Tahvonen Pirita, Oikarinen Heljä, Tervonen Osmo
Department of Radiology, Lapland Central Hospital, Rovaniemi, Finland.
Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
Acta Radiol. 2020 Aug;61(8):1042-1049. doi: 10.1177/0284185119893091. Epub 2019 Dec 22.
According to international guidelines, radiological examinations of the lumbar spine are of limited value and do not improve clinical outcome unless there are clinical red flags present suggesting serious pathology. Nevertheless, the utilization of lumbar spine imaging remains high.
To follow up the effects of active referral guideline implementation and education on the number and appropriateness of lumbar spine radiographs and computed tomography (CT) examinations in young patients and to evaluate whether the appropriate radiographs have more significant findings.
Referral guidelines for spine examinations and info pocket cards on radiation protection were distributed to referring practitioners. Educational lectures were provided annually. The number of lumbar spine radiographs and CT examinations on patients aged <35 years was analyzed before and three years after the interventions. Appropriateness and findings of 313 radiographs and appropriateness of 117 CT scans of the lumbar spine were assessed.
The number of lumbar spine radiographs and CT scans decreased significantly after the interventions and the level remained unchanged during the follow-up (-33% and -72%, respectively, < 0.001). Appropriateness improved significantly in radiographs from 2005 to 2009 (65% vs. 85%) and in CT scans already from 2005 to 2007 (23% vs. 63%). Radiographs that were in accordance with the guidelines had more significant findings compared to radiographs that were not; in young adults, this was 56% versus 21% ( < 0.001).
A combination of interventions can achieve a sustained reduction in the number of lumbar spine examinations and improve appropriateness. Inappropriate lumbar spine radiographs do not seem to contain significant findings that would affect patient care.
根据国际指南，腰椎的放射学检查价值有限，除非有提示严重病变的临床警示信号，否则不会改善临床结局。尽管如此，腰椎影像学检查的使用率仍然很高。
随访积极转诊指南的实施和教育对年轻患者腰椎X线片和计算机断层扫描（CT）检查数量及合理性的影响，并评估合适的X线片是否有更显著的发现。
向转诊医生分发脊柱检查转诊指南和辐射防护信息袖珍卡。每年举办教育讲座。分析干预前及干预三年后年龄<35岁患者的腰椎X线片和CT检查数量。评估313张腰椎X线片的合理性和检查结果以及117次腰椎CT扫描的合理性。
干预后腰椎X线片和CT扫描的数量显著减少，且在随访期间保持不变（分别减少33%和72%，P<0.001）。2005年至2009年X线片的合理性显著提高（从65%提高到85%），CT扫描从2005年至2007年就已显著提高（从23%提高到63%）。与不符合指南的X线片相比，符合指南的X线片有更显著的发现；在年轻人中，这一比例分别为56%和21%（P<0.001）。
综合干预措施可实现腰椎检查数量的持续减少并提高合理性。不合适的腰椎X线片似乎不包含会影响患者治疗的显著发现。
