INVITED COMMENTARY

Misuse and overuse of medical imaging have gained wide-spread attention due to rising costs, radiation exposure risks, and limited comparative effectiveness evidence. Involving patients in shared decision making offers an opportunity to more clearly define risks and benefits, thus allowing patients to consider both personal values and the best available evidence. Over the past 2 decades, the medical imaging indus-try has experienced considerable technological inno-vation and growth. A retrospective analysis of advanced diagnostic imaging at 6 large integrated health systems for the 15-year period 1996–2010 showed annual increases of 7.8 % for use of computed tomography (CT), 10 % for use of magnetic resonance imaging (MRI), and 3.9 % for use of ultrasound [1]. During the 12-year period 1996–2007, the number of CT scans performed during emergency depart