Knee-jerk reaction we’re scanning: CT use up 83% in Australia
Australia’s health safety watchdog says knee CT scans rose 83% in five years and ultrasounds 26% among people 45 and over, despite guidelines against routine imaging for osteoarthritis. A rheumatologist warns the scans can lead to further tests and unnecessary surgery.
Knee CT scans in Australia have surged by 83% in five years, according to a new report from the Australian Commission on Safety and Quality in Health Care. Doctors say the knee-jerk reaction we’re scanning for sore joints may be doing patients harm.
Clinical guidelines have long advised against routine imaging to diagnose knee osteoarthritis, a joint condition. The report, titled Atlas Focus Report: Osteoarthritis of the Knee, says Australians are getting more knee scans than ever anyway.
What the report found
Knee ultrasounds rose 26% among Australians aged 45 and over in the five years to 2023-24. General practitioners (GPs) requested more than 90% of those ultrasounds.
One possible explanation is a change to Medicare funding in 2018. It restricted GP-requested knee MRIs for patients aged 50 and over.
Dr Phoebe Holdenson Kimura, a medical advisor at the Commission and a practising GP, acknowledged the link. “In 2018, GPs’ ability to refer for MRI over the age of 50 was restricted,” she said. “It’s difficult to know but it’s possible that has contributed to the increase in the rates of CT and ultrasound as alternatives to MRI.”
Downstream consequences
Professor David Hunter, a rheumatologist and clinical researcher at the University of Sydney and Royal North Shore Hospital, contributed to the report’s expert group. He said the harm from unnecessary imaging can extend well beyond the first scan.
“The bigger concern I have, is that the <a he said. Patients go on to have further investigations, he said, and some receive inappropriate interventions such as arthroscopy, a keyhole surgical procedure.
Hunter said structural abnormalities such as degenerative meniscal lesions are very common in older adults, including people with knee pain and other symptoms. A scan that shows one can therefore look like an explanation when it is not.
Once a patient or GP has seen the scan, it can reinforce the belief that a specialist referral is necessary. “When the patient sees that scan, they see a war zone of a report, and it’s very hard for them to unsee that report,” Hunter said.
“We really need to get the message out about the downstream consequences, that people don’t necessarily think about with regards to the initial investigation.”
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