CT Imaging Use in U.S. Emergency Departments Nearly Doubles Over the Past Decade, Study Finds

A new study published in Radiology reveals that CT scan utilization in U.S. emergency departments (EDs) has surged dramatically since 2013, driven not by more patients but by a higher number of scans conducted per ED visit. The research, based on Medicare data, shows this trend spans all types of computed tomography, including CT angiography, underscoring CT’s expanding role in emergency care.

“The pronounced increase in CT utilization per ED encounter may reflect an evolving role of CT in ED care delivery; for example, when prompt CT ordering is used to expedite patient turnover,” wrote Dr. Andrew B. Rosenkrantz and Dr. Ryan W. Cummings, radiologists at NYU Langone Health, in the study published September 30. “Nonetheless, further study is warranted to better understand the drivers of the growth.”

Using fee-for-service Medicare data from 2013 to 2023, the researchers found significant shifts in emergency department imaging trends over the decade. While the overall number of ED encounters per 100 Medicare beneficiaries declined by 16%—from 65 in 2013 to 54.5 in 2023—the use of CT imaging nearly doubled.

X-ray imaging per 100 beneficiaries remained unchanged at 37.3, and ultrasound increased modestly by 19.7% (from 2.3 to 2.8 per 100). In contrast, CT utilization per 100 beneficiaries jumped by 95.8%, rising from 18.7 to 36.7 per 100 over the same period.

When adjusted for imaging use per 100 ED encounters, the upward trend was even more pronounced. X-ray use increased by 19.2% (from 57.4 to 68.5 per 100 encounters), ultrasound by 42.7% (from 3.6 to 5.1), and CT by an astonishing 133.5%, climbing from 28.7 to 67.1 scans per 100 encounters.

The researchers noted that the more modest growth in ultrasound use may reflect the increasing adoption of point-of-care ultrasound (POCUS) by emergency physicians and other non-radiologist clinicians. This practice allows for quicker, bedside imaging without involving radiology departments, potentially offsetting some growth in traditional ultrasound orders.

Experts suggest several factors may be driving the dramatic increase in CT use, including technological advances, greater diagnostic reliance on imaging, and pressures to accelerate patient evaluation and discharge in overcrowded emergency departments. CT imaging’s speed and accuracy make it indispensable for diagnosing conditions such as stroke, pulmonary embolism, and trauma-related injuries—scenarios in which rapid decision-making is critical.

However, the study also raises concerns about resource strain within radiology departments. “Such growth in ED imaging can strain radiology practices given radiologist shortages and expectation of providing prompt interpretations on a 24-7 basis,” Rosenkrantz and Cummings wrote.

The findings highlight an important tension in emergency medicine: while CT scans improve diagnostic accuracy and patient outcomes, their growing use amplifies workload pressures, costs, and the potential for incidental findings that may lead to further testing.

As emergency departments continue to evolve, the study’s authors emphasize the need for further research to understand the balance between efficiency, patient outcomes, and sustainability in imaging utilization—a challenge increasingly central to modern emergency care.