- Reflecting on diagnostic imaging
- Letters from the Chief Medical Officer
- Musculoskeletal resources and information
- Continuing Professional Development
- Additional information and tools
- Organisations and agency information
- Frequently Asked Questions
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
- Myback self-assessment tool allows patients experiencing an episode of low back pain to conduct self-assessments to estimate how their recovery is likely to compare to the average person. It can give patients personalised information on their risk, and what choices are available to help plan their recovery.
- Scan Your Options brochure for patients considering lumbar imaging (PDF 590 KB). Wiser Healthcare researchers would like your feedback on these resources. Email any feedback on the brochures or posters to info.imh@sydney.edu.au
- Low back pain: Do you need a scan? (PDF)
- 10 things you need to know about low back pain
Resources for medical professionals
- Wiser Healthcare's GP, physiotherapy, and rheumatology researchers from the University of Sydney and Monash University have developed the following resources to assist GPs and patients with having conversations about when imaging may be unnecessary for back pain:
Clinic poster 1: Back scans can cause harm (PDF 2924 KB)
Clinic poster 2: Many people who have a back scan will get a false alarm (PDF 1067 KB)
Clinic poster 3: False alarms from back scans can lead to ineffective surgery (PDF 1080 KB)
Clinic poster 4: Back scans rarely find the cause of back pain (PDF 1371 KB)
Wiser Healthcare researchers would like your feedback on these resources. Email any feedback on the brochures or posters to info.imh@sydney.edu.au - Choosing Wisely has developed an education video clip showing the conversation between a GP and patient who requests a MRI for back pain.
- NPS MedicineWise have a dedicated program focusing on Low Back Pain Imaging.
- CPD case study: Taking action for acute low back pain
Shoulder
Resources for patients and medical professionals
- Wiser Healthcare researchers from the University of Sydney and Monash University have developed the following shoulder pain brochure—Scan Your Options brochure for patients considering shoulder imaging (PDF 385 KB)—to assist GPs and patients with having a conversation about when imaging may not be essential for shoulder pain. Wiser Healthcare researchers would like your feedback on these resources. Email any feedback on the brochures or posters to info.imh@sydney.edu.au
- Arthritis Australia provides information for patients and health professionals, with a focus on what causes shoulder pain, what symptoms to watch for and ways to manage shoulder pain.
- Academic journal articles and news:
- General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: An Australian national survey
- Management of shoulder pain by UK General Practitioners (GPs): a national survey—a national survey
- Non-traumatic shoulder pain in general practice: a pragmatic approach to diagnosis (includes videos, infographic)
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
- Patient resource: Discussing acute ankle and knee injuries (PDF)
- Acute knee injuries explained
- Ankle sprains: 10 things you should know
Resources for medical professionals
- Wiser Healthcare researchers from the University of Sydney and Monash University have developed the following knee pain brochure—Scan Your Options brochure for patients considering knee imaging (PDF 306 KB)—to assist GPs and patients with having a conversation about when imaging may be unnecessary for knee pain. Wiser Healthcare researchers would like your feedback on these resources. Email any feedback on the brochures or posters to info.imh@sydney.edu.au
- Ankle and Knee Imaging Program
- News: In my practice: Ankle and knee imaging
- News: Diagnosing knee pain in middle-aged patients
- Videos: Physical examination of acute ankle and knee injuries
- CPD case study: Diagnostic imaging in acute ankle and knee injuries
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
- The Royal Australian and New Zealand College of Radiologists (RANZCR) education modules for appropriate imaging referrals. These modules provide information about evidence-based clinical decision rules and include a set of cases for a number of clinical scenarios.
- Wiser Healthcare will be hosting the 7th international Preventing Overdiagnosis scientific conference in Sydney, 5-7 December 2019. Information about this conference is detailed on their website.
- NPS MedicineWise offer the following:
- The Australian Association of Musculoskeletal Medicine is offering a Certificate in Musculoskeletal Medicine for doctors wishing to upgrade their confidence and skills in assessing and managing patients with a wide range of common musculoskeletal pain problems. The modules are accredited for RACGP and ACRRM professional development points.
Additional information and tools
Information for consumers
- Imaging explained
- Imaging and children
- Understanding medical tests
- Patient resource: Your medical imaging test (PDF)
- Ask your doctor poster (PDF 2020 KB). Wiser Healthcare researchers would like your feedback on this resource. Email any feedback on the poster to info.imh@sydney.edu.au
Information for medical practitioners
- Diagnostic imaging pathways
- Inside Radiology
- News: Tests and treatments: do they always help?
- HP resource: Diagnostic imaging in clinical practice (PDF)
Imaging referrals
Radiation risks
- The Australian Radiation Protection and Nuclear Safety Agency provides general information about radiation risks
- News: Ionising radiation risk in abdominal imaging
- News: Kids, CT scans and radiation risks: resources for everyone
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 CDP 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. The table below outlines how the MMM aligns to the categories.
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 | Yes |
Knee | ![]() | Yes | ![]() | ![]() |
Hip | Yes | Yes | ![]() | ![]() |
Neck | ![]() | Yes | Yes | Yes |
Shoulder | Yes | Yes | ![]() | ![]() |