A new study published in Spine examines the geographic variation in the early MRI for acute work-related low back pain. The researchers examined acute, disabling low back pain cases between the beginning of 2002 and end of 2007 from a large workers’ compensation data source. The researchers identified patients who received MRI within 30 days of onset as well as pain severity and concurrent injuries or diseases. They found that state rates of early MRI scanning varied from 6.0 percent to 58.4 percent. In the twelve selected most extreme states, non-hospital MRI sites and lower state median income were associated with higher rates of early MRIs, explaining 84 percent of between-state variation. Pransky et al concluded that between-state inappropriate early MRI variability is largely explained by the rate of non-hospital MRI sites and state median income. Potential solutions include efforts to address inappropriate referral patterns based on private MRI facility ownership, and to improve quality of communication with low-income patients.