Imaging is the production of a clinical image of the human body using medical techniques such as x-rays, ultrasound, computed tomography (CT) scan and magnetic resonance (MRI). Imaging is commonly performed for musculoskeletal conditions and is an important aspect of the management of these conditions. In some instances, imaging may not be appropriate, for example x-rays for acute low back pain, and in other instances, imaging is under utilised, for example bone mineral density testing to diagnose people at risk for osteoporosis. The identification of interventions that improve the appropriate use of imaging (either decreasing inappropriate use or increasing appropriate use) for musculoskeletal conditions would be of great value, potentially resulting in improved health outcomes for patients and reduced healthcare costs. The aim of this systematic review was to identify those interventions that improve appropriate use of imaging and to quantify their effects.

Twenty eight studies met our inclusion criteria. The majority of studies evaluated interventions designed to change health professional behaviour, for example, the distribution of educational materials, reminders to health professionals and patient education. For improving the use of imaging in osteoporosis, most interventions aimed at health professionals demonstrated benefit, and patient mediated, reminder, and organisational interventions appeared to have most potential for benefit. For low back pain studies, the most common intervention evaluated was distribution of educational materials and this showed varying effects. Other interventions in low back pain studies showed variable effects. For other musculoskeletal conditions, distribution of educational materials, educational meetings and audit and feedback were not shown to be effective for changing imaging ordering behaviour. Across all conditions, increasing the number of intervention components did not result in a larger effect of interventions.