Use of Diagnostic Imaging Studies and Associated Radiation Exposure For Patients Enrolled in Large Integrated Healthcare Systems, 1996–2010

By R. Smith-Bindman, Diana L. Miglioretti, Eric A. Johnson, Choonsik Lee, H. Feigelson, M. Flynn, R. Greenlee, R. Kruger, M. Hornbrook, D. Roblin and 4 more. Journal of the American Medical Association (JAMA), 2012

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Context Diagnostic imaging use increased significantly within fee-for-service models of care. Little is known about patterns of imaging among members of integrated health care systems. Objective To estimate trends in imaging utilization and associated radiation exposure among members of integrated healthcare systems. Design, Setting, and Participants Retrospective analysis of electronic records of members of six large integrated health systems from diverse regions of the country. Review of medical records allowed direct estimation of radiation exposure from selected tests. Between 1–2 million member-patients were included each year from 1996 to 2010. Main Outcome Measure Advanced diagnostic imaging rates, and cumulative annual radiation exposure from medical imaging. Results During the 15 year study period, enrollees underwent a total of 30.9 million imaging examinations (over 25.9 million person-years), reflecting 1.18 (95% CI 1.17–1.19) tests per person per year, of which 35% were for advanced diagnostic imaging (CT, MRI, nuclear medicine, and ultrasound). Use of advanced diagnostic imaging increased from 1996 to 2010; computed tomography examinations increased from 52/1000 enrollees in 1996 to 149/1000 in 2010, 7.8% annual growth (95% CI 5.8%, 9.8%); MRI increased from 17/1000 to 65/1000, 10% annual growth (95% CI 3.3%, 16.5%); and ultrasound increased from 134/1000 to 230/1000, 3.9% annual growth (95% CI 3.0% to 4.9%). While nuclear medicine decreased from 32/1000 to 21/1000, 3% annual decline (95% CI 7.7% decline to 1.3% increase), after 2004, PET imaging rates increased from 2.2/10 000 to 23.5/10 000, 15.2% annual growth. While imaging increased within all health systems, the adoption of different modalities for anatomic area assessment varied. Increased use of CT resulted in increased radiation exposure for enrollees, with a doubling in the mean per capita effective dose and in the proportion of enrollees who received high (>20–50 mSv) or very high (>50mSv) annual radiation exposure. By 2010, nearly 7% of enrollees who underwent imaging received a high annual radiation exposure (>20–50 mSv) and 4% received a very high annual exposure (>50 mSv). Conclusion Within integrated health care systems there was a large increase in the rate of advanced diagnostic imaging and associated radiation exposure between 1996 and 2010.

Subfields: Pulmonary and Respiratory Medicine, Radiology, Nuclear Medicine and Imaging

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Citations in the corpus

Age and Cancer Risk (2014, neutral): “Use of medical imaging procedures such as CT scans and PET scans has increased dramatically over the past 20 years, particularly among those in midlife who have chronic conditions.(41,42) Evidence from epidemiologic studies and models of radiation-induced cancer show that exposures to radiation duri”
Deep Learning Applications in Medical Image Analysis (2018, background): “[2] looked at imaging use from 1996 to 2010 across six large integrated healthcare systems in the United States, involving 30.”