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Comment & Response |

Inappropriate Use of Lumbar Magnetic Resonance Imaging: Limitations and Potential Solutions—Reply

Derek J. Emery, MD1; Thomas E. Feasby, MD, FRCPC2,3
[+] Author Affiliations
1Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
2Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
3Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
JAMA Intern Med. 2013;173(21):2012-2013. doi:10.1001/jamainternmed.2013.9956.
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In Reply We thank the authors for their interest in our study1 and will respond to their criticisms. The RAND-University of California, Los Angeles, appropriateness method2 was criticized for not following “widely-accepted evidence-based criteria.” Rather than accepting published guidelines with their reliance on other sources, we used the RAND method, which combines all the available evidence with expert opinion. In many cases, there is inadequate published evidence to classify a medical procedure or test as appropriate or inappropriate, which is certainly the case for lumbar magnetic resonance imaging (MRI), making the use of published guidelines questionable. The use of an expert multispecialty panel has been shown to be a substantial strength of the RAND method,3 rather than relying on the consensus of a narrower specialty base as in the study by Kovacs et al.4

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November 25, 2013
Francisco M. Kovacs, MD, PhD; Estanislao Arana, MD, PhD; Ana Royuela, PhD
1Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Palma de Mallorca, Spain2Research Department, Fundación Kovacs, Palma de Mallorca, Spain
1Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Palma de Mallorca, Spain3Servicio de Radiología. Fundación Instituto Valenciano de Oncología, Valencia, Spain4Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
1Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Palma de Mallorca, Spain5Centros de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, Spain6Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain
JAMA Intern Med. 2013;173(21):2012. doi:10.1001/jamainternmed.2013.9964.
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