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Background and Purpose: We conducted a prospective randomized study of patients with acute low back pain and/or radiculopathy to assess the effect of knowledge of diagnostic findings on clinical outcome. The practice of ordering spinal imaging, perhaps unintentionally, includes a large number of patients for whom the imaging test is performed for purposes of reassurance or because of patient expectations. If this rationale is valid, one would expect to see a measurable effect from diagnostic information, per se., Materials and Methods: A total of 246 patients with acute (<3 weeks) low back pain (LBP) and/or radiculopathy (150 LBP and 96 radiculopathy patients) were recruited. Patients were randomized using a stratified block design with equal allocation to either the unblinded group (MR imaging results provided within 48 hours) or the blinded group (both patient and physician blinded to MR imaging results.) After the initial MR imaging, patients followed 6 weeks of conservative management. Roland function, visual pain analog, absenteeism, Short Form (SF)-36 Health Status Survey, self-efficacy scores, and Fear Avoidance Questionnaire were completed at presentation; 2, 4, 6, and 8 weeks; and 6, 12, and 24 months. Improvement of Roland score by 50% or more and patient satisfaction assessed by Cherkin symptom satisfaction measure were considered a positive outcome., Results: Clinical outcome at 6 weeks was similar for unblinded and blinded patients. Self-efficacy, fear avoidance beliefs, and the SF-36 subscales were similar over time for blinded and unblinded patients, except for the general health subscale on the SF-36. General health of the blinded group improved more than for the unblinded group (P = .008)., Conclusions: Patient knowledge of imaging findings do not alter outcome and are associated with a lesser sense of well-being.

Rationale and Objectives: Total body screening, despite its popularity, has not been evaluated in clinical trials. Even the appropriate target for screening has not been addressed. In this study, we determined the variables from a subject's demographic and medical and family history that are predictive of actionable findings on total body screening., Materials and Methods: Over a 3-year period, 982 self-referred subjects underwent total body screening with multislice computed tomography and completed a demographic and medical history questionnaire. The study sample was divided into training and testing samples. Univariate and multiple-variable statistical methods were used on the training sample to derive models that predict actionable lung findings, actionable heart findings, actionable abdomen/pelvis findings, and any actionable findings on total body screening. The training models were then applied and evaluated on the test sample., Results: A subject's age at the time of screening was the single most important predictor and often the only significant predictor of actionable findings. Among subjects younger than 40 years of age, 22.5% had actionable findings; this number nearly doubled, to 43.5%, for subjects between 40 and 49, and increased to 80% for subjects 80 years and older. Overall, every increase of 10 years in age brings an increase of 1.6 in the likelihood of an actionable finding., Conclusions: Total body screening targeted at older subjects has the highest yield of actionable findings. The efficacy and cost-effectiveness of total body screening for older subjects is unknown and needs further assessment.