Choosing wisely in neuroradiology: evaluating CT and MR utilization trends in Europe

OBJECTIVES: To assess trends in volume and utilization of neuroimaging (CT and MR) across Europe over the last decade, within the context of evolving clinical practice on behalf of the European Society of Neuroradiology's Choosing Wisely committee. MATERIALS AND METHODS: A systematic search of PubMed was performed (following PRISMA 2020 guidelines) to identify studies reporting European neuroimaging volumes. As no eligible studies were identified, descriptive analysis of Eurostat and OECD data was performed for 29 European countries from 2015 to 2022, covering CT and MR examination volumes and scanner availability per 100,000 population across four geographic regions (Northern, Southern, Eastern, and Western Europe). Total CT/MR volumes served as neuroimaging surrogates. RESULTS: 316 publications were identified (with none meeting predefined inclusion criteria). Eurostat data from 29 countries revealed substantial growth in imaging from 2015 to 2022. Per capita CT exam rates increased 40.8% (10,872 to 15,312 per 100,000 population), and MR scan rates increased 43.5% (5746 to 8244 per 100,000 population). Scanner availability also increased (CT scanners from 2.3 to 2.68, MR scanners from 1.43 to 2.11 per 100,000 population). Regional variations were evident: Western Europe showed the highest utilization rates, Eastern Europe demonstrated the largest relative growth despite lower absolute numbers. All regions experienced consistent growth except during the 2020 COVID-19 disruptions. CONCLUSION: Neuroimaging utilization has substantially increased across Europe from 2015 to 2022, with disproportionate growth in scan volumes relative to scanner availability. These findings highlight regional disparities in utilization and underscore the need for coordinated evidence-based appropriateness initiatives to support sustainable neuroimaging practice. KEY POINTS: Question Have CT and MR neuroimaging utilization rates changed across Europe over the last decade compared to scanner availability? Findings CT and MR scan rates increased 40.8% and 43.5%, respectively, from 2015 to 2022, reflecting increased per-scanner utilization across the continent. Clinical relevance Neuroimaging examination volumes increased substantially across Europe from 2015 to 2022. This highlights the value of evidence-based imaging appropriateness initiatives to ensure sustainable healthcare resource utilization.