RSNA2023 Leading Through Change
Daily Bulletin

Studies of Cardiac Imaging Utilization Show Unexpected Results

Thursday, Nov. 30, 2023

By Melissa Silverberg

Understanding recent trends in imaging, including utilization of cardiac CT and MRI among the Medicare population, can help radiologists understand overall specialty trends and predict future workforce needs, according to a Wednesday session.



"Heart diseases have been a leading cause of morbidity and mortality, and their prevalence has been increasing with age. Because of the aging population, more cardiac testing is being performed, especially among the Medicare population," said Mustafa Al-Ogaili, MD, research scholar at the Mayo Clinic in Phoenix.

Cardiac CT Usage Increased In Proportion To Population

Dr. Al-Ogaili's study evaluated the utilization of cardiac CT among the Medicare population from 2013 to 2020, overall, and by provider type. In 2013, 38,806 cardiac CT exams were performed, a number that increased by 190% to 112,909 exams performed in 2020.

This period also saw a shift in who was evaluating cardiac CTs. In 2013, cardiologists interpreted 19,913 (49.2%) of exams, followed by radiologists 17,306 (42.8%). In 2020, that statistic flipped with radiologists interpreting 69,552 (58.4%), followed by cardiologists at 44,165 (37.1%).

Dr. Al-Ogaili said the increase in services provided is proportional to the increase in the Medicare population, but there is a need for more radiologists to keep pace with demand, especially as more radiologists, as opposed to cardiologists, are interpreting the scans.

"Increase in utility of these services will likely increase waiting times and ultimately impact health care," Dr. Al-Ogaili said. "This increase in demand could be accounted for if it was met by a proportional increase in workforce along with the implementation of AI to assist in interpretation services and better cardiac illness prevention."

Drop in Cardiac MR Observed During COVID-19

As cardiac CT imaging was increasing, cardiac MR imaging began to decrease in this same population.



Zahra Beizavi, MD, a resident physician at Columbia University in New York and previously a research scholar at the Mayo Clinic in Phoenix, found outpatient utilization of cardiac MR among the Medicare population abruptly contracted in 2020 as the pandemic took hold.

Her study found that 13,354 cardiac MR exams were performed in 2013, with the amount increasing each year of the study period up to 31,662 in 2020. However, between 2019 and 2020, the total number of cardiac MR exams performed dropped by more than 7%.

Dr. Beizavi said this data is just one way to look at the overall detrimental effect of the pandemic on other parts of health.

"Decreased imaging, preventive services and elective care all occurred due to the COVID-19 pandemic," Dr. Beizavi said. "Also, patients experienced delays in care, delayed diagnoses and worse outcomes, particularly older patients and those with cancer or cardiovascular disease."

Between the buildup of those conditions and the possible long term cardiovascular effects of COVID-19 infection, understanding cardiac imaging trends will be important going forward.

"Cardiac imaging plays a pivotal role in predicting, preventing, and diagnosing cardiovascular pathologies," Dr. Beizavi said. "Studying the prevalence of services provided for the Medicare population would certainly portray a picture that can help us clear the obstacles in the way of meeting the requirements for a high quality of service and a workforce that matches the increasing demand."

Access the presentations, "Trends in Medicare Utilization of Cardiac CT," (W7-SSCA08-1) and "Trends in Medicare Utilization of Cardiac MRI," (W7-SSCA08-2) on demand at