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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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Evaluation and Treatment of Sacroiliac Joint Dysfunction in the Primary Care Setting: A Practical Review

Teaser: 

Sydney Rucker, BS, 1 Adrienne Kelly, MD, FRCSC,2 David W. Polly, MD,3Robert J. Ferdon, MS,4 Robert A. Ravinsky, MDCM, MPH, FRCSC,5

1Medical University of South Carolina College of Medicine, Charleston, SC.
2 Orthopaedic Surgeon, Sault Area Hospital, Assistant Professor, Northern Ontario School of Medicine, Sault Ste Marie, ON.

3 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.

4 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, University of South Carolina School of Medicine, Columbia, SC.

5 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC.

CLINICAL TOOLS

Abstract: Mechanical dysfunction of the sacroiliac joint (SIJ) is an often overlooked, but a common cause of low back pain in the North American adult population. The diagnosis is primarily clinical and requires the exclusion of other potential etiologies of low back pain (LBP). A number of non-surgical treatment options are available for patients with this pathological entity. In cases of persistent, severe SIJ pain refractory to non-operative measures, SIJ fusion may be considered as a surgical intervention.
Key Words: sacroiliitis, sacroiliac dysfunction, sacroiliac joint (SIJ), low back pain (LBP), gluteal pain, SI joint fusion, percutaneous SI joint fixation.

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
1. The SI joint is a known contributor to low back pain
2. Non-surgical treatment remains the primary management approach for SIJ dysfunction
3. Diagnostic intra-articular injections performed under image guidance are considered the gold standard for confirming SIJ-mediated pain
4. For patients with clinically debilitating mechanical SIJ dysfunction who have failed an exhaustive course of non-operative treatment, surgical options may be considered
1. SIJ dysfunction is a known contributor to low back pain, accounting for approximately 15-30% of LBP cases in the outpatient setting.
2. While imaging plays a role in excluding alternative diagnoses, no imaging modality has demonstrated reliable diagnostic utility for mechanical SIJ dysfunction although there is some utility of MRI in the setting of inflammatory sacroiliitis.
3. Patients with SIJ pain typically report symptoms consistently localized to an area within 1cm inferomedial to the posterior superior iliac spine (PSIS) that may radiate into the buttocks, groin, posterior thigh or even past the knee and into the foot.
4. Diagnosis is by physical examination which should include a variety of SIJ-specific provocation tests. Three or more positive results out of five standardized maneuvers is supported by Level 1 evidence for a Clinical Diagnostic Rule.
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, sacroiliitis, sacroiliac dysfunction, sacroiliac joint, low back pain, gluteal pain, SI joint fusion, percutaneous SI joint fixation