Researchers: Uri Arad¹, Dan Caspi¹, Gabriel Chodik²

Background: Bone scans are widely used but involve exposure to radiation, considerable accumulated cost and their contribution to the diagnostic process in many cases is not clear.

Objectives: To evaluate and quantify the use of bone scans in the ambulatory medical system.

Method: A survey was conducted among senior specialists in rheumatology and orthopedics with "paper cases" that describe clinical scenarios. Digital data was collected regarding all patients performing a bone scan and their referring physicians in 2012 in Maccabi sick fund. 200 patient files were manually studied.

Findings: In many cases, bone scans do not contribute significantly to the diagnosis or clinical decision making.

Conclusions: 25-35% of all bone scans are not clinically justified.

Recommendations: 1. Determine and enforce a standard isotope dose for bone scans.
2. Test results should indicate the actual isotope dose delivered.
3. Educate physicians regarding the justified indications for performing bone scans.
4. Construct and use an electronic form for ordering bone scans in which the physician should choose from a list of accepted indications or justify an unconventional indication.
5. Identify the physicians who order an exceptional large volume of bone scans and clarify the justification of these orders.

Research end date: 04/2017