Low back pain accounts for some of the highest healthcare spending in the U.S. Given how many patients are affected, even small changes in imaging practices could substantially impact healthcare resource use. A retrospective cohort study led by Mass General Brigham researchers found that only 24 of 2,924 urgent care lumbar spine X-rays for uncomplicated low back pain were followed by emergency department advanced imaging within 30 days. An urgent care X-ray used about one-quarter of the imaging resources of an emergency department CT or MRI. The results, suggesting that urgent care may be an appropriate, less resource-intensive pathway, are published in the Journal of the American College of Radiology.
"Clinicians need evidence to help decide when advanced imaging is likely to change care and when a less intensive evaluation may be appropriate," said senior author Marc Succi, MD , emergency radiologist and founder and principal investigator of the IO Lab at Mass General Brigham. "That decision also matters to patients who may otherwise undergo additional testing for findings unrelated to their pain. This affects cost, quality of care and the efficient provisioning of limited resources."
The study analyzed 16,754 lumbar spine imaging studies from 15,759 patients across 23 Mass General Brigham urgent care centers and affiliated emergency departments over seven years. Escalation to emergency department imaging stayed low across urgent care networks, age groups and years, even as urgent care imaging volume nearly doubled. Two radiologists reviewed each of the 24 patients who returned to the hospital and found only one true finding missed on the original urgent care X-ray.
"For most people with lower back pain, urgent care can be a good place to start. Fewer than 1 in 100 people who received x-rays of their lower back at urgent care required advanced imaging within the next month," said Michael Hood, MD, who served as co-first author with Joel Samuel, MD, both of the IO Lab.
"It's important that we examined the return cases, including the missed fracture, because that makes our findings more useful in determining what to study next," Succi said. "We're excited about the potential to evaluate selected patients with fewer imaging resources while preserving access to advanced imaging when needed. The next step should be a prospective study across several health systems that follows patients beyond 30 days and tracks subsequent care."
Authorship: In addition to Succi, Mass General Brigham authors include Michael Hood, Joel K. R. Samuel, Praneet Khanna, Ali Ebada, and Arya Rao.
Disclosures: None.
Funding: None.
Paper cited: Hood M et al. "Urgent Care Radiography for Low Back Pain Is Rarely Followed by Emergency Advanced Imaging," Journal of the American College of Radiology. DOI: 10.1016/j.jacr.2026.10.023
