title: Utilization Trends in Noncardiac Thoracic Imaging, 2002-2014.
abstract: OBJECTIVE
  To analyze recent trends in utilization of the various noncardiac thoracic imaging modalities in the Medicare population.
  
  
  METHODS
  The Medicare Part B databases for 2002 through 2014 were reviewed. All CPT codes pertaining to noninvasive imaging of the thorax were selected and grouped into seven categories: x-ray, CT, computed tomographic angiography (CTA), nuclear scans (noncardiac), MRI, MR angiography, and ultrasound. Yearly utilization rates per 1,000 Medicare beneficiaries were calculated. Medicare physician specialty codes were used to determine how many studies were performed by radiologists versus nonradiologist physicians.
  
  
  RESULTS
  The total utilization rate of all chest imaging peaked at 1,090 per 1,000 in 2005, then progressively declined to 913 by 2014 (-16%). In 2002, radiologists' share of thoracic imaging was 87% and increased to 91% by 2014. Among all providers, the total utilization rate of chest CT rose sharply, peaked at 100 in 2007, and has remained steady at around 89-91 in more recent years. The CTA utilization rate rose progressively from 2 in 2002 to 23 in 2014. Utilization rates of nuclear chest imaging decreased steadily after 2002. Chest x-ray rates reached a peak of 976 in 2005 but then declined to 790 in 2014; this change was largely responsible for the decline in total thoracic imaging.
  
  
  CONCLUSIONS
  Overall thoracic imaging utilization rates have declined in recent years, despite an increase in use of CT and CTA. The decline largely resulted from a decrease in use of chest x-rays.
authors.affiliation: Center for Research on Utilization of Imaging Services (CRUISE), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. Electronic address: sarah.kamel@jefferson.edu.
authors.forename: Sarah I
authors.initials: SI
authors.lastname: Kamel
authors.affiliation: Center for Research on Utilization of Imaging Services (CRUISE), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; HealthHelp, Inc, Houston, Texas.
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
authors.affiliation: Center for Research on Utilization of Imaging Services (CRUISE), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.affiliation: Center for Research on Utilization of Imaging Services (CRUISE), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Rao
mesh_terms: D039702:Current Procedural Terminology; D016208:Databases, Factual; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D016345:Medicare Part B / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D013909:Thorax / Q000000981:diagnostic imaging*; D014481:United States; D014600:Utilization Review
keywords: Thoracic CT; medical economics; radiology and radiologists; socioeconomic issues; thoracic imaging; utilization of imaging