First, do no harm

It should be noted that fewer than 1% of presentations of spinal pain in primary care are associated with a serious disorder (such as fracture, malignancy, infection, cauda equina syndrome).1

When deciding which imaging is most likely to aid in diagnosis, the risk versus the potential benefit of the procedure should be considered, especially with regard to the patient’s exposure to ionising radiation. This is important as radiation exposure from medical imaging substantially increases the risk of cancer.1 When considering computed tomography (CT) or magnetic resonance imaging (MRI) scans, it is important to note that there is substantial evidence on CT scans2,3 to suggest they should be avoided, whenever possible, in children and young adults, to minimise potential risks of ionising radiation;3 the risks are negligible in older patients. A study of more than 680 000 Australians exposed to CT scans in childhood or adolescence showed that, overall, they had a 24% greater incidence of cancer than those not exposed.2

Australia’s Medicare allows only medical specialists to request a rebatable MRI spinal investigation, unless patients are aged under 16 years and meet specialised criteria. If Medicare is not changed to allow GPs to refer young adults for a rebatable spinal MRI, patients aged 16 years and over will continue to undergo unnecessary doses of CT ionising radiation, with potential risks to their long-term health. As cancer risk is summative, spinal CT imaging needs to be evaluated with regard to a patient’s lifetime total radiation risk.4

I believe this potential health risk cannot be ignored. Whenever imaging is clinically indicated, non-carcinogenic spinal MRI should be used instead of potentially carcinogenic CT imaging. The consequent reduction in exposure of the at-risk community to ionising radiation would lead to an important contribution to public health.