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Objective:
Utilization of advanced imaging, such as CT, MR, and PET, has increased in recent years. We aim to evaluate trends in radiologist wRVU production, including modality case mix, from 2013 to 2020.

Materials and Methods:
All outpatient imaging claims submitted by diagnostic radiologists were extracted from the CMS POSPUF database from 2013–2020. Using the NITOS classification, CPT codes were assigned an imaging modality (i.e., CT, MRI, radiography/fluoroscopy, procedural, ultrasound [US]). These data were merged with year-specific CMS professional relative value unit (wRVU) files. The total number of wRVUs produced overall and by imaging modality was calculated for each radiologist. For each individual radiologist, the imaging modality that resulted in the largest number of wRVUs from 2013–2020 were determined. Average radiologist modality specific case mix, calculated as the sum of all modality-specific wRVUs produced, divided by the number of radiologists submitting claims for that modality, was calculated for each imaging modality from 2013–2020.

Results:
In 2013, 29,584 diagnostic radiologists submitted 156,739,445 imaging service claims, corresponding to 58,469,330 wRVUs. In 2020, 32,144 (CAGR: +1.2%) diagnostic radiologists submitted 176,297,932 (CAGR: +1.7%) imaging service claims, corresponding to 59,489,480 (CAGR: +0.25%) wRVUs. In 2013, individual radiologists had the largest number of wRVUs from CT: 12,575 individual radiologists (42.5% of all radiologists), radiography/fluoroscopy 9,837 (33.3%), MRI 2861 (9.7%), and procedural 2767 (9.4%). In 2020, individual radiologists had the largest number of wRVUs from CT: 15,276 individual radiologists (47.5% of all radiologists), radiography/fluoroscopy 8773 (27.3%), MRI 3993 (10.6%), and procedural 3090 (9.6%). From 2013–2020, 8.8% (2,701/30,864 [average number of radiologists]) more of all radiologists had their largest number of wRVUs from CT. Average radiologist modality specific case mix for CT increased from 41% in 2013 to 48% in 2020, decreased for radiography/fluoroscopy from 33% in 2013 to 31% in 2020, remained unchanged for MRI at 21% in 2013 and 2020, increased for procedural from 17% in 2013 to 18% in 2020, and decreased for US from 11% in 2013 to 10% in 2020.

Conclusion:
Changing trends in imaging utilization have resulted in CT interpretation becoming a much larger proportion of the individual radiologist’s case mix since 2013, and decreases have occurred in radiography/fluoroscopy and US. Awareness of these changing trends are important to manage the expectations of the current radiologist workforce and optimally prepare the pipeline of future radiologists for the workplace demands they are likely to encounter.