Kendrick et al in their article of the 17th, Feb 2001 stated, “in the
absence of indications for serious spinal disease, radiography in patients
with low back pain was not associated with improved clinical outcome but
was associated with increased satisfaction with care” (1). An audit was
conducted on the influence of the article on GPs requests for lumbar spine
radiography for low back pain six weeks before and after the 28th, Feb
2001.
The number of requests increased slightly from 110 before 28/02/01 to
122 after, particularly in the acute (less than six weeks duration) group
from 17 before to 27 after the 28th, Feb 2001. This indicates that the
article written by primary care physicians has made no impact on the GPs
requests for lumbar spine radiography.
We are aware of the demands made on GPs by patients and reassurance
provided by “normal” radiological reports (2, 3,). However, unnecessary
investigations are an inappropriate use of ionising radiation and an
inefficient and ineffective use of scarce resource (4).
If, as appears, general practitioners are taking no cognisance of
numerous articles including a recent one (1) by their own peers, perhaps
it is time for radiologists to consider rejecting requests, which do not
conform
to the Royal College of Radiologists` guideline (4).
John F Calder – Consultant Radiologist, Victoria Infirmary, Langside
Rd, Glasgow G44
Kaseem A Ajilogba – SpR in Radiology, Victoria Infirmary. Langside Rd,
Glasgow G44.
1. Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle
M. Radiography of the lumbar spine in primary care patients with low back
pain: randomised controlled trial. BMJ 2001 Feb 17; 322(7283): 400-5.
2. Little P, Cantrell T, Roberts L, Chapman J, Langridge J,
Pickering. Why do GPs perform investigations? The medical and social
agendas of back X rays. Fam Pract. 1998 Jun; 15 (3): 264-5.
3. Ansgar Espeland, Anders Baerheim, Grethe Albrektsen, Knut
Korsbrekke, John L Larsen. Patient’s views on Importance and Usefulness of
Plain Radiography for Low Back Pain. SPINE 2001; 26:1356-1363.
4. Royal College of Radiologists WP. Making the best use of a
department of clinical radiology: guidelines for doctors, 4th ed. London:
Royal College of Radiologists.
Competing interests:
No competing interests
06 July 2001
J F Calder
(1) Cosultant Radiologist, (2) Spr Radiology
K A Ajilogba
X Ray Dept, Victoria Infirmary, Langside Rd, Glasgow
Rapid Response:
Radiography of the Lumbar spine
Letter to the Editor of the BMJ
Dear Sir,
Radiography of the lumbar spine
Kendrick et al in their article of the 17th, Feb 2001 stated, “in the
absence of indications for serious spinal disease, radiography in patients
with low back pain was not associated with improved clinical outcome but
was associated with increased satisfaction with care” (1). An audit was
conducted on the influence of the article on GPs requests for lumbar spine
radiography for low back pain six weeks before and after the 28th, Feb
2001.
The number of requests increased slightly from 110 before 28/02/01 to
122 after, particularly in the acute (less than six weeks duration) group
from 17 before to 27 after the 28th, Feb 2001. This indicates that the
article written by primary care physicians has made no impact on the GPs
requests for lumbar spine radiography.
We are aware of the demands made on GPs by patients and reassurance
provided by “normal” radiological reports (2, 3,). However, unnecessary
investigations are an inappropriate use of ionising radiation and an
inefficient and ineffective use of scarce resource (4).
If, as appears, general practitioners are taking no cognisance of
numerous articles including a recent one (1) by their own peers, perhaps
it is time for radiologists to consider rejecting requests, which do not
conform
to the Royal College of Radiologists` guideline (4).
John F Calder – Consultant Radiologist, Victoria Infirmary, Langside
Rd, Glasgow G44
Kaseem A Ajilogba – SpR in Radiology, Victoria Infirmary. Langside Rd,
Glasgow G44.
1. Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle
M. Radiography of the lumbar spine in primary care patients with low back
pain: randomised controlled trial. BMJ 2001 Feb 17; 322(7283): 400-5.
2. Little P, Cantrell T, Roberts L, Chapman J, Langridge J,
Pickering. Why do GPs perform investigations? The medical and social
agendas of back X rays. Fam Pract. 1998 Jun; 15 (3): 264-5.
3. Ansgar Espeland, Anders Baerheim, Grethe Albrektsen, Knut
Korsbrekke, John L Larsen. Patient’s views on Importance and Usefulness of
Plain Radiography for Low Back Pain. SPINE 2001; 26:1356-1363.
4. Royal College of Radiologists WP. Making the best use of a
department of clinical radiology: guidelines for doctors, 4th ed. London:
Royal College of Radiologists.
Competing interests: No competing interests