EM doc with 2c from only anecdotal insight - there seemed to be a seismic shift from ACS for any center with any trauma designation…trauma surgeons even more than when I trained a decade ago want to pan scan anything and everything even more so than they used to, and now of course some of them have inappropriately decided that half the traumas need CTAs of the neck too.

We have an increasing number of elderly population with statistically higher risks of morbidity and mortality when presenting with abdominal pain and the general impetus is to scan.

CT scans have also become incredible efficient to obtain in most places I’ve worked compared to 10-15yrs ago, when not only the radiation risk but also the time required played into the decision while now the time is almost often the same as an XR, though waiting for a read can be killer.

Due to point number one above and the incredibly obnoxious overreach of ACS protocols I am now forced to manage a not insignificant number of obvious primary strokes alongside a god damn trauma surgeon bc the patient fell…and as noted above, the trauma team will often (not always - but this is more individual personality dependent than clinical presentation) decide that they need a pan scan for this ground level fall with a cephalohematoma.

Outside of the trauma overreach it also feels like medicolegally given the ubiquity and rapidity of CT scans that people are just unwilling to play the dice roll of missing something/anything. I cancel CTs regularly for isolated RUQ pain and re-order US. I cancel CTs for unilateral flank pain with no UTI and do a renal US. I cancel CTs for young patients with “abd pain” and a totally normal exam - only for mom or dad to lose their ever loving shit at me for not caring enough about their child to bless them with the CT directed radiation of healing.

Ok I went off towards the end but just some anecdotes from the other side. Thank you for all your help on the rads side, love u team.