Optimizing Musculoskeletal Imaging Referrals: Making Wise Choices in Sohag Health Insurance Organization

Background: Musculoskeletal (MSK) imaging is essential for diagnosing bone, joint, and soft tissue disorders, but inappropriate referrals remain a widespread challenge. Excessive and unnecessary MRI requests increase healthcare costs and offer limited clinical benefit. This study aimed to assess current MSK imaging referral patterns, identify areas of inappropriate imaging, and implement evidence-based guidelines adapted to the local context. Methods: A prospective audit and intervention development study was conducted at the Sohag Health Insurance Organization over five months (Phase 1: four months; Phase 2: one month). Adult patients referred for MSK imaging and their referring clinicians in orthopedics, family medicine, rheumatology, and emergency medicine were included. Referral appropriateness was evaluated using international imaging guidelines, and data on imaging findings, clinical benefit, and follow-up were analyzed before and after guideline implementation. Results: Among 199 referrals, 43.2% originated from orthopedics, 26.1% from neurology, and 24.6% from neurosurgery. Low back pain (33.7%) was the most common indication, and 49.7% of MRIs showed abnormal findings. However, only 28.1% were clinically useful, while 46.8% were unnecessary. A significant relationship was found between referring specialty and MRI usefulness (p = 0.010) and between MRI findings and follow-up availability (p < 0.001). Following the implementation of local referral guidelines, the rate of appropriate imaging requests improved, particularly among orthopedic clinicians. Conclusion: A large proportion of MSK MRI referrals were found to be inappropriate, especially for non-specific back pain. The introduction of evidence-based, locally tailored referral guidelines improved imaging appropriateness and clinical efficiency.