De Roo B, et al. - Expert sought to investigate the compliance of lumbar spine imaging referrals with national imaging recommendations and to estimate the influence of inappropriate imaging on the collective radiation dose and health insurance costs. A total of 633 lumbar spine imaging referrals were assessed across 9 Belgian hospitals between 2011 and 2015. A new clinical anamnesis and physical examination were conducted for each patient. The collective radiation dose was calculated for the radiography and CT procedures. Although a positive trend was seen for CT, there was no significant improvement in requesting justified lumbar spine imaging procedures between 2011 and 2015. A shift from CT to MRI is required to increase the appropriateness of lumbar spine imaging referrals and to decrease the collective radiation dose.