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Trends in CT Angiography of the Head and Neck, 2017-2024: Provider Volume, Specialty Distribution, and Workforce
Keervani Kandala1, Chris J Lee1, Raj Moily1
1From the Department of Radiology and Biomedical Imaging (K.K., R.M., D.F.), Yale School of Medicine (C.J.L.), New Haven, CT, USA; Department of Radiology (M.K.), University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery (D.R.), Radiology and Biomedical Imaging, Department of Radiology (C.W.), Department of Radiology and Biomedical Imaging and Neurosurgery (A.M.), Yale School of Medicine, New Haven, CT, USA; Department of Radiology (S.P.), Columbia University Irving Medical Center, New York, NY, USA; Department of Radiology (D.A.L., West Virginia University, Suncrest, WV, USA; Interventional Neuroradiology; Nuclear Medicine, Neurology and Neurosurgery (D.G.), University of Maryland School of Medicine, Baltimore, MD, USA; Department of Neuroradiology (M.M.C.), University of Texas MD Anderson Cancer Center, Houston, TX, USA and University of Texas Medical Branch (M.W.), Galveston, TX, USA.
Background And Purpose:
CT angiography (CTA) of the head and neck has experienced rapid utilization growth, yet the distribution of interpretation across physician specialties and its implications for the neuroradiology workforce are poorly characterized. We analyzed Medicare claims to assess trends in CTA utilization, provider volume, and neuroradiologists' evolving role from 2017 to 2024.
Methods:
This retrospective analysis of the complete Medicare Fee-for-Service Part B claims for CPT codes 70496 and 70498 classified physicians as neuroradiologists (validated NITOS wRVU classification), other radiologists, or other specialty physicians. Within-physician changes were assessed with paired Wilcoxon signed-rank testing and Hodges-Lehmann shifts with 95% confidence intervals (CIs); group-share changes used NPI-clustered nonparametric bootstrap resampling to account for clustering of services within physicians.
Results:
Across 2017-2024, 8,712,757 CTA services were billed by 19,143 unique physicians (3,182 neuroradiologists, 15,199 other radiologists, 762 other specialty physicians). The number of providers per year grew from 9,134 to 13,021 (+43%). Among neuroradiologists present in both endpoints (n = 1,530), the within-physician Hodges-Lehmann increase was 70 studies (95% CI 64-77; P < .001). The per-1,000 Fee-for-Service beneficiary rate grew 206% (16.5 to 50.7). Neuroradiologists' share changed by -1.42 pp (37.7% to 36.3%; 95% CI -3.51 to +0.36; P = .16), other radiologists' share rose 2.26 pp (P = .01), and other specialty physicians' share fell 0.84 pp (P < .001). Neuroradiologists comprised 57.5% of top-decile providers. Among neuroradiologists, median (IQR) annual CTA volume rose from 102 (59-169) in 2017 to 165 (88-271) in 2024.
Conclusions:
Head and neck CTA utilization in Medicare Fee-for-Service grew substantially from 2017 to 2024, with per-beneficiary rates tripling. Neuroradiologists dominate high-volume interpretation but their proportional share has remained essentially stable, with implications for workforce planning and neurovascular imaging training.
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