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AJR Am J Roentgenol. 2011 Apr;196(4):848-52. doi: 10.2214/AJR.10.5823.

The effect of self-referral on utilization of advanced diagnostic imaging.

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  • 1Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Main 1090, 132 S 10th St, Philadelphia, PA 19107, USA.



This article reviews the evidence on the relationship between recent increases in utilization of diagnostic imaging and self-referral. The evidence shows that self-referral invariably leads to higher utilization and the attendant higher costs.


Because most physicians do not own advanced imaging equipment, their own best interests are being thwarted by the practice of self-referral. Congress and the Centers for Medicare and Medicaid Services should restrict the in-office ancillary services exception to the Stark laws as it applies to advanced imaging.

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