From the Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA (R.S.-B., Y.W., C.S., J.L., P.W.C.); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (R.S.-B.); Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA (R.S.-B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA (M.K.); Department of Radiology, University of Washington, Seattle, WA (A.C.W.); Department of Radiology, University of Maryland Medical Center and Baltimore VA Medical Center, Baltimore, MD (E.S.); Department of Medicine and Pediatrics, University of California Davis Health, Sacramento, CA (M.R., P.S.R.); Department of Radiology, University of Wisconsin, Madison, WI (T.P.S.); and Kaiser Foundation Health Plan and Hospitals (A.B.B.).

Received for publication October 3, 2023; and accepted for publication, after revision, November 24, 2023.

Conflicts of interest and sources of funding: A.B.B., M.K., and R.S.-B. are co-founders of Alara Imaging, Inc, a company focused on improving the clinical and operational aspects of health systems, including collecting and reporting radiation dose and image quality associated with computed tomography as part of payer-led quality programs. T.P.S. is a consultant for Alara Imaging. Alara Imaging played no role in any aspect of the article. The other authors have no conflicts of interests relevant to this article to disclose.

This work was supported by the Patient-Centered Outcomes Research Institute (PCORI; award no. DI-2018C1-11375) and the Centers for Medicare and Medicaid Services (CMS; Cooperative Agreement #1V1CMS331638). PCORI and CMS had no role in the study design, collection, analysis, interpretation, and reporting of data, or decision to publish. The views in this article are solely the responsibility of the authors and do not necessarily represent the views of PCORI or CMS.

Correspondence to: Rebecca Smith-Bindman, MD, Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, Box 0560, San Francisco, CA 94143. E-mail: [email protected].

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