Imaging utilization for low back pain in the primary care setting has increased from 2011 to 2016 — specifically the use of radiographs compared with other imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and myelography, according to study results published in the Journal of the American College of Radiology.

Patients age 18 to 64 years who presented to an outpatient family medicine or general internal medicine provider for the first visit associated with a diagnosis of low back pain were included in the study; any patients with a concomitant encounter diagnosis such as disc herniation or spinal stenosis were excluded from the study. 

A total of 627,118 individual patients were included in the study (mean age, 45 years; 53% women). Diagnostic imaging was utilized in 92,946 (14.8%) encounters, and the percentage of patients who underwent diagnostic imaging increased from 14.3% in 2011 to 16.0% in 2016.

Of the patients who underwent imaging, 89,410 had radiography (14.3%), 3158 MRI (0.5%), 1715 CT (0.3%), and 13 myelography (<0.01%). The use of MRI increased from 0.5% in 2011 to 0.6% in 2016; however, the use of CT did not significantly change during that period.

The majority of patients with low back pain lived in the South (18.5%), followed by the Midwest (13.9%), the West (13.6%), and the Northeast (6.2%).

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“We found that imaging utilization for the initial evaluation of back pain in the primary care setting has moderately increased on a national level, with imaging ordered for 16% of patients presenting for an initial evaluation of low back pain in 2016,” the investigators concluded.


Pakpoor J, Raad M, Harris A, et al. Diagnostic imaging use for the initial evaluation of low back pain by primary care providers in the United States: 2011-2016 [published online May 21, 2019]. J AM Coll Radiol. doi:10.1016/j.jacr.2019.04.015