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spinal infection

Optimizing Patient Care Through Evidence-Based Imaging: A Collaborative Approach—Don’t Shoot the Radiologist

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

Medical Director, Journal of Current Clinical Care and www.healthplexus.net, Adjunct Clinical Lecturer, Departments of Medical Imaging and Family Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Background: Effective collaboration between radiologists and ordering physicians is essential for optimal patient care, yet tensions can arise when radiologists suggest alternative imaging approaches. This article examines the importance of evidence-based imaging selection and provides a framework for improved interdisciplinary collaboration.
Purpose: To demonstrate how collaborative imaging decisions, particularly in critical diagnoses such as spinal infections, can improve patient outcomes while reducing medicolegal risk, and to offer practical strategies for enhancing communication between radiologists and ordering physicians.
Methods: We review current literature comparing imaging modalities for spinal infections, analyze medicolegal implications of imaging choices, and propose institutional and technological solutions for improved collaboration.
Results: Evidence demonstrates significant superiority of MRI with intravenous contrast over CT for diagnosing spinal infections, with MRI showing 96-100% sensitivity versus CT’s 66-84% sensitivity for discitis/osteomyelitis. For epidural abscess detection, MRI approaches 100% sensitivity while CT ranges from 50-90%. Missed diagnoses due to suboptimal imaging choices represent a significant source of malpractice litigation.
Conclusion: When radiologists suggest alternative imaging approaches, these recommendations represent evidence-based efforts to optimize patient care rather than challenges to clinical autonomy. Successful collaboration requires mutual respect, open communication, and shared commitment to evidence-based practice. Implementation of multidisciplinary conferences, clinical decision support systems, and rapid consultation protocols can significantly improve imaging appropriateness and patient outcomes.

Key Words: Radiology collaboration, evidence-based imaging, spinal infections, MRI, patient safety, healthcare communication.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Collaboration Improves Outcomes—Effective communication between radiologists and ordering physicians enhances diagnostic accuracy and patient care, especially in complex cases like spinal infections.
MRI is Superior for Spinal Infections—MRI with contrast offers significantly higher sensitivity and specificity than CT for diagnosing discitis, osteomyelitis, and epidural abscess, leading to earlier and more accurate detection.
Missed Diagnoses Carry Legal Risk—Inadequate imaging choices can lead to delayed diagnoses and serious complications, increasing the risk of malpractice claims and emphasizing the need for evidence-based imaging.
Practical Strategies Enhance Teamwork—Institutional tools like multidisciplinary conferences, clinical decision support systems, and rapid consultation protocols foster better collaboration and imaging appropriateness.
Always prioritize MRI with contrast for suspected spinal infections—it offers near 100% sensitivity and can detect early changes invisible on CT, enabling timely diagnosis and intervention.
When radiologists suggest alternative imaging, it’s a clinical partnership—not a challenge to autonomy. Their input is grounded in evidence and aimed at optimizing patient outcomes.
Don’t rely solely on negative initial imaging—if clinical suspicion for spinal infection remains high, pursue further evaluation, as early imaging (especially CT) can miss critical findings.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Radiology, radiology collaboration, evidence-based imaging, spinal infection, MRI, patient safety, healthcare communication
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Spine Infections

Teaser: 

Jessica Albanese, MD,1 Brett Rocos, MB, ChB, MD, FRCS (Tr & Orth),2

1 Adult Spine Fellow, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
2 Assistant Professor of Orthopaedic Surgery, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.

CLINICAL TOOLS

Abstract: Though they have significant morbidity and mortality, spine infections are a rare cause of back pain. Because they are uncommon, it is important to recognize the signs and symptoms of a spine infection, to establish the diagnosis, and to treat appropriately, guided by culture results, with antibiotic therapy. Surgical intervention is indicated in cases of significant neurologic deficit, significant spinal deformity, instability, and/or failed medical management.
Key Words:spinal infection, spondylodiscitis, discitis, vertebral osteomyelitis, epidural abscess, back pain.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Patients with spine infections often present with back pain and may have radicular pain, neurologic deficits, or constitutional signs and symptoms of infection
Workup begins with laboratory studies including, CBC, CRP, and ESR
The gold standard for imaging is MRI
Definitive diagnosis may require CT-guided biopsy and culture
The mainstay of treatment is at least 6 weeks of antibiotic therapy guided by culture results
Surgical intervention is indicated in cases of progressive neurologic deficit or spinal deformity, instability, or failed medical management
Spinal infections can present insidiously
Refer early if patients present with back pain and unexplained fever
Prompt identification with MRI improves likelihood of recovery
Antibiotic treatment for 6 weeks is recommended
Surgery is useful for neurological deficit or instability
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, spinal infection, spondylodiscitis, discitis, vertebral osteomyelitis, epidural abscess, back pain