Two-tiered approach to MRI for headache: A cost-effective way to use an expensive technology

Aseem Sharma, Martin Reis, Matthew S. Parsons, Franz J. Wippold, John Chrisinger, Todd J. Schwedt, Thomas K. Pilgram

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


OBJECTIVE. The purpose of this study was to compare the diagnostic efficacy and cost implications of a proposed two-tiered approach to MRI in patients with headache. MATERIALS AND METHODS. We identified 245 consecutive patients with headache using MRI studies performed at a tertiary care facility between October 2009 and July 2011. Three radiologists prospectively used FLAIR sequences from these MR studies to diagnose underlying abnormality or to identify the need for a comprehensive MRI study. We compared the diagnostic efficacy and the cost implications of such a two-tiered approach with those of conventional MRI from the perspectives of the payer, the patient, and the imaging facility. RESULTS. The sensitivity and specificity for two-tiered (83.3% and 100%, respectively) and conventional (91% and 97.8%, respectively) MRI approaches were not significantly different. Assuming a 50% reduction in the payment for the initial limited MRI performed as a first step of the two-tiered approach, this approach would have resulted in 44.8% savings to the payer. A substantial reduction in the scanner utilization time from 4168 minutes to 1249 minutes for the two-tiered approach would have enabled increased throughput at the imaging facility. Although 27 (11%) patients would have been recalled for a comprehensive MRI study in the two-tiered approach, the average time spent in the scanner by each patient would have been less for the two-tiered approach (5.1 minutes vs 17.0 minutes). CONCLUSION. A two-tiered approach to MRI can serve as a viable cost-effective alternative to the conventional approach.

Original languageEnglish (US)
Pages (from-to)W75-W80
JournalAmerican Journal of Roentgenology
Issue number1
StatePublished - Jul 2013


  • Cost-effectiveness
  • Headache
  • Health care cost
  • Health care policy
  • MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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