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Hidden workload in pediatric radiology: a 20-year retrospective time-trend study of the increasing number of images per study

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Abstract

Background

Workload among pediatric radiologists is rising, driven by staff shortages, case complexity, and call demands. Higher imaging volumes are linked to diagnostic errors and job dissatisfaction, affecting patient care and radiologists’ retention and recruitment. Technological advances may have increased the number of images generated per study, contributing a hidden workload not captured by study counts alone.

Objective

To determine the increase in the number of images per study in pediatric ultrasound (US), computed tomography (CT), and magnetic resonance (MR) at a pediatric tertiary care hospital between 2004 and 2023.

Materials and methods

A single-center retrospective review was conducted on the number of images acquired in select US, CT, and MR studies for patients under 18 years during the week of June 1-7, from 2004 to 2023. Trends were assessed with linear regression, with statistical significance at a P-value of <0.05.

Results

A total of 1,751 studies were reviewed and 749,152 total images were analyzed. The average number of US images per study increased from 38.67 to 165.24, MR from 185.62 to 1,292.00, and CT from 42.53 to 266.00. Regression analysis indicated statistically significant increases in all modalities: US by 7.41 images per year, MR by 51.60, and CT by 22.27 (P<0.0001 for all). Stratification based on study subtype was also performed.

Conclusion

The number of images per study has significantly increased over the two decades, adding hidden strain on pediatric radiologists’ workload. Imaging protocols should be reviewed to optimize the number of acquired images without losing diagnostic accuracy.

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Data Availability

The dataset is not publicly available due to patient identifiers, but if required, it can be anonymised and sent if requested.

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Acknowledgements

We thank Joycelyne Ewusie for her help with the statistical analyses of our study.

Author information

Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, L8P 1H6, Canada

    Xinye Lu

  2. Medical Imaging, McMaster University, Hamilton, Canada

    Nina Stein & Kelly E. Ainsworth

  3. Department of Medical Imaging, McMaster Children’s Hospital, Hamilton, Canada

    Nina Stein & Kelly E. Ainsworth

  4. Institute for Disability and Rehabilitation Research, University of Ontario Institute of Technology, Oshawa, Canada

    Carol Cancelliere

  5. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada

    Carol Cancelliere

Authors
  1. Xinye Lu
  2. Nina Stein
  3. Carol Cancelliere
  4. Kelly E. Ainsworth

Contributions

Study conception and design were completed by K.A. Material preparation and data collection were performed by X.L and K.A. Statistical analysis was performed by X.L and C.C. The first draft of the manuscript was written by X.L. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xinye Lu.

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Conflicts of interest

None

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Lu, X., Stein, N., Cancelliere, C. et al. Hidden workload in pediatric radiology: a 20-year retrospective time-trend study of the increasing number of images per study. Pediatr Radiol (2025). https://doi.org/10.1007/s00247-025-06482-1

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  • DOI: https://doi.org/10.1007/s00247-025-06482-1

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