Trends in Pediatric Imaging From 1997 to 2024 in an Integrated Health Care Setting

OBJECTIVE: Characterize cross-sectional imaging (magnetic resonance imaging [MRI], computed tomography [CT], ultrasonography [US]) use in children between 1997 and 2024. METHODS: Retrospective cross-sectional study of cross-sectional imaging from Kaiser Permanente Northern. Cross-sectional imaging rates per 1000 children by modality, age, and body region were computed. Joinpoint regression was used to analyze trends in cross-sectional imaging use. RESULTS: In total, 1 237 794 cross-sectional imaging examinations were performed in 18 132 171 children. From 2017 to 2024, cross-sectional imaging increased 50% (relative rate 1.46 [95% CI, 1.45-1.48]) from 79 (95% CI, 79-79) to 116 (95% CI, 115-117) examinations/1000 children associated with an average annual increase of 6.3% (95% CI, 5.0%-6.5%). Average annual MRI growth 2017 to 2024 was 6.7% (95% CI, 6.1%-7.3%); MRI use reached its peak rate in 2024: 41 (95% CI, 40-41) examinations/1000 children. CT use increased prior to 2009 (average annual change 7.6% [95% CI, 5.9%-9.2%]), decreased between 2009 and 2016 (average annual change: -2.9% [95% CI, -4.7% to -1.0%]), and then increased from 2017 to 2024 (average annual change: 7.3% [95% CI, 4.1%-11%]), reaching a peak rate of 26 (95% CI, 26-26) examinations/1000 children in 2024. Average annual change in US use 2017-2024 was 3.0% (95% CI, -0.3% to 6.4%), reaching its peak use rate in 2024 of 49 (95% CI, 49-49) examinations/1000 children. An estimated 8,880 future cancers in 2017 and 15,420 in 2024 in the United States may be attributable to CT use observed in this cohort. CONCLUSION: Cross-sectional imaging use in children significantly increased over time, reaching its highest use in 2024. CT imaging grew markedly, reversing a previous trend of decreasing CT use. Additional research is needed to identify factors driving increased imaging use.