Use trends and geographic variation in neuroimaging: nationwide medicare data for 1993 and 1998.

BACKGROUND AND PURPOSE Powerful tools, including CT and MR imaging, have revolutionized neuroimaging. These are routinely used, but the extent and variation of use has not been studied. Our purposes were to determine the use rates of MR imaging and CT (of spine, brain, or head and neck), myelography, conventional angiography, and MR angiography in diagnosing neurologic disorders; to study trends in use; and to determine regional variations in use. METHODS We used the National Part B Medicare Database for 1993 and 1998 to compare rates of use for these procedures in 10 geographic regions. RESULTS In 1993 and 1998, respectively, 13,897 and 19,431 (39.8% increase) neuroimaging procedures were performed per 100,000 Medicare beneficiaries nationwide. Use of brain or head and neck CT (30.4%) and MR imaging (43.6%), spinal CT (3.5%) and MR imaging (83.0%), myelography (56.6%), and conventional angiography (24.3%) increased in 1998 versus 1993. Increases in MR angiography were not assessed, because this procedure was not reimbursable in 1993. Regional use of brain or head and neck and spinal CT and MR studies varied considerably; ratios of highest and lowest rates were 1.38-1.56. Use of MR angiography, myelography, and conventional angiography varied three- to fourfold. CONCLUSION Use of MR and CT studies of the brain or head and neck and of the spine increased considerably in the Medicare population between 1993 and 1998. Use of conventional invasive procedures such as myelography and angiography increased strikingly, contrary to the expected decline. Regional use varied substantially.