Which specialties refer the most MSK extremity imaging exams to radiologists?

Radiologists receive the most referrals for musculoskeletal (MSK) extremity imaging examinations from orthopedic surgeons, according to a new study published in the American Journal of Roentgenology. In this modern era of value-based care, the authors explained, understanding such patterns can help radiologists optimize utilization and provide the best care possible.

The authors, led by Paul Harkey, MD, with the department of radiology and imaging services at Emory University School of Medicine in Atlanta, used publicly available data to evaluate more than 4.2 million MSK extremity imaging examinations. The five most common specialties of referring providers were orthopedic surgery (more than 37 percent), internal medicine (more than 20 percent), family practice (more than 14 percent), emergency medicine (more than 7 percent) and rheumatology (more than 5 percent).

Diving deeper into the data, orthopedic surgery also ordered the most MSK extremity CT, MRI and radiography examinations. Internal medicine ordered the most MSK extremity ultrasound examinations. In addition, the MSK extremity imaging examination most commonly ordered by orthopedic surgeons was knee radiography. For podiatrists, it was foot radiography, and for sports medicine therapists, it was shoulder radiography.

Harkey et al. emphasized that it is important for radiologists to understand these utilization trends.

“Awareness of these referral patterns may help direct future education and outreach efforts, fostering partnerships between radiologists and ordering specialties to improve resource utilization,” the authors wrote. “For example, clinical decision support software could leverage the observations regarding modality- and specialty-specific referral patterns to provide more targeted guidance regarding order appropriateness. In addition, in light of the wide spectrum of specialties that order MSK imaging, radiologists may expand their out-reach efforts beyond primary care and look to incorporate rheumatologists, sports medicine physicians, physical medicine and rehabilitation specialists, and podiatrists.”