Physician self-referral of lumbar spine MRI with comparative analysis of negative study rates as a marker of utilization appropriateness

AJR Am J Roentgenol. 2012 Jun;198(6):1375-9. doi: 10.2214/AJR.11.7730.


Objective: Financial interest in imaging equipment may affect the imaging referral patterns of ordering physicians. The purpose of this article is to determine whether ownership of MRI equipment by ordering physicians predicts the likelihood and prevalence of positive findings on lumbar spine MRI as a metric for comparison of utilization.

Materials and methods: A retrospective review was performed of 500 consecutive diagnostic lumbar spine MRI examinations in one radiology practice ordered by two separate referring physician groups serving the same geographic community: one with financial interest in the MRI equipment used (financial-interest group) and one without financial interest in the MRI equipment used (no-financial-interest group). Negative examinations and total number of lesions per positive study were recorded for each group.

Results: Five hundred scans met inclusion criteria during the study period (250 in the financial-interest group and 250 in the no-financial-interest group). The negative scan frequency was 86% higher in the financial-interest group (p < 0.0001). Among positive scans, there was no significant difference in the average total number of positive lesions per scan (3.93 for the financial-interest group and 4.31 for the no-financial-interest group; p = 0.132). The average age of patients imaged by the financial-interest group was 49.8 years, versus 56.9 years for the no-financial-interest group (p < 0.0001).

Conclusion: Lumbar spine MRI examinations referred by the financial-interest group were significantly more likely to be negative than those referred by the no-financial-interest group. Lesion frequency among positive scans suggests similar severity of disease between the two patient populations. Patients imaged by the financial-interest group were significantly younger than those imaged by the no-financial-interest group.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Female
  • Humans
  • Lumbar Vertebrae*
  • Magnetic Resonance Imaging / economics*
  • Magnetic Resonance Imaging / statistics & numerical data*
  • Male
  • Middle Aged
  • Ownership
  • Physician Self-Referral / statistics & numerical data*
  • Retrospective Studies
  • Spinal Diseases / diagnosis*
  • Statistics, Nonparametric