Diagnose First, Scan Second

3 April 2020

The use of radiography (X-ray), MRI, or CT scans in patients with low-back pain does not improve clinical outcomes. This was what a recent study found; where patients had no indication of a serious underlying condition. The study suggests that clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain; especially without features suggesting a serious underlying condition.

Study On Scans


Authors of The Lancet article, “Imaging strategies for low-back pain: systematic review and meta-analysis“, reviewed trials of six separate studies. These studies covered over 1800 patients. The analysis found no significant differences between immediate imaging and usual clinical care.

Authors of the study added, “Rates of utilisation of lumbar MRI are increasing, and implementation of diagnostic-imaging guidelines for low-back pain remains a challenge. However, clinicians are more likely to adhere to guideline recommendations about lumbar imaging now that these are supported by consistent evidence from higher-quality randomised controlled trials. Patient expectations and preferences about imaging should also be addressed, because 80% of patients with low-back pain in one trial would undergo radiography if given the choice, despite no benefits with routine imaging. Educational interventions could be effective for reducing the proportion of patients with low-back pain who believe that routine imaging should be done. We need to identify back-pain assessment and educational strategies that meet patient expectations and increase satisfaction, while avoiding unnecessary imaging.”

What Our Physiotherapist Says

Sylvia Ho says

“Given that imaging such as MRI and CT scans are relatively costly and have no significant impact in such cases, it would be wise not take them unnecessarily. Even in cases of X-rays which are now relatively cheap, unnecessary exposure to the radiation should be considered.”

– Sylvia Ho, Principal Physiotherapist with Core Concepts, a musculoskeletal healthcare group.

“You first need to know what you are looking for when ordering a scan. An improperly directed scan can sometimes miss crucial pieces of information.” says Sylvia Ho.

Detailed scans such as MRIs can also reveal too much and mislead the clinician on the diagnosis. A New York Times report (8 December 2008), The Pain May Be Real, but the Scan Is Deceiving, provides an excellent read on this issue.


1. Imaging strategies for low-back pain: systematic review and meta-analysis, The Lancet, Volume 373, Issue 9662, Pages 463 – 472, 7 February 2009 doi:10.1016/S0140-6736(09)60172-0

2. The Pain May Be Real, but the Scan Is Deceiving