PURPOSE Patients with low back pain (LBP) rarely have serious underlying pathology but frequently undergo inappropriate imaging. A range of guidelines and red flag features are utilised to characterise appropriate imaging. This scoping review explores how LBP imaging appropriateness is determined and calculated in studies of primary care practice. METHODS This scoping review builds upon a previous meta-analysis, incorporating articles identified that were published since 2014, with an updated search to capture articles published since the original search. Electronic databases were searched, and citation lists of included papers were reviewed. Inclusion criteria were studies assessing adult LBP imaging appropriateness in a primary care setting. Twenty-three eligible studies were identified. RESULTS A range of red flag features were utilised to determine imaging appropriateness. Most studies considered appropriateness in a binary manner, by the presence of any red flag feature. Ten guidelines were referenced, with 7/23 (30%) included studies amending or not referencing any guideline. The method for calculating the proportion of inappropriate imaging varied. Ten per cent of the studies used the total number of patients presenting with LBP as the denominator, suggesting most studies overestimated the rate of inappropriate imaging, and did not capture where imaging is not performed for clinically suspicious LBP. CONCLUSION Greater clarity is needed on how we define and measure imaging appropriateness for LBP, which also accounts for the problem of failing to image when indicated. An internationally agreed methodology for imaging appropriateness studies would ultimately lead to an improvement in the care delivered to patients. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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在腰痛研究中定义和测量影像学适合性：一项范围界定性综述。

目的下腰痛（LBP）患者很少有严重的基础病理，但经常进行不适当的成像。一系列指南和红旗功能可用于表征适当的成像。该范围回顾探讨了在初级保健实践研究中如何确定和计算LBP成像的适当性。方法：本研究范围回顾基于先前的荟萃分析，纳入了自2014年以来发表的已鉴定文章，并进行了更新搜索以捕获自原始搜索以来发表的文章。搜索了电子数据库，并审查了包括论文的引文清单。纳入标准是评估初级保健机构中成人LBP影像学适合性的研究。确定了二十三项合格研究。结果利用一系列的红旗特征来确定成像的适当性。大多数研究都通过存在任何红旗特征以二进制方式考虑适当性。参考了十项指南，其中7/23（30％）包括修改或未参考任何指南的研究。计算不适当成像比例的方法各不相同。10％的研究使用了以LBP为分母的患者总数，这表明大多数研究高估了不当成像的发生率，并且没有捕捉到对于临床可疑LBP没有进行成像的地方。结论我们需要更加清晰地定义和测量LBP的成像适用性，这也解决了指示时无法成像的问题。一项国际公认的影像学适应性研究方法将最终改善对患者的护理。这些幻灯片可以在电子补充材料下找到。