MRI Check-list for Lumbar Spine

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MRI Check-list for Lumbar Spine


Saskatchewan’s health system physicians and other leaders have identified improving Appropriateness of Care as a key system priority. A provincial framework has been developed by clinicians and others with the intent that the framework’s processes will be broadly applied and widely utilized by clinicians and health care organizations in SK across the continuum of care.

MRI of the lumbar spine has been selected as the pilot project to test and improve the Appropriateness of Care framework in 2015-16, with the goal of improving appropriateness of MRI requests. A provincial Clinical Development Team of clinical experts is steering the improvement work. The team includes representatives from several physician specialties in Saskatoon and Regina. These include radiologists, orthopedic surgeons, neurosurgeons, family practitioners and patients from Saskatoon Health Region and Regina Qu’Appelle Health Region.

We, the Clinical Development Team have met several times over the past few months and after reviewing data and leading practices from other jurisdictions, a consensus is emerging that there is an opportunity to improve the process for ordering an MRI for patients with low back pain with or without associated leg pain. We are recommending that a Lumbar Spine MRI Checklist be completed and accompany each freeform requisition for a Lumbar Spine MRI for low back pain. The checklist provides an easy way to present important patient information and help us better understand the reasons for ordering an MRI and whether or not these reasons conform with current guideline recommendations.

We are using a phased-in implementation approach- the checklist was implemented in Saskatoon Health Region on October 1, and will be required to accompany RQHR’s MRI requisition form for all adult outpatient lumbar spine MRI referrals as of November 9, 2015 Project team members have communicated this information with key physicians and their office staff over the past few weeks providing information about the checklist.

Please complete the checklist along with the usual requisition and fax both to Medical Imaging as per usual process. If Medical Imaging staff receive a requisition without the checklist they will send your office a fax back explaining the checklist, asking you to complete it and indicating that the MRI referral will not be processed until the checklist is received. The intent is to use this current draft checklist until January 31, 2016 and then make revisions based on your feedback. At the bottom of the checklist is a space for you to provide your comments/feedback regarding the process of both the content of the checklist and completing the checklist.

Although the checklist may take a minute more of your time, the accompanying patient information, developed by “Choosing Wisely Canada”, may save several minutes of discussion with patients.

Below you'll find the MRI Checklist for Low Back Pain and the patient information pamphlet.

If you have any questions please let us know.

Thanks for your help in making this a reality.


Dr. C. Ekong (RQHR neurosurgeon) Dr. P. Babyn (SHR Medical Imaging Dept Head)
Dr. K. Goyal (RQHR radiologist) Dr. A. Woo (SHR orthopedic surgeon)
Dr. K. Rodwan (RQHR orthopedic surgeon) Dr. D. Fourney (SHR neurosurgeon)
Cindy Dumba (patient representative) Heather Thiessen (patient representative)
Dr. M. Shepel (SHR radiologist) Dr. B. Konstantynowicz (RQHR family physician)