A ‘walk-in’ X-ray is often all that’s needed for lumbar-pain diagnostics: New study
Note to patients suffering low-back pain without having signs or symptoms of severe injury or illness: You’ll do well for yourself—and for U.S. healthcare—to get an X-ray at an urgent-care clinic rather than going to a hospital emergency room for more advanced imaging.
That’s the conclusion of researchers who found only 24 of almost 3,000 urgent-care lumbar X-rays—less than 1%—preceded a pricey CT or MRI scan at an ER within 30 days.
The low follow-up rate adds to evidence suggesting most low-back pain subsides without need for additional imaging, much less professional intervention or other downstream episodes of care.
Given the population-level pattern, the findings suggest, a quick X-ray can help confidently rule out serious harm when none appears to be present.
This should come as good news to watchers of medical spending, as advanced imaging for low-back pain has often been referred to as the “poster child” for healthcare overutilization.
For the present study, radiologist Marc Succi, MD, of Mass General Brigham and colleagues analyzed records of adults who were X-rayed at urgent-care clinics—sometimes called “walk-in” clinics—for low-back pain between 2019 and 2025. They identified patients who went to the ER with the same complaint less than one month after the clinic visit.
They also measured resource intensity as total Relative Value Units (RVU) per study, converting this figure to approximate Medicare-allowed dollars.
The study’s other key findings include:
- Of the 24 patients who went to the ER with the same complaint within the one-month window, about half did so within 24 hours of the clinic X-ray visit.
- Of those 24, radiologists in the study found only one true missed fracture on the initial X-ray.
- Escalation remained low across three urgent care networks, age groups and study years.
- Urgent-care X-rays used about one-quarter of the imaging resources of emergency department CTs and MRIs (1.43 vs 5.14 total RVU per study—about $48 vs $171).
- Among 16,754 studies (2,924 urgent-care radiographs, 13,830 ER scans) from 15,759 patients, urgent-care patients were considerably younger (median 50 vs 67 years).
The findings, published in the Journal of the American College of Radiology (JACR), suggest that urgent care may be an appropriate first setting for imaging low-acuity low back pain, Succi and team comment in their discussion section.
“Our findings align with the ACR Appropriateness Criteria and Choosing Wisely recommendations, which reserve advanced lumbar imaging for red-flag presentations and discourage routine cross-sectional imaging for acute nontraumatic low-back pain,” they write.
Succi and co-authors note that return visits for low-back pain tend to cluster in the first days after an index encounter, an observation supported by the present findings.
“Here the timing, supported by radiologist review of the return events, suggests appropriate escalation, not diagnostic failure of the index urgent-care radiograph,” they add.
“Most fracture-related returns followed a radiograph read as suspicious or indeterminate for fracture, which is the intended next step in a radiograph-first pathway.”
In Mass General Brigham’s own coverage of the research, Succi discusses the study in the context of value-based care.
“Clinicians need evidence to help decide when advanced imaging is likely to change care and when a less intensive evaluation may be appropriate,” he says. “That decision also matters to patients who may otherwise undergo additional testing for findings unrelated to their pain. This affects cost, quality of care and the efficient provisioning of limited resources.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.