LAUSR

Key Points Question How has utilization of low-value carotid imaging for carotid bruits, preoperative evaluation, and syncope changed in the Veterans Health Administration system from 2007 to 2016? Findings In this serial cross-sectional study of 809 071 carotid imaging examinations in the national Veterans Affairs Health system, there was a modest decrease in rates of imaging for carotid bruits that predated Choosing Wisely recommendations, and no significant trends in rates of preoperative carotid imaging or imaging for syncope. Meaning These findings suggest that to reduce low-value testing and utilization cascades, interventions targeting ordering clinicians are needed to augment the impact of public awareness campaigns.