{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:15:39Z","timestamp":1790424939964,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians\u2019 specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists\u2019 training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of &amp;lt;6\u2009weeks duration being the most common indication. Significant differences in inappropriate orders were found (P\u2009&amp;lt;\u2009.001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in training (27.8%), and non-specialists with \u22653 (60.0%) and &amp;lt;3 (36.9%) years in practice, respectively. Approximately one-third of lumbar spine radiographs performed in the ED were inappropriately ordered by American College of Radiology guidelines; specialists training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce health care costs.<\/jats:p>","DOI":"10.1093\/intqhc\/mzad021","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T16:37:20Z","timestamp":1681317440000},"source":"Crossref","is-referenced-by-count":7,"title":["Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8322-1500","authenticated-orcid":false,"given":"Yi Xiang","family":"Tay","sequence":"first","affiliation":[{"name":"Radiography Department, Division of Allied Health, Singapore General Hospital , Outram Rd., Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7603-7334","authenticated-orcid":false,"given":"Ling Ling","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital , Outram Rd., Singapore 169608, Singapore"},{"name":"Duke-NUS Graduate Medical School , 8 College Road, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin Ru","family":"Than","sequence":"additional","affiliation":[{"name":"Department of Oncologic Imaging, National Cancer Centre Singapore , 30 Hospital Blvd., Singapore 168583, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gek Hsiang","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Division of Musculoskeletal Sciences, Singapore General Hospital , Outram Rd., Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark Bangwei","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital , Outram Rd., Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May San","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital , Outram Rd., Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlu","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital , Outram Rd., Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy Choon Peng","family":"Wee","sequence":"additional","affiliation":[{"name":"Health 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