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In Reply We thank the authors for their interest in our study1 and will respond to their criticisms. The RAND-University of California, Los Angeles, appropriateness method2 was criticized for not following “widely-accepted evidence-based criteria.” Rather than accepting published guidelines with their reliance on other sources, we used the RAND method, which combines all the available evidence with expert opinion. In many cases, there is inadequate published evidence to classify a medical procedure or test as appropriate or inappropriate, which is certainly the case for lumbar magnetic resonance imaging (MRI), making the use of published guidelines questionable. The use of an expert multispecialty panel has been shown to be a substantial strength of the RAND method,3 rather than relying on the consensus of a narrower specialty base as in the study by Kovacs et al.4
Emery DJ, Feasby TE. Inappropriate Use of Lumbar Magnetic Resonance Imaging: Limitations and Potential Solutions—Reply. JAMA Intern Med. 2013;173(21):2012–2013. doi:10.1001/jamainternmed.2013.9956