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Objective:
Physicians spend large amounts of time on protocolling imaging studies, limiting their time spent on other clinical tasks. Most musculoskeletal MRI studies are performed for the evaluation of joint pain and are usually acquired without contrast. Contrast-enhanced studies are performed for evaluation of infections, neoplasms, and rheumatological conditions. This project's purpose was to assess the effect of automatic protocoling on the rate of MRI examinations obtained without contrast for infection, neoplasms, and rheumatological indications.

Materials and Methods:
All musculoskeletal reports of MRIs during the last two months of the years before and after the implementation of automatic protocolling (intervention) were searched for the presence of indications related to neoplasms, infections, and rheumatological conditions. For each of the three categories, we determined the number of MRIs obtained with and without contrast before and after the intervention. For each matching study obtained without contrast, the patient chart was reviewed for contraindications to contrast, positive final diagnosis, whether interpreting radiologist mentioned the examination being limited by lack of contrast, and recommendations for a follow-up contrast-enhanced study.

Results:
A total of 846 musculoskeletal MRI studies were performed prior to intervention, and 822 MRI studies were performed afterwards. Overall, 25% of the studies were performed without contrast prior to the intervention, and 31% of studies were performed without contrast afterwards. No report contained a recommendation for a contrast-enhanced follow-up study before or after intervention. Positive diagnosis was reached in 50% of neoplasm studies before intervention and in 40% afterwards. Positive diagnosis was reached in 71% of infection studies before the intervention and in 24% afterwards. All rheumatological studies were negative for the diagnosis of inflammatory arthritis or myositis before and after intervention.

Conclusion:
Automatic protocolling of routine noncontrast imaging studies resulted in a minimal (6%) increase in the overall number of noncontrast-enhanced studies obtained for work-up of neoplasms, infections, and rheumatological conditions. We believe that this is an acceptable increase justified by substantial time savings for radiologists, allowing them to perform other clinically important tasks. Although some studies were considered “limited” by the interpreting radiologist, we have not yet encountered a study that required recalling the patient for contrast-enhanced MRI. This study demonstrates that the implementation of automatic protocolling in routine noncontrast imaging studies can result in substantial time savings for radiologists with minimal downsides.