Objective To determine whether an additional ‘high noon’ radiograph along the plane of penetrating foreign bodies improves accuracy and confidence in assessing cortical involvement of foreign bodies, whilst also remaining feasible for routine acquisition by medical radiation technologists. Materials and Methods Consecutive patients presenting with a penetrating foreign body at four participating sites were assessed. Routine radiographs, including standard views, were acquired. All patients also received a ‘high noon’ view aligned along the long axis of the partly penetrating foreign body. Two blinded musculoskeletal radiologists reviewed the images. Confidence in cortical involvement was assessed using a 5-point Likert scale, with and without the 'high noon' view. Subjective utility of the view was recorded. Accuracy was defined as the correct identification of the presence or absence of cortical bone involvement. Results Twenty-one cases (19 males, 2 females; mean age 36 ± 19 years) were analyzed. Only a single attempt at ‘high noon’ view was needed in 17 of 21 (81%) of cases. The ‘high noon’ view improved accuracy for Reviewer 1 from 15/20 (71%) to 21/21 (100%) and for Reviewer 2 from 11/20 (52%) to 17/20 (81%). Likert confidence scores were significantly improved for both reviewers (Wilcoxon Signed rank test Z-value = -3.41, p < 0.001 for reviewer 1, and Z-value = -1.83, p = 0.033 for reviewer 2). Subjective beneficial utility was reported by reviewers in 12/21 (57%) and 13/21 (62%) cases, respectively. Conclusion Adding a ‘high noon’ view markedly improved diagnostic accuracy and radiologist confidence for cortical involvement of penetrating foreign bodies. The ‘high noon’ view was subjectively rated as helpful in over half of the cases. Operationally, the projection was easy for technologists to acquire as part of the routine workflow. This low-cost modification warrants further evaluation in larger studies, including cases with confirmed cortical involvement. Plain Language Summary Penetrating injuries can be hard to assess on regular X-ray images. This study explored whether adding a special view called the high noon view could help radiologists see if a foreign object had reached the hard outer layer of bone. This study found that this extra view made readings more accurate and helped radiologists feel more confident in their assessments. This matters because better imaging can support safer care and quicker decisions for people with these injuries.

Medical imaging, including MRI, CT, and nuclear medicine play a critical role in healthcare but also imposes significant environmental burdens due to high energy consumption and waste production. Of the diagnostic modalities, MRI is the most energy-intensive modality, consuming up to 60 kWh per scan, followed by CT, which ranges from 1.0 to 11.4 kWh per scan. Lifecycle analyses show that operational energy use far exceeds manufacturing emissions, highlighting the need for energy-saving strategies. Implementing standby and power-off modes, optimizing scan protocols, and using AI-driven efficiency improvements can significantly reduce unnecessary energy use. Additionally, sustainable infrastructure, such as variable-flow cooling systems and strategic equipment placement, can further minimize environmental impact. Nuclear medicine, while relatively lower in energy consumption, relies on energy-intensive radioisotope production, often requiring fossil fuel-powered reactors and extensive transport logistics. Contrast agents in MRI and CT pose contamination risks in wastewater, as they are inadequately removed via conventional treatment plants methods. This results in the accumulation of gadolinium and iodinated byproducts in drinking water sources, posing potential human and ecological risks. Nuclear medicine radioisotopes, including Tc-99, also contribute to long-term contamination concerns. Strategies to mitigate these impacts include urine recycling, contrast separation, and advanced wastewater treatment. Sustainable practices in medical imaging require a multi-pronged approach, combining operational efficiency, renewable energy adoption, and stricter waste management protocols. Future efforts may also focus on promoting low-field MRI, AI-driven scan optimization, and alternative contrast agents, ensuring that radiology departments balance diagnostic efficacy with environmental responsibility.

Proximal femoral fractures are a serious life-threatening injury with high morbidity and mortality. Magnetic resonance (MR) imaging has potential to non-invasively assess proximal femoral bone strength in vivo through usage of finite element (FE) modelling (a technique referred to as MR-FE). To precisely assess bone strength, knowledge of measurement error associated with different MR-FE outcomes is needed. The objective of this study was to characterize the short-term in vivo precision errors of MR-FE outcomes (e.g., stress, strain, failure loads) of the proximal femur for fall and stance loading configurations using 13 participants (5 males and 8 females; median age: 27 years, range: 21–68), each scanned 3 times. MR-FE models were generated, and mean von Mises stress and strain as well as principal stress and strain were calculated for 3 regions of interest. Similarly, we calculated the failure loads to cause 5% of contiguous elements to fail according to the von Mises yield, Brittle Coulomb-Mohr, normal principal, and Hoffman stress and strain criteria. Precision (root-mean squared coefficient of variation) of the MR-FE outcomes ranged from 3.3% to 11.8% for stress and strain-based mechanical outcomes, and 5.8% to 9.0% for failure loads. These results provide evidence that MR-FE outcomes are a promising non-invasive technique for monitoring femoral strength in vivo.

Background Podcasts have become an increasingly popular method of communicating information in medicine, including in radiology. However, the effect of podcasts on the reach of journal articles remains unclear. Purpose To evaluate the influence of Radiology podcasts on the performance metrics, including downloads, citations, and Altmetric Attention Score (AAS), of Radiology articles. Materials and Methods This was a retrospective study. All articles published in the print version of Radiology from January 2021 to December 2022 were reviewed; editorials and case reports were excluded. Articles featured on Radiology podcasts were included in the podcast group. Articles published within the same journal issue and category were the nonpodcast group. Downloads, Google Scholar citations, Dimensions citations, and AAS metrics were recorded. The Mann-Whitney U test was used to compare medians and evaluate differences between older and more recently published articles. Results The podcast group, composed of 88 articles, exhibited significantly higher median values for downloads (PG, 4521.0; nonpodcast group, 2123.0; P < .001), Google Scholar citations (podcast group, 14.5; nonpodcast group, 10.0; P = .01), Dimensions citations (podcast group, 12.0; nonpodcast group, 9.0; P = .01), and AAS (podcast group, 43.0; nonpodcast group, 10.0; P < .001) compared with the nonpodcast group of 378 articles. Within both groups, articles published in the earlier nonpodcast group (January to June 2021) had higher downloads (podcast group, P = .08; nonpodcast group, P < .001), Google Scholar citations (podcast group and nonpodcast group, P < .001), and Dimension citations (podcast group and nonpodcast group, P < .001) than articles from the later period (July to December 2022). AAS markedly increased in recent podcast articles (P = .03), but AAS for nonpodcast articles significantly decreased over time (P = .01). Conclusion Radiology articles featured on the Radiology podcast had greater median metrics, including downloads, Google Scholar citations, Dimensions citations, and AAS, compared with nonpodcast articles, suggesting that podcasts can be an effective method of disseminating and amplifying research within the field of radiology. © RSNA, 2024 See also the editorial by Chu and Nicola in this issue.

Immediate and strategic action is needed to improve environmental sustainability and reduce the detrimental effects of climate change. Climate change is already adversely affecting the health of Canadians related to worsening air pollution and wildfire smoke, increasing frequency and intensity of extreme weather events, and expansion of vector-borne and infectious illnesses. On one hand, radiology contributes to the climate crisis by generating greenhouse gas emissions and waste during the production, manufacture, transportation, and use of medical imaging equipment and supplies. On the other hand, radiology departments are also susceptible to equipment and infrastructure damage from flooding, extreme temperatures, and power failures, as well as workforce shortages due to injury and illness, potentially disrupting radiology services and increasing costs. The Canadian Association of Radiologists' (CAR) advocacy for environmentally sustainable radiology in Canada encompasses both minimizing the detrimental effects that delivery of radiology services has on the environment and optimizing the resilience of radiology departments to increasing health needs and changing patterns of disease on imaging related to climate change. This statement provides specific recommendations and pathways to help guide radiologists, medical imaging leadership teams, industry partners, governments, and other key stakeholders to transition to environmentally sustainable, net-zero, and climate-resilient radiology organizations. Specific consideration is given to unique aspects of medical imaging in Canada. Finally, environmentally sustainable radiology programs, policies, and achievements in Canada are highlighted.

Fasting guidelines for children recommend restricting clear fluids for one or two hours before a procedure to reduce pulmonary aspiration. Gastric volumes < 1.5 mL·kg−1 do not seem to present an increased risk of pulmonary aspiration. Our aim was to quantify the time to achieve a gastric volume < 1.5 mL·kg−1 after clear fluid ingestion in children. We conducted a prospective observational study in healthy volunteers aged 1–14 yr. Participants followed American Society of Anesthesiologists fasting guidelines prior to data collection. Gastric ultrasound (US) was performed in the right lateral decubitus (RLD) position to determine the antral cross-sectional area (CSA). Following baseline measurements, participants consumed 250 mL of a clear fluid. We then performed gastric US at four time intervals: 30, 60, 90, and 120 min. Data were collected following a predictive model for gastric volume estimation using the formula: volume (mL) = −7.8 + (3.5 × RLD CSA) + (0.127) × age (months). We recruited 33 healthy children aged 2–14 yr. The mean gastric volume per weight (mL·kg−1) at baseline was 0.51 mL·kg−1 (95

PURPOSE:Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups.METHODS:Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call.RESULTS:During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected.CONCLUSIONS:Annual increases in scan volumes were modest. Although residents' experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.

Objective: The aim of this study was to explore association between hypermobility and osteoarthritis (OA) at the first carpometacarpal (CMC) joint, using magnetic resonance imaging (MRI) to identify early change in women at high risk of developing OA but without yet established diagnoses. Methods: For this observational study, 33 women (aged 30-50 years) with self-reported history of maternal hand OA but without personal diagnoses of OA were recruited. Participants completed a 5-point hypermobility questionnaire. The 20 participants with 2 or more positive responses were categorized with "high hypermobility scores." The remaining 13 were categorized with "low hypermobility scores." Data collection included functional index, hand pain measure, parity, smoking status, and body mass index. Each participant underwent dominant hand radiographic and MRI examination. Imaging studies were interpreted by assessors blinded to hypermobility score categorization. Results: No significant differences in age, body mass index, parity, functional index, or pain scores were observed between higher and lower hypermobility score groups. Similarly, there were no significant differences between groups for radiographic changes. However, significantly higher proportions of women with higher hypermobility scores were observed on MRI to have abnormalities of trapezium cartilage (75% vs. 38%), metacarpal cartilage (80% vs. 38%), and trapezium bone (70% vs. 31%); p < 0.05 for all. Conclusions: First CMC joint structural abnormalities were more frequently observed in women with higher hypermobility scores. Identification of early preradiographic changes in this group supports the concept that early-life joint laxity may contribute to future OA predisposition. Magnetic resonance imaging may be a preferred imaging test for detection of early cartilage changes in people at high risk of CMC joint OA.

Background:The biomechanical role of the proximal long head of the biceps tendon (PLHB) in glenohumeral joint stability remains controversial. This retrospective study aims to correlate between humeral head migration and PLHB pathology in patients with and without rotator cuff tendon tears using imaging.Methods:Seventy-nine patients who underwent 3T magnetic resonance imaging of the shoulder were retrospectively reviewed. Imaging findings were documented by a fellowship-trained musculoskeletal radiologist. PLHB tendon diameter change, contour irregularity, and signal intensity change were assessed. Rotator cuff status was given a binary assignment of intact vs. torn. Radiographs were used for measurement of the acromiohumeral distance and a cutoff value of 7 mm was set as a lower limit of normal.Results:In the cohort of 79 shoulders, 41.8% (33/79) of patients had intact PLHB tendon and rotator cuff, 26.6% (21/79) demonstrated isolated PLHB tendon pathology, 13.9% (11/79) demonstrated isolated rotator cuff tears, and 17.7% (14/79) demonstrated concomitant PLHB tendon pathology and rotator cuff tears. Acromiohumeral distance was preserved in 97.0% (32/33) of patients with intact PLHB tendon and rotator cuff, 28.6% (6/21) of patients with isolated PLHB tendon pathology, 81.8% (9/11) of patients with isolated rotator cuff tears, and 14.3% (2/14) of patients with concomitant PLHB tendon pathology and rotator cuff tears (P < .0001).Conclusion:Results of this study have shown that a statistical correlation was present between superior humeral head migration and PLHB tendon pathology with or without rotator cuff tears, compared to rotator cuff pathology alone. Findings suggest that intact PLHB tendon plays an important role in glenohumeral stability.

Purpose: Determine the educational background, research publications/presentations experience, and rates of research publication and presentation inaccuracies in applications to a Canadian diagnostic imaging residency program. Method: The education and publication/presentation sections of the Canadian Resident Matching Service form for all applicants to the University of Saskatchewan diagnostic imaging residency program from 2019–20 and 2020–21 were reviewed. Number of advanced degrees (Master’s/PhDs), publications, and presentations were recorded. Accuracy of publications listed was confirmed via PubMed-MEDLINE, journal’s website, or internet searching. Accuracy of presentations was confirmed via society and residency program websites. Inaccuracies of non-authorship, incorrect authorship order/status (self-promotion or demotion), and nonexistence of article/presentation from a verifiable source were recorded. Result: There were a total of 106 applicants. Thirty (28%) had advanced degrees. There were 230 publications from 61 applicants with inaccuracies in only 5 (2%) of the publications (2 self-promotion, 3 self-demotion). For the 77 publications listed as pending, 25 (31%) were published within 6 months of applications deadlines with 1 non-authorship, 1 self-promotion, and 1 self-demotion. For scientific presentations, there were 467 listed presentations by 91 applicants. Two hundred and twenty-one presentations were from verifiable sources with inaccuracies in 28 (13%) of presentations (9 self-promotion, 9 self-demotion, 1 non-authorship, and 9 non-existence). Conclusion: Despite some uncertainty with scientific articles reported as pending and scientific presentations, radiology residency applicants are accurately representing their published articles with a negligible number of misrepresentations. Canadian radiology residency programs should regard the publication profiles of the applicants with a high level of confidence.

Objective: Determine how many radiology resident research day projects are presented at the Canadian Association of Radiologists Annual Scientific Meeting (CAR ASM) and if presentation at the CAR ASM is associated with increased rates of publication. Methods: A database of radiology resident presentations from 2012 to 2017 research days at seven Canadian radiology programs was utilized. Each presenting resident was searched for in 2011-2019 CAR ASM books of abstracts to identify all CAR ASM presentations both related to and separate from their research day projects. These presentations were matched with resident research day presentations and their publication status. Descriptive statistical analysis and calculation of relative risk (RR) between publication of research day projects and presentation at CAR was performed. Results: 208 residents presented 288 projects at internal research days. 93 of the 208 residents had a total of 195 presentations at CAR (mean .94 +/- 1.91 SD). 36 of the 288 (13%) research day projects were presented at a CAR ASM, of which 18/36 (50%) were published. 83 of the 252 (32%) research day projects not presented at CAR were published. CAR ASM presentation of a research day project was associated with an increased rate of publication (RR 1.537 P=.0396). There was no significant association between research day project publication and unrelated CAR ASM presentations (P=.275). Most research day projects both presented at CAR ASM and published (56%) were in the Canadian Association of Radiologists Journal. Conclusion: CAR ASM presentation of research day projects is associated with an increased rate of publication.

Background  Four-corner arthrodesis (4CA) can be performed with a variety of methods. To our knowledge, fewer than 125 cases of 4CA with a locking polyether ether ketone (PEEK) plate have been reported, necessitating further study. Purpose  The purpose of this study was to evaluate the radiographic union rate and clinical outcomes in a series of patients who received 4CA with a locking PEEK plate. Methods  We re-examined 39 wrists in 37 patients at a mean follow-up of 50 months (median: 52 months, range: 6-128). Patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and participated in measurements of grip strength and range of motion. Anteroposterior, lateral, and oblique radiographs of the operative wrist were examined for union, screw breakage and/or loosening, and lunate change. Results  The mean QuickDASH score was 24.4 and the mean PRWE score was 26.5. Mean grip strength was 29.2 kg or 84% of the nonoperative hand. Mean flexion, extension, radial deviation, and ulnar deviation were : 37.2, 28.9, 14.1, and 17.4 degrees, respectively. Eighty-seven percent of wrists achieved union; 8% had nonunion; and5% had indeterminate union. There were seven cases of screw breakage and seven cases of screw loosening (as defined by lucency or bony resorption surrounding screws). Twenty-three percent of wrists required reoperation (four total wrist arthrodesis and five reoperations for other reasons). Conclusion  4CA with a locking PEEK plate has clinical and radiographic outcomes similar to other methods. We observed a high rate of hardware complications. It is unclear whether this implant offers a clear advantage over other methods of fixation used in 4CA. Type of Study/Level of Evidence  Level IV, therapeutic study.

Background . Detection of ankylosing spondylitis (AS) in the preclinical stage could help prevent long term morbidity in this patients’ population. The aim of this study was to examine the prevalence of active sacroiliitis in first-degree relatives of AS patients using MRI with clinical and laboratory correlations as these patients may benefit from MRI screening and early treatment. Methods . Seventeen first-degree relatives of AS patients were recruited prospectively. AS screening questionnaires (Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index & Visual Analogue Scale), blood tests (C-Reactive Protein, HLA-B27), and an MRI of the SIJs were taken. Two musculoskeletal radiologists interpreted the MRI scans, and two physiotherapists applied four symptom provocation tests (Gaenslen's test, posterior pelvic pain provocation test, Patrick's Faber (PF) test and palpation of the long dorsal SIJ ligament test), and two functional movement tests (active straight leg raise and Stork test). Results . Seven (41%) of the 17 participants demonstrated MRI evidence of active sacroiliitis. Of the 7 participants with active sacroiliitis, two (29%) had no history of recent low back pain (LBP), two (29%) had negative HLA-B27, and one (14%) participant had neither back pain nor positive HLA-B27. The Cohen's Kappa score for the interobserver agreement between the radiologists was 1.00 ( p-value <0.0001 ). Despite fair to strong between therapist agreement for the physical test outcomes (Kappa 0.26 to 1.00), the physical test results per se did not have any predictive association with a positive MRI. Conclusions . MRI detected active sacroiliitis in 41% of first-degree relatives of AS patients. The lack of a history of prior LBP or positive HLA-B27 in active sacroiliitis participants might suggest that MRI screening for this high-risk population is warranted; however, further larger studies are needed to help elucidate its cost-effectiveness and long-term benefits.

Purpose: Assess quality metrics of modified barium swallow studies (MBSS) with and without a radiologist present during the procedure. Methods: Retrospective review of MBSS performed on adult inpatients at a tertiary care hospital 6-months pre- and post-institutional change from having to not having a radiologist present during the examination. Factors assessed included: fluoroscopy time; study duration; number of cine loops; number of images; efficiency of collimation (using a 5-point scoring system); time to final report; radiologist-speech language pathologist report disagreement; and recalls for inadequate studies. Statistical analysis was via Welch's t-test and a test of proportions for continuous and count data under the normal approximation. Results: 106 and 119 MBSS were analyzed from the radiologist present and radiologist absent periods, respectively. No statistically significant differences were found for: average fluoroscopy time (116.1 s vs. 126.9 s; P = 0.161); study duration (400.4 s vs. 417.3 s; P = 0.453); number of cine loops (9.3 vs. 10.2; P = 0.075); number of images (620.5 vs. 581.1; P = 0.350); or report disagreement. There was improved performance without the radiologist present for collimation (1.92 vs. 1.43; P = 0.003) and fewer non-diagnostic images (6.5 vs. 4.5; P = 0.001). Time to final report was longer with the radiologist absent due to more reports with significant delays. There were no repeated studies because of inadequate technique in either group. Conclusion: MBSS performed by technologists without radiologist supervision is not inferior to those performed with radiologist supervision on multiple performance measures. This supports technologist operated MBSS without radiologist supervision, while acknowledging a need to further address radiologist report time delay.

Objective Femoral epiphyseal spurs are developmental projections that form at the edge of the physis. Although considered incidental, their association with acetabular labral tears has never been examined. Our aim was to assess the prevalence of femoral epiphyseal spurs in symptomatic patients with mechanical hip pain and explore if they are associated with labral tears on MRI. Materials and methods Hip MRI scans performed on a Siemens 3 T MRI using femoroacetabular impingement protocol were retrospectively reviewed. All patients were referred by orthopaedic surgeons for mechanical hip pain. Two musculoskeletal radiologists blinded to initial reports evaluated MRI images for the presence of an epiphyseal spur and acetabular labral changes. A consensus was achieved on all cases by the two readers. The association between epiphyseal spurs and labral changes was assessed using Fisher's exact test. Results A total of 115 patients (178 hip MRI scans) were reviewed; the mean age was 28.8 years (SD 7.1). There were 52 females (45.2%) and 63 males (54.8%). There were 115 hips with labral tears (64.6%). Fourteen hips (7.8%) in ten patients (8.7%) demonstrated epiphyseal spurs and all of them showed labral tears (100%). There was statistically significant association between epiphyseal spurs and labral tears on MRI (p value = 0.0024). Conclusion Femoral epiphyseal spurs were observed in 8.7% of our defined patient population, and all patients with epiphyseal spurs demonstrated labral tears. Epiphyseal spurs should be documented on imaging reports due to their potential association with labral tears. Future research is needed to further delineate and guide management of these entities.

OBJECTIVE:Twenty-one previous studies have shown a mean presentation to publication conversion rates at radiology conferences of 26%. There have been no prior studies on publication of medical imaging residency research presentations. Our objective was to determine how many medical imaging resident research projects presented at internal program research days across Canada go on to publication.METHODS:A list of unique medical imaging resident research presentations given at program research days during the 2012-2013 to 2016-2017 academic years was generated via e-mail contact of programs or review of publicly available data on program websites. Unique resident presentations were identified and publications associated with these presentations were sought via database and Internet searching. The number of publications, publishing journals, and time to publication was determined.RESULTS:Data from 32 research days at 7 programs were assessed. A total of 287 resident presentations were identified. Of these 287 presentations, 99 had associated publications (34% presentation to publication conversation rate), with variation in presentation numbers and publication conversion rates between schools. These 99 presentations were associated with a total of 118 publications in a total of 57 different journals. Time from presentation to publication was calculable for 109 of the 118 articles. Fifteen (14%) were published before research day and 94 (86%) were published after research day with a mean time to publication of 12.3 ± 13.6 months for all articles.CONCLUSIONS:Thirty-four percent of resident research presentations at Canadian medical imaging program research days go on to publication.

BACKGROUND:The utility of magnetic resonance imaging (MRI) in the primary care setting is uncertain, with a perception that there is less likelihood for surgery after MRI ordered by general practitioners (GPs) when compared with orthopaedic surgeons and sports medicine physicians. Additionally, the influence of patient age and sex on subsequent surgical intervention is currently unknown. PURPOSE/HYPOTHESIS:The purpose of this study was to compare surgical incidence after MRI referrals by orthopaedic surgeons, GPs, and sports medicine physicians, including a subset analysis for GP patients based on type of approval given by the radiologist. The authors also wanted to explore the association of age and sex on subsequent surgical intervention. They hypothesized that surgical incidence after MRI ordered by orthopaedic surgeons and sports medicine physicians would be higher than after MRI ordered by GPs. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Knee MRI referrals by the 3 physician cohorts during May to December 2017 were assessed. For GP patients, the types of approval or recommendation from a radiologist were categorized. Subsequent surgical intervention status was then compared among referral groups up to 2 years after MRI. Associations of age and sex with surgical occurrence were also assessed. Chi-square test, analysis of variance, and univariate/multivariable logistic regression were used for statistical analysis. RESULTS:Overall, 407 referrals were evaluated (GP, n = 173; orthopaedic, n = 176; sports medicine, n = 58). Surgical incidence was not significantly higher for orthopaedic and sports medicine than GP referrals at 3 months (10%, 3%, and 6%, respectively; P = .23), 6 months (20%, 17%, and 15%; P = .49), and 2 years (30%, 35%, and 24%; P = .25). Surgical incidence for GP patients was higher after discussion with a radiologist or when evaluating specific pathology on prior imaging versus less defined reasons (30.4% vs 15.7%, respectively; P = .03). Surgical incidence was lower for older patients (11% vs 31% for >60 years vs all other age groups combined; P = .002), and women were less likely to undergo surgery than men (22% vs 35%, respectively; P = .008). CONCLUSION:Surgical incidence after MRI was likely appropriately lower for older patients. Lower incidence for female patients is of uncertain cause and warrants further study.