| Low-value medical imaging exams | ||||||||
| Exam | More sensitive version of measures | More specific version of measures | ||||||
| Count per 100 beneficiaries | % low-value care | Spending (in millions) | % low-value spending | Count per 100 beneficiaries | % low-value care | Spending (in millions) | % low-value spending | |
| Imaging for nonspecific low-back pain | 12.4 | 15 | 226 | 3 | 4.5 | 14 | 82 | 4 |
| Stress testing for stable coronary disease | 7.8 | 10 | 2,065 | 24 | 0.8 | 2 | 212 | 11 |
| Colon cancer screening for elderly patients (excludes CTC) | 7.7 | 10 | 573 | 7 | 0.9 | 3 | 7 | 0 |
| Carotid screening for asymptomatic patients | 6.6 | 8 | 323 | 4 | 5.6 | 17 | 274 | 14 |
| Preoperative chest radiography | 5.5 | 7 | 75 | 1 | 1.6 | 5 | 22 | 1 |
| Head imaging for headache | 3.4 | 4 | 211 | 2 | 2.4 | 7 | 146 | 8 |
| Head imaging for syncope | 1.4 | 2 | 85 | 1 | 1 | 3 | 60 | 3 |
| Bone mineral density testing at frequent intervals | 1 | 1 | 20 | 0 | 0.8 | 3 | 17 | 1 |
| Carotid artery screening for syncope | 1 | 1 | 49 | 1 | 0.7 | 2 | 33 | 2 |
| Preoperative echocardiography | 0.8 | 1 | 58 | 1 | 0.3 | 1 | 21 | 1 |
| Preoperative stress testing | 0.7 | 1 | 180 | 2 | 0.3 | 1 | 81 | 4 |
| CT for rhinosinusitis | 0.6 | 1 | 42 | 1 | 0.3 | 1 | 23 | 1 |
Low-value medical imaging exams
May 12, 2014
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
