Nonetheless, hospitals also saw their volumes decline recently. While office volumes dropped 7.7 percent from 2008 to 2009, hospital inpatient volumes fell 14.3 percent and outpatient volumes 2 percent in the same period, according to the study.

Imaging in the emergency department rose over that period, about 1.2 percent.


MRI, mammo and modality trends

The report also broke down volume changes by modality, finding mixed fortunes, with CT volumes and spending still increasing, as mammography remains stable and MRI and DXA bone scans slightly dipped.

MRI volumes rose from under 3 million in 1999 to around 6.5 million in 2009. However, volume leveled off after 2006, and recently it began to slide. From 2008 to 2009, volume dropped 1.2 percent, even though at the same time spending saw a just under 1 percent increase.

Both volume and spending for CT rose over the past decade. But it's slowing down, according to recent figures. From 2008 to 2009, the growth rate fell from 2.6 percent to 1.6 percent, its lowest in the study period.

For screening mammography, volume hovered under 6 million in 2009. Volume decreased one-third of 1 percent from 2008 to 2009, compared with a nearly 3 percent CAGR over the whole time period of the study.

Film mammography volumes have been falling since 2004-2005, but the overall mammo volume has remained relatively steady, the authors said, as the volume of digital mammography has risen dramatically over the past six or seven years.

DXA bone scans reached their peak in 2005, but have been declining gradually since then, the report said. From 2008 to 2009, volume dropped 2.2 percent, and spending decreased a full 16 percent, from $162 million to $136 million.

"Whack-a-ball" with spending

AMIC, which sponsored the study and was formed in 2005 in reaction to DRA, wants imaging tied to appropriateness guidelines, such as those promoted by the American College of Radiology. But the group balks at measures like the DRA, and other Centers for Medicare and Medicaid Services cuts that specifically target imaging centers, fearing they could hurt providers and lead to reduced patient access.

"This is playing whack-a-ball with payment systems, not looking at outcomes, not looking at appropriateness," said Tim Trysla, executive director of AMIC, in a call.

Nonetheless, it's still not clear if the mostly very small declines seen in this study represent the future.

"From a patient care perspective, we've very troubled by this trend," Patti said. "We'll just have to wait and see if it continues or not."

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