{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:16:35Z","timestamp":1787019395937,"version":"build-2736575974"},"reference-count":40,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Acta Radiologica Open"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>An ever-increasing technological development in the field of radiology urges a need for guidelines to provide predictable and just health services. A musculoskeletal guideline was developed in Norway in 2014, without active implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate the impact of active guideline implementation on the use of musculoskeletal diagnostic imaging most frequently encountered in general practice (pain in the neck, shoulders, lower back, and knees).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>The total number of outpatient radiological examinations across modalities registered at the Norwegian Health Economics Administration between January 2013 and February 2019 was assessed using an interrupted time series design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A 12% reduction in the total examination of Magnetic Resonance Imaging shoulder and knee, and x-ray lower back and shoulder was found at a significant level ( p\u2009=\u20090.05). Stratified analysis (Magnetic Resonance Imaging examination as one group and x-ray examinations as the other) showed that this reduction mainly was due to the reduction in the use of Magnetic Resonance Imaging examinations (shoulder and knee) which was reduced by 24% at a significant level ( p\u2009=\u20090.002), while x-ray examinations had no significant level change ( p\u2009=\u20090.71). No other statistically significant changes were found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The impact of the implementation on the use of imaging of the neck, shoulder, lower back, and knee is uncertain. Significant reductions were demonstrated in the use of some examinations in the intervention county, but similar effects were not seen when including a control group in the analysis. This indicates a diffusion of the implementation, or other interventions or events that affected both counties and occurred in the intervention period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2058460120988171","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T13:54:12Z","timestamp":1615989252000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7930-1022","authenticated-orcid":false,"given":"Ann M","family":"Gransj\u00f8en","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gj\u00f8vik, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjetil","family":"Thorsen","sequence":"additional","affiliation":[{"name":"The Norwegian Air Ambulance Foundation, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin B","family":"Lysdahl","sequence":"additional","affiliation":[{"name":"Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siri","family":"Wiig","sequence":"additional","affiliation":[{"name":"SHARE-Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn M","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gj\u00f8vik, Norway"},{"name":"Center for Medical Ethics, University of Oslo, Blindern, Oslo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"bibr1-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780199639977.001.0001"},{"key":"bibr2-2058460120988171","first-page":"603","volume":"7","author":"Elshaug AG","year":"2010","journal-title":"JACR"},{"key":"bibr3-2058460120988171","first-page":"192","volume":"7","author":"Lehnert BE","year":"2010","journal-title":"JACR"},{"key":"bibr4-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.20295"},{"key":"bibr5-2058460120988171","first-page":"50A","volume":"192","author":"Cascade PN.","year":"1994","journal-title":"Radiology"},{"key":"bibr6-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2017.05.009"},{"key":"bibr7-2058460120988171","unstructured":"Helsedirektoratet.\n                      Nasjonal faglig retningslinje for bildediagnostikk ved ikke-traumatiske muskel-og skjelettlidelser \u2013 Anbefalinger for prim\u00e6rhelsetjenesten\n                      . Oslo, Norway: Helsedirektoratet.no: Helsedirektoratet, 2014."},{"key":"bibr8-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-7-21"},{"key":"bibr9-2058460120988171","unstructured":"Riksrevisjonen.\n                      Riksrevisjonens unders\u00f8kelse av bruken av poliklinisk bildediagnostikk\n                      . Oslo, Norway: Riksrevisjonen, 2017."},{"key":"bibr10-2058460120988171","doi-asserted-by":"crossref","unstructured":"Gransj\u00f8en AM, Lysdahl KB, Hofmann BMJAR. Geographical variations in the use of diagnostic imaging of musculoskeletal diseases in Norway. 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Forekomst og kostnader knyttet til skader, sykdommer og plager i muskel-og skjelettsystemet\n                      [A musculosceletal accounting prevalence and expenses associated with injuries, diseases and ailments of the musculoskeletal system]. 2013. Ullev\u00e5l, Nydalen, Oslo: Muskel og Skjelett Ti\u00e5ret (MST), v\/ FORMI, Klinikk for kirurgi og nevrofag, Oslo universitetssykehus."},{"key":"bibr18-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2004.08.002"},{"key":"bibr19-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-1968-4"},{"key":"bibr20-2058460120988171","volume":"13","author":"Sheehan SE","year":"2016","journal-title":"JACR"},{"key":"bibr21-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1177\/0284185116661879"},{"key":"bibr22-2058460120988171","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-7-115"},{"key":"bibr23-2058460120988171","unstructured":"Gottman JM.\n                      Time-series analysis: a comprehensive introduction for social scientists\n                      . 1981. Cambridge: Cambridge University."},{"key":"bibr24-2058460120988171","doi-asserted-by":"crossref","unstructured":"French SD, Green S, Buchbinder R, et\u00a0al. 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