that were in accordance with the guidelines had more significant findings compared to radiographs that were not; in young adults, this was 56% versus 21% (P < 0.001).

Conclusion: A combination of interventions can achieve a sustained reduction in the number of lumbar spine examinations and improve appropriateness. Inappropriate lumbar spine radiographs do not seem to contain significant findings that would affect patient care.

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Series: Acta radiologica
ISSN: 0284-1851
ISSN-E: 1600-0455
ISSN-L: 0284-1851
Volume: 61
Issue: 8
Pages: 1042 - 1049
Article number: 0284185119893091
DOI: 10.1177/0284185119893091
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Foundation Acta Radiologica 2019. Reprinted by permission of SAGE Publications. This work is distributed under the Creative Commons Attribution 4.0 License.