Unnecessary imaging wastes $12B a year and uses enough electricity to power a small town

Unnecessary medical imaging costs the United States about $12 billion annually, previous research has found, and it’s also wasting enough electricity to power a small town. 

Neiman Health Policy Institute experts recently made this assertion in a new study published Friday by the Journal of the American College of Radiology. Between 2017 and 2021, all low-value imaging generated upward of 129.2 kilotons per year, with CT and MRI accounting for the largest portion. 

That’s enough wasted energy to service upward of 70,000 individuals for a year, imaging experts noted. 

“Our analysis demonstrates the potential to meaningfully reduce our carbon footprint by decreasing unnecessary imaging orders,” study co-author Elizabeth Rula, PhD, executive director of the Neiman Health Policy Institute, established by ACR in 2012, said in a statement. “These findings add an additional, important reason to reduce inappropriate imaging utilization, which would also decrease the risk and cost to patients, cost to the healthcare system, and volumes contributing to the current radiology workforce shortage.” 

For the study, researchers used the yearly number of imaging exams from Medicare Part B, along with rates of inappropriate imaging derived from a 2014 RAND Corp. report. They modeled 2017 to 2021 low-value imaging utilization for the four most-common modalities including MR, CT, X-ray and ultrasound. RAND’s formulas gave an inefficiency rate ranging from 1.1% to 78.9% across the exam types. Rula and colleagues then used a per-exam figure to calculate final greenhouse gas emissions. 

Between 4% and 30% of medical imaging in American is low value, previous research has shown. This would result in an average of between 3.55 to 129.2 kilotons of excess carbon dioxide per year from radiology. That’s enough power for 2,000 to 70,000 people for an entire year, the authors estimated. Low-end estimates only included energy used during an imaging exam, while high-end tallies incorporated when scanners are on stand-by mode or in-production between scans.

Bottom line: Inappropriate medical imaging “carries a heavy economic toll,” said co-author Michael Atalay, MD, PhD, a professor and director of cardiac imaging at Brown University.

“Overuse of imaging is a strain on our healthcare system and radiology workforce,” he said in the announcement from the Neiman Institute. 

Atalay and co-authors believe their findings are “particularly relevant,” given sustained increases in imaging volumes over the past decade and the likelihood for more growth. The CO2 estimates are only for Medicare Part B participants, representing 23.2% of national healthcare spending. Total nationwide carbon emissions for inappropriate imaging are “potentially 4 to 5 times higher during this period,” the authors added. 

They believe this is the first study to estimate CO2 emissions from inappropriate imaging, adding an “additional imperative” to address this issue. 

“Radiologists can help educate clinicians about the environmental impact of inappropriate imaging, particularly MR and CT, and help clinicians select lower impact modalities, such as ultrasound, if they can address the clinical question at hand,” the authors advised. “Increasing adherence to appropriateness criteria using clinical decision support software or an incentive program are two examples of concrete actions to encourage appropriate image ordering, and further studies could elucidate even more ways to reduce waste and inefficiency.”