CHRT Project: Radiology

Encouraging Appropriate and Judicious Use of High Technology Radiology for Patients with Low Back Pain

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CHRT Press Release
July 13, 2011

Wacky BackQuack™ game is helping consumers and physicians determine the best course of treatment for acute back pain

The BackQuack online game takes players through animated scenarios demonstrating what not to do

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In The Media

New York Times 08/27/2009

Care Delivery and Financing System

This study examines two interventions aimed at improving health outcomes for patients with low back pain and avoiding the excess cost and potentially negative patient outcomes associated with over-utilization of high technology scanning.


The objectives of the study are to:

  • Increase patient knowledge about treatment options
  • Increase patient involvement in treatment decision making
  • Improve patient and provider satisfaction with the decision making process and the treatment decision
  • Reduce rates of inappropriate CT and MRI scans compared to the control group
  • Show cost savings attributable to a reduction in the use of high-tech radiology


Diagnostic imaging has resulted in significant improvements in quality of care. At the same time, there is concern that this advanced technology is used more than needed. The cost of inappropriate use of advanced imaging is more than it seems: scan findings can inappropriately drive surgery and other dangerous, useless, and expensive treatments, and lead patients toward more fear and disability. Therefore the goal is to encourage practitioners to use scans judiciously and educate patients that most back problems do not require high tech scans.

The cost trend for diagnostic radiology for Blue Cross Blue Shield of Michigan (BCBSM) increased from $672 million in 2004 to $763 million in 2006. Seventy two percent of this spending was on high tech imaging. Reversing the trend of increased utilization of expensive high technology imaging is a potential area for significant cost savings in the healthcare system.


1. Emergency Department Partnerships
This program develops partnerships between emergency departments, physical therapy departments, and primary care or physiatry groups. By providing reliable, good quality, rapid follow-up opportunities, this partnership lets emergency departments elect to defer extensive testing and interventions without fear that they have not done enough for the patient.

2. Community Spine Project
This intervention is the core of the efforts at reducing inappropriate imaging. In order to promote behavior change, the approach is to “educate the doctors, educate the patients, let the doctors know the patients know, and let the patients know the doctors know.” This will be accomplished through a Second Life type virtual reality computer game.

Related Research and Information

Rapid Magnetic Resonance Imaging vs Radiographs for Patients With Low Back Pain: A randomized controlled trial
JAMA. 2003;289:2810-2818.

Imaging strategies for low-back pain: systematic review and meta-analysis
The Lancet.  Volume 373, Issue 9662, Pages 463 - 472, 7 February 2009  (Subscription required to view full text)

Utilization of Radiology Services in the United States: Levels and Trends in Modalities, Regions, and Populations
Radiology. 2005;234:824-832.