Diagnostic Imaging Requests

Page last updated: 10 September 2020

Reflecting on diagnostic imaging

General Practitioners (GPs) are important stewards in maximising the quality use of diagnostic imaging for the benefit of patients. Imaging is an essential element of modern medical practice, but also has downsides which need to be considered.

By reducing the overuse of medical imaging, we can reduce the potential for harms from: (i) cumulative exposure to ionising radiation for some investigations, and (ii) reduce the identification of incidental findings that might lead to a cascade of further potentially risky tests and treatments and increase patient anxiety.

Letters from the Chief Medical Officer (CMO)

In November 2019, the Chief Medical Officer (CMO) wrote to some GPs providing feedback about their requesting rates for imaging compared to their peers. The letters are not indicating that an individual GP is requesting imaging inappropriately. They simply show that the GP’s requesting rate is higher than their peers’ rate. A GP’s requesting may be appropriate for their practice type or patient cohort. GPs should continue to request imaging where it is clinically appropriate. However, there may also be opportunities to reduce requesting, where clinically indicated.

The intent of the letter is for GPs to reflect on their requesting rate, and to consider whether there are any opportunities in their practice to reduce imaging requests, where clinically indicated.

The letters were sent to GPs whose requesting rate of musculoskeletal diagnostic imaging was in the top 20% of GPs practicing in Australia, and whose requesting rate of 4 or more individual imaging areas was also in the top 20%. The letter uses percentiles to give GPs information about how their requesting rate for specific musculoskeletal imaging services compares to other GPs practicing in a similar geographical region in Australia.

Musculoskeletal resources and information

The following resources include suggestions from, and links to information provided by, NPS MedicineWise, Wiser Healthcare, the Australian Medical Association (AMA) and Royal Australian College of General Practitioners (RACGP).

Low Back

Resources for patients

Resources for medical professionals

Shoulder

Resources for patients and medical professionals

Neck

Resources for patients and medical professionals

  • Arthritis Australia provides information for patients and health professionals, with a focus on what causes neck pain, what symptoms to watch for and ways to manage neck pain.

Ankle and knee

Resources for patients

Resources for medical professionals

Hip

Resources for patients and medical professionals

  • Arthritis Australia provides information for patients and health professionals, with a focus on what causes hip pain, what symptoms to watch for and ways to manage hip pain.

Continuing Professional Development

Additional information and tools

Information for consumers

Information for medical practitioners

Imaging referrals

Radiation risks

Relevant organisation and agency information

Royal Australian College of General Practitioners (RACGP)

Australian Medical Association (AMA)

Australian College of Rural and Remote Medicine (ACRRM)

Wiser Healthcare
Wiser Healthcare is a research collaboration involving The University of Sydney, Bond University, Monash University, the University of Wollongong, and international collaborators. Wiser Healthcare investigates the cause and size of the problem and test new solutions, in the areas of cancer, cardiovascular disease and musculoskeletal disorders, with a particular focus on overdiagnosis caused by imaging (like CT scans and MRI scans), testing biomarkers (for example, blood tests like the Prostate Specific Antigen test), and genetic tests. Here clinicians and health consumers can read about the work of Wiser Healthcare, see the evidence about overdiagnosis, and get help to make decisions.

NPS MedicineWise
NPS MedicineWise has a wide range of musculoskeletal imaging tools, information and CPD courses and studies available with information relating to requesting diagnostic imaging, musculoskeletal pain management and information for consumers.

Choosing Wisely
Choosing Wisely Australia is an initiative of NPS MedicineWise in partnership with Australia's health professional colleges, societies and associations. The campaign is enabling clinicians, consumers and healthcare stakeholders to start important conversations about tests, treatments and procedures where evidence shows they provide no benefit, or in some cases, lead to harm.

Frequently Asked Questions

What data was used to calculate my rate?
Your rate was calculated using Medicare Benefits Schedule (MBS) data. This includes data on the number of musculoskeletal diagnostic imaging requests that resulted in at least one service being rendered by a radiologist and claimed under the MBS, and data on the number of consultations you billed to the MBS, excluding incentive items.

How was my rate calculated?
Your request rate is based on the number of musculoskeletal services that you requested for your patients in 2018. We have only included those requests that led to a Medicare Benefits Scheme (MBS) service being rendered by a radiologist.

Who was I compared to?
The Modified Monash Model (MMM) method was used to categorise GPs as either urban/regional/remote. Your MMM classification was determined based on your primary practice address as at March 2019. To determine your requesting percentile, your requesting rate was compared with other GPs within the same category.

What imaging areas and types were included?
The musculoskeletal imaging areas and types included are summarised in the table below.

Imaging area
Ultrasound
X-ray
CT
MRI
Ankle/hind foot
Yes
Low back
Yes
Yes
Knee
Yes
Hip
Yes
Yes
Neck
Yes
Yes
Yes
Shoulder
Yes
Yes

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