Can you remember the last time you worked a shift in the emergency department and ordered zero computed tomography (CT) scans? Can you even imagine a time in history when the number of CT scans to rule out pulmonary embolism ordered was compiled in a monthly total rather than a daily report? There was, indeed, a time when it was not so common to parade a CT about town in such innovations as mobile stroke units.
With minimal barriers to use and the appeal of diagnostic certainty, CT use has spiraled out of control. Choosing Wisely implicates excessive use of advanced imaging as low-value care consumers should question. Despite ACEP publishing its own recommendations for avoiding low-value imaging and the known financial and physiologic harms of CT overuse, the literature remains replete with examples of inappropriate use. In even just the past few months, multiple publications have indicted a wide variety of imaging modalities: