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WCB for health care providers > Medical advisory guidelines > Medical advisory guideline specifics > Magnetic Resonance Imaging (MRI) - M2.1

Magnetic Resonance Imaging (MRI) - M2.1

Definition: Magnetic resonance imaging is a non-invasive imaging technique employing magnetic fields and radio waves to produce images of the body without ionizing radiation.  An MRI system consists of no moving parts and allows direct coronal, axial and sagittal images to be produced without moving the subject.  It may be used in conjunction with intravenous contrast agents.  These agents to date have a greater margin of safety than radiographic contrast agents containing iodine used in conjunction with x-ray diagnostic procedures.

Issue statement: Medical literature indicates that 25% or more of MRI reports may be false positives and/or reveal asymptomatic pathology complicating adjudication and future management of the claim.1,2,3,4  Requests for MRI exams should only be approved when appropriate medical indications exist and when the WCB is responsible for the requested exam i.e. MRI is required because of a work related injury/illness.

WCB-Alberta position

Indications

MRI is the primary imaging modality for evaluation of all central nervous system disorders including intervertebral disc disease. It is also a valuable tool in the detection of injuries or other abnormalities involving soft tissues (muscles, tendons, and ligaments) including soft tissue elements of joints.

Work relationship criteria

  • the region to be examined must include the region of injury accepted by the WCB

Clinical criteria for acceptance of responsibility

  • a report from a consultant documenting the objective clinical findings and requesting the need for MRI scanning to confirm the diagnosis

Optional

  • reports from other consultants or previous radiology reports alluding to the possible need for MRI scanning

WCB requirements for arranging expedited examinations

  • a completed requisition submitted to the Case Manager/Medical Expeditor by an attending consultant, independent medical examiner, ROHAC consultant or Medical Advisor
  • a copy of the examination report of the attending consultant making the request for the MRI scan.
  • an up-to-date C031 defining responsibilities accepted to date under the claim.
  • reports of all previous x-ray examinations on file.
  • first page of C060 (Worker's Report of Accident)

Criteria for denial of responsibility

  • objective findings recorded by the consultant are absent or very marginal.
  • cases where it appears the examination is being requested entirely at the insistence of the claimant without documented medical need for same.
  • cases where it appears the consultant is requesting examination on a medical-legal basis to rule out pathology rather than to confirm objective clinical findings.
  • the request is from a family physician.

Authorization

  • combined responsibility of the Case Manager and Unit Medical Advisor
  • in the absence of clinical criteria an "administrative MRI" may be requested.  Under these circumstances, the Unit Medical Advisor should state "administrative authorization" within the date stamp.
  • if no resolution can be reached by the Case Manager and Unit Medical Advisor, requests will be reviewed by the Chief Medical Advisor

FOOTNOTES:
1 Best Evidence Synthesis. Spine, (April 15, 1995), 20(8S) Supplement, 275

2  How to Distinguish Painful Disc Problems from Silent Abnormalities:  Clues from a Surprising New Study. The Backletter, (1995), 10(8), 85,93

3 Jensen, M.C.J., Brant-Zawadzik, M.N., et al., Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain (1994). New England Journal of Medicine, 331(2), 69-73

4 Boden, S.D., Davis, D.O., et al., Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic ubjects(1990). Journal of Bone and Joint Surgery, 72-A(3), 403-408

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