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J Am Coll Radiol. 2017 Jun;14(6):778-782. doi: 10.1016/j.jacr.2017.02.031. Epub 2017 Apr 21.

MRI Before Radiography for Patients With New Shoulder Conditions.

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Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address:
The Ottawa Hospital Research Institute and the Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.



To assess the patterns of Appropriate Criteria application among orthopedic specialists and other fields of medicine for use of MRI and radiography and the subsequent necessity for surgical intervention.


The hospital electronic medical record was used to identify all shoulder MRI studies at a single large urban teaching hospital between January 2, 2011, and June 30, 2011. For each study, variables collected included ordering department, patient age, patient gender, patient's self-reported race/ethnicity, whether the patient obtained surgery for an issue related to the MRI diagnosis, the type of MRI ordered, the date of pain onset, the date of x-ray (if any), and the date of the MRI.


A total of 475 patients who underwent shoulder MRI were included in our study. We found significant associations between a patient having had a prior x-ray and ordering department (P < .0001), male gender (P = .0005), and subjects who had subsequent surgery (P = .0006). Neither age nor race and ethnicity had an influence on x-ray before MRI. Orthopedic specialists ordering MRIs had the highest percentage of patients undergo subsequent surgery (33.3%) compared with the second-most, primary care (18.4%), and all other ordering departments (P = .0009).


Detailed analysis suggests that providers who do not have specific training in shoulder pathology should consider consultation with an orthopedic surgeon before ordering shoulder MRI for patients who may need additional imaging after radiography.


Appropriate Use Criteria; MRI; shoulder

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