1. When is MRI appropriate? B. McClarty Dept. of Radiology

2. MRI Utilization

3. Methods 1.American College of Radiology Appropriateness Criteria 2.CAR Medicalis Pilots 3. BSCG project

4. ACR Appropriateness Criteria Recommendation of which examination is most useful for investigation of a clinical symptom or condition MRI is the preferred method for investigation of the CNS and musculo skeletal complaints and is complimentary examination for the chest, abdomen, and cardiovascular conditions.

5. ACR con’t Shortened ACR criteria for CNS complaints If you are ordering an infused CT of the brain or spinal cord, consider MRI Do uninfused CT in preference to MRI for assessment of bone fractures or hemorrhage including SAH Do CT for mastoids, sinuses due to high bone air contrast and better spatial resolution of CT

6. CT vs. MRI Mastoids

7. ACR con’t Infused CT is the primary modality for the assessment of neck lesions /cervical lymphadenopathy CT angiography has higher spatial resolution and better image quality than MRA Consider local availability, patient’s ability to tolerate long MRI examination time

8. Medicalis projects Evidence based order entry system piloted in pediatrics and more recently SE Manitoba Dr.Martin Reed /Canadian Association of Radiologists British Society of Radiology criteria modified to Canadian environment and placed in an electronic order entry system

9. BGSG Project Bridging the generalist to specialist gap- Luis Oppenheimer Initial project for assessment of low back pain. Advantage for having patient and physician engagement in process

11. Thank you