The number of radiology procedures ordered in the United States continues to increase at an unrelenting pace. Studies now suggest that at least one in ten residents currently receives a computed tomography (CT) scan each year and one in twenty undergoes a magnetic resonance scan (MRI). So where is the source of this seemingly endless demand for radiology images? Is it the aging population? The technology? Aggressive marketing by physician investors/owners of imaging equipment and imaging centers? The referring physicians? Cardiologists and other specialists? Or perhaps the radiologists themselves? While we can continue to point fingers, we in radiology must take action to demonstrate to ourselves, our patients, and the payors that we can manage radiology utilization responsibly. Here are four specific recommendations:

• Implement and maintain an active quality assurance program that reviews utilization and sets standards on a regular basis. The quality assurance team must be sponsored and led by the senior leadership in the practice.
• Develop and implement a formal mechanism for educating referring physicians and communicating with them on a regular basis regarding appropriate ordering criteria.
• Enforce the standards. Contact the referring physician if the wrong test is ordered and discuss why you either believe an alternate test is more appropriate or perhaps no test is necessary. Without this dialogue and feedback, behavior will not change.
• Set up a system to monitor and track compliance.

Whatever the economics involved, the patient’s well being must be our ultimate concern. It is highly inappropriate to promote a system that scans patients unnecessarily. While the distinction between what is deemed necessary and unnecessary often falls within a “grey zone” of clinical judgment, stakeholders must seriously address radiology utilization and implement programs that promote or even force proper utilization. If we do not, governments and insurance companies will eventually do this for us.