4.           Areas of responsibility of the Knee Imaging Working Group

The principal purpose of this review was to consider:

1. whether current items reflect contemporary best clinical practice based on scientific data

2. whether patients have access to health services that have the potential to improve health outcomes through improved diagnostic accuracy and decision-making and/or harm reduction

3. whether changes to item descriptors, item existence, scope of referral privileges and location of items in clinical sections would support evidence-based practice and more appropriate utilisation or would allow more accurate evaluation of utilisation patterns.

It has been identified that the knee is an area where imaging may be performed for indications that are not evidence-based. Particularly, there is a concern about inappropriate use of MRI knee imaging, as a high volume is performed in patients over 50 who often have coexistent symptoms of osteoarthritis that can be difficult to distinguish from those of meniscal tear and incidental meniscal tears are common in elderly patients with osteoarthritis.

The American Choosing Wisely2 have also identified MRI of the knee as an area where ’low value’ care may be being provided and should be addressed. The Royal Australian College of General Practitioners (RACGP)6 and the Royal Australian and New Zealand College of Radiologists (RANZCR) have guidelines for referral for MRI, particularly relating to referring for MRI of the knee.

The following MBS group items were identified for review.

Item group name 1

Magnetic resonance imaging (MRI) of the knee (6 items)

Item group name 2

Ultrasound of the knee (4 items)

Item group name 3

X-ray of the knee (8 items)

Item group name 4

Computed tomography (4 items).

In FY 2014/15, these items accounted for approximately 96 million services and $134 million in benefits7.