September 04, 2019

ACR Statement on JAMA Article on Trends in Medical Imaging Use

Smith-Bindman et al., published Sept. 3 in Journal of the American Medical Association (JAMA), reinforces that — despite an aging population and more people receiving care — the rate of growth of medical imaging use has decreased as technology has matured and doctors have become more educated on when to use these lifesaving exams.

As the accompanying editorial indicates, whether an exam is appropriate for a patient’s condition is far more important than is simply counting the number of scans performed.

Imaging exams are generally safer and cost less than invasive procedures they replace. Scans reduce unnecessary hospital admissions and length of hospital stays. Imaging is directly linked to greater life expectancy and declines in mortality. Americans with greater access to imaging live longer than those with lesser access.

Newer technologies are now helping doctors better prescribe these exams. Starting Jan. 1, 2020*, The Centers for Medicare and Medicaid Services (CMS) will require providers to consult appropriate use criteria (AUC)-based clinical decision support (CDS) when ordering magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine and positron emission tomography (PET) exams for Medicare outpatients.

More than 2,000 hospitals and health systems nationwide now use these systems. Studies at the University of Virginia, Institute for Clinical Systems Improvement, Partners Healthcare and numerous R-SCAN case studies and papers (Wang 2018, Wang 2019) show that CDS use reduces low-value imaging (and associated cost).

Greater use of CDS is the primary step to assuring that patients who need imaging receive the best test for their condition and that patients who do not need a scan avoid unnecessary care. CDS does this via transparent, evidence-based, point of care guidance that does not delay needed care or interfere in doctor-patient decisions.

The ACR looks forward to working with CMS, insurers, referring providers, radiologists and other medical professionals to implement this sensible, quality-based approach to imaging utilization management.

CMS provides more information on the AUC/CDS initiative here.

Get more information on medical imaging exams at

*This Medicare AUC mandate starts with a one-year “Educational and Operations” testing period (with no penalties on rendering physicians for incorrect reporting). Penalties begin Jan. 1, 2021.