PURPOSE: To project the future imaging utilization through 2055 and assess the contributions of population growth and aging, insurance type, and utilization trends on it. METHODS: The study used claims data from two sources (2018-2022): a CMS 5% sample of Medicare fee-for-service beneficiaries and the Inovalon Insights, LLC, database for individuals with commercial insurance, Medicare Advantage, or Medicaid. Based on sex, age, and insurance type, future utilization was statistically modeled based on US Census Bureau population projections and recent utilization trends by modality. RESULTS: The statistical analysis was based on person-year samples of 348,214,053 insured individuals covering those with Medicare fee-for-service, Medicare Advantage, Medicaid, and commercial insurance. Assuming no continuation of recent utilization trends, projected imaging utilization is 16.9% to 26.9% higher in 2055 compared with 2023 with this range, reflecting differences by modality. If recent utilization trends continue through 2030, this range is 5.6% less to 45.2% more. Population growth accounts for 73% to 88% of utilization increases across modalities
population aging accounts for 12% to 27%. Average utilization differed by insurance type (eg, average CT use was 0.70 for Medicare fee-for-service and 0.40 Medicare Advantage). CONCLUSIONS: Projected imaging utilization in 2055 is 16.9% to 26.9% higher than 2023 levels assuming current per-person utilization will persist into the future, but continuation of recent per-person utilization trends broadens this range. Population growth is the largest driver of increasing future utilization. The continued shift to Medicare Advantage lowers utilization growth given its lower per-person utilization compared with Medicare fee-for-service.