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I know what the imaging guidelines say, but...
  1. Kieran O’Sullivan1,2,
  2. Gilat Linn Grunau3,
  3. Bruce B Forster3,
  4. Peter P O’Sullivan4,
  5. Timothy Flynn5,
  6. Ben Darlow6
  1. 1 Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Department of Clinical Therapies, University of Limerick, Limerick, Ireland
  3. 3 Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  5. 5 School of Physical Therapy, South College, Knoxville, Tennessee, USA
  6. 6 Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
  1. Correspondence to Dr Kieran O’Sullivan, Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; kieran.osullivan{at}

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Despite evidence to the contrary, the public, and clinicians, often believe that low back pain (LBP) diagnosis and management are enhanced through the use of imaging such as MRI and CT. In the USA alone, nearly $6 billion is spent on spinal MRI scans annually, stretching limited resources. We have previously discussed1 how imaging rates for LBP may be safely reduced and aligned with guidelines,2 using methods such as clinician decision support to ‘shape the path’.3 Nevertheless, reducing imaging rates for LBP is difficult. There may be additional value in gaining a better understanding of the decision-making processes, and motivations, of referring clinicians.

Reasons for guideline non-adherence

There is considerable variation in imaging referral patterns between clinicians, with variation the greatest for LBP presentations not involving trauma or radiculopathy (the majority of people with LBP). This suggests clinician factors, in addition to system factors, contribute to the variation. Many clinicians are aware of, and broadly agree with, recommended clinical …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.