Head CT scans ordered in U.S. emergency departments have more than doubled in the last 15 years, according to a new study.
Researchers reported in Neurology that ERs ordered nearly 16 million head CT scans in 2022, compared with fewer than 8 million in 2007.
Dr. Layne Dylla, the study’s lead author and an assistant professor of emergency medicine at Yale School of Medicine, said head CT scans remain essential for diagnosing conditions such as stroke. However, she noted that the growing use of these scans brings concerns about higher medical costs, radiation exposure, and longer wait times in already crowded emergency departments.
Researchers pointed out that head CT scans offer limited value when evaluating symptoms such as headaches, seizures, or dizziness. In these situations, scans may not improve diagnosis but do increase cost and delay care. “It’s important to balance the benefits of these scans with the risks and costs,” Dylla said.
The study examined head CT scan use reported in a national hospital database. By 2022, more than 10% of all ER visits included a head CT scan, up from under 7% in 2007.
The analysis also uncovered significant disparities:
- Black patients were 10% less likely to receive a head CT scan than white patients.
- Medicaid patients were 18% less likely to receive a scan than those with Medicare or private insurance.
- Rural patients were 24% less likely to receive a scan than patients in urban hospitals.
- Adults 65 and older were six times more likely to undergo a scan than children under 18.
Dylla said the findings show the need for fairer access to neuroimaging and stronger review of whether each head CT scan is appropriate based on clinical guidelines. She added that both underuse and overuse carry risks. Missing a scan can delay diagnosis, while unnecessary scans expose patients to radiation and create additional costs for the health system.
In an accompanying editorial, European radiology experts warned about the broader consequences of excessive CT use. Dr. Alex Rovira, chair of the referral guidelines subcommittee of the European Society of Radiology, noted that unnecessary radiation exposure should not be taken lightly.
He cited recent research estimating that 93 million CT scans performed in the U.S. in 2023 could lead to more than 100,000 future cancer cases if current trends continue.
The editorial also highlighted that overuse often begins early in medical training. One study found that nearly 70% of cases handled by new medical trainees involved ordering unnecessary CT scans or X-rays, exposing many patients to avoidable radiation.
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