Appropriateness of Referrals for Lumbar Spine MRI in a Tertiary Care Center

Introduction: Magnetic resonance imaging (MRI) is a vital diagnostic tool for evaluating lumbar spine pathology, particularly in cases of low back pain. However, widespread use has raised concerns regarding the appropriateness of referrals, especially when guideline adherence is inconsistent. Unnecessary imaging may lead to increased costs, patient anxiety, and clinical inefficiencies. This study aimed to evaluate the appropriateness of lumbar spine MRI referrals in a tertiary care center hospital using the American College of Radiology (ACR) appropriateness criteria and to identify influencing factors. Methods : This prospective cross-sectional study was conducted from October to December 2024 at the Department of Radiology, Bir Hospital, Kathmandu, Nepal. A total of 368 MRI referrals were evaluated using ACR criteria and classified into six clinical categories. Descriptive statistics summarized referral patterns by department, age group, and gender. Results : Of the 368 cases, 177 (48.1%) were deemed appropriate, while 191 (51.9%) were inappropriate. Orthopedics and general medicine contributed the highest volume of referrals, with nearly balanced patterns of appropriateness. No significant differences were noted across gender or age groups. Most appropriate referrals were linked to patients with prior lumbar surgery and recurrent symptoms. Conclusion : Despite a lower rate of inappropriate referrals compared to some international studies, over half of the lumbar MRI requests in this setting lacked clinical justification. These findings emphasize the need for greater adherence to imaging guidelines. Institutional measures such as structured referral templates, decision-support tools, and clinician education may enhance the quality and efficiency of MRI utilization.