Study Shows 45 Percent Increase in Emergency Department Neuroimaging Over the Last Decade

New research demonstrates significant increases in neuroimaging utilization, particularly computed tomography (CT) scans, in emergency departments (EDs) over a 10-year-period.

For the study, recently published as a research letter in the American Journal of Roentgenology (AJR), researchers reviewed data from 1,030,277 neuroimaging CT and MRI examinations and 3,980,847 ED encounters that occurred between 2016 and 2025. The EHR data was derived from the Cosmos research platform (Epic Systems Corporation), which aggregates EHR data from more than 2,000 hospitals across more than 200 participating organizations across the United States and other countries, according to the study.

The study authors found that neuroimaging utilization increased 45 percent from 175 per 1,000 ED encounters in 2016 to 316 per 1,000 ED visits in 2025.

“The observed contemporary increase in encounter-adjusted ED neuroimaging utilization using the Cosmos EHR platform has implications for imaging costs, radiation exposure, workflow efficiency, and radiologist demands. The need for 24/7 rapid interpretation amplifies the challenges that the utilization growth creates for emergency radiology services,” noted lead study author Pranjal Rai, MD, a radiology fellow affiliated with the Department of Radiology at the Mayo Clinic in Rochester, Minn., and colleagues.

The researchers noted significant spikes in ED CT usage. Non-contrast head CT exams, head and neck CT exams and spine CT imaging increased by 33 percent, 76.9 percent and 52.9 percent, respectively, per 1,000 ED encounters over the last decade, according to the study authors.

“CTA utilization more than doubled during the decade; this growth may reflect expanded CT-based emergency neurovascular workflows after widespread thrombectomy implementation including code-stroke pathways and broader use of CTA-based triage in trauma imaging,” posited Rai and colleagues.

The study authors also noted 33 percent and 42.9 percent increases in head MRI and spine MRI utilization, respectively, per 1,000 ED visits between 2016 and 2025.

In regard to study limitations, the authors acknowledged a lack of analysis with respect to imaging protocol details, imaging findings and impact on patient outcomes. The researchers also suggested that increasing representations of stroke centers within the utilized dataset may have had an impact on the study results.