Use of Diagnostic Imaging Studies and Associated Radiation Exposure for Patients Enrolled in Large Integrated Health Care Systems, 1996-2010
Open accessAbstract
CONTEXT: Use of diagnostic imaging has 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 health care systems. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of electronic records of members of 6 large integrated health systems from different regions of the United States. Review of medical records allowed direct estimation of radiation exposure from selected tests. Between 1 million and 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 (25.8 million person-years), reflecting 1.18 tests (95% CI, 1.17-1.19) per person per year, of which 35% were for advanced diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MRI], nuclear medicine, and ultrasound). Use of advanced diagnostic imaging increased from 1996 to 2010; CT examinations increased from 52 per 1000 enrollees in 1996 to 149 per 1000 in 2010, 7.8% annual increase (95% CI, 5.8%-9.8%); MRI use increased from 17 to 65 per 1000 enrollees, 10% annual growth (95% CI, 3.3%-16.5%); and ultrasound rates increased from 134 to 230 per 1000 enrollees, 3.9% annual growth (95% CI, 3.0%-4.9%). Although nuclear medicine use decreased from 32 to 21 per 1000 enrollees, 3% annual decline (95% CI, 7.7% decline to 1.3% increase), PET imaging rates increased after 2004 from 0.24 to 3.6 per 1000 enrollees, 57% annual growth. Although imaging use increased within all health systems, the adoption of different modalities for anatomic area assessment varied. Increased use of CT between 1996 and 2010 resulted in increased radiation exposure for enrollees, with a doubling in the mean per capita effective dose (1.2 mSv vs 2.3 mSv) and the proportion of enrollees who received high (>20-50 mSv) exposure (1.2% vs 2.5%) and very high (>50 mSv) annual radiation exposure (0.6% vs 1.4%). By 2010, 6.8% of enrollees who underwent imaging received high annual radiation exposure (>20-50 mSv) and 3.9% received 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.
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Hospitalized patients receive an average of 1.42 diagnostic images per patient stay.
“hospitalized patients receiving an average of 1.42 diagnostic images per patient stay22”
From AgentClinic: a multimodal benchmark for tool-using clinical AI agents (2026) · cites this paper as [22]
The Results (page unavailable) report 1,420 imaging examinations per 1,000 health-plan enrollees per year, equivalent to 1.42 per enrollee per year. They do not report 1.42 images per hospitalized patient per stay; the cited figure has a different population and denominator. (LLM, conf=0.88)
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“Additionally, imaging tools such as X-ray, CT, and MRI provide a detailed and rich view into the patient, with hospitalized patients receiving an average of 1.42 diagnostic images per patient stay 22 .”
Influential
- Authors
- Smith-Bindman, R., Miglioretti, D. L., Johnson, E., Lee, C., Feigelson, H. S., Flynn, M., Greenlee, R. T., Kruger, R. L., Hornbrook, M. C., Roblin, D., Solberg, L. I., Vanneman, N., Weinmann, S., & Williams, A. E.
- Affiliations
- Group Health Cooperative (US)
- National Institutes of Health (US)
- Kaiser Permanente (US)
- Henry Ford Health (US)
- Marshfield Clinic (US)
- Regions Hospital (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-06-13
- Volume
- 307
- Issue
- 22
- Pages
- 2400-9
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3859870
- OpenAlex
- W1984781901
- Cited by
- 898
- References
- 42
- Citations by year
- 2026: 35 · 2025: 40 · 2024: 59 · 2023: 52 · 2022: 51 · 2021: 59 · 2020: 72 · 2019: 73 · 2018: 66 · 2017: 72 · 2016: 62 · 2015: 91 · 2014: 100 · 2013: 54 · 2012: 12
- FWCI
- 62.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Kaiser Permanente
- National Institutes of Health (NIH K24)
- National Cancer Institute (U19/CA 79689, R21CA131698, K24CA125036, U19CA079689, ZIACP010222)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- diagnostic imaging utilization, radiation exposure, integrated health system, computed tomography, magnetic resonance imaging, ultrasound, nuclear medicine, positron emission tomography, health care utilization trends, health care costs, managed care, models of care
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Health Maintenance Organizations, Humans, Infant, Magnetic Resonance Imaging, Male, Medical Records, Middle Aged, Radiation Dosage, Retrospective Studies, Tomography, X-Ray Computed, United States, Delivery of Health Care, Integrated, Young Adult
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