{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T07:15:40Z","timestamp":1781680540753,"version":"3.54.5"},"reference-count":37,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100009826","name":"Harvey L. Neiman Health Policy Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacr.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the American College of Radiology"],"published-print":{"date-parts":[[2023,1]]},"DOI":"10.1016\/j.jacr.2022.07.014","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T13:17:06Z","timestamp":1665062226000},"page":"18-28","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":15,"title":["Out-of-Pocket Expenditures for Imaging Examinations: Perspectives From National Patient Surveys Over Two Decades"],"prefix":"10.1016","volume":"20","author":[{"given":"Eshani J.","family":"Choksi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8506-2133","authenticated-orcid":false,"given":"Kumar","family":"Mukherjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gelareh","family":"Sadigh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Richard","family":"Duszak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jacr.2022.07.014_bib1","unstructured":"CMS.gov. National health expenditure fact sheet. Published 2020. Available at: https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/NHE-Fact-Sheet. Accessed November 9, 2021."},{"key":"10.1016\/j.jacr.2022.07.014_bib2","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1377\/hlthaff.28.5.1276","article-title":"Income, insurance, and technology: why does health spending outpace economic growth?","volume":"28","author":"Smith","year":"2009","journal-title":"Health Affairs"},{"key":"10.1016\/j.jacr.2022.07.014_bib3","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1056\/NEJMhpr0808703","article-title":"Health insurers and medical-imaging policy\u2014a work in progress","volume":"360","author":"Iglehart","year":"2009","journal-title":"New Engl J Med"},{"key":"10.1016\/j.jacr.2022.07.014_bib4","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.2214\/AJR.13.10999","article-title":"Comparative analysis of Medicare spending for medical imaging: sustained dramatic slowdown compared with other services","volume":"201","author":"Lee","year":"2013","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2022.07.014_bib5","doi-asserted-by":"crossref","first-page":"959","DOI":"10.2214\/AJR.17.18360","article-title":"Health care price transparency and communication: implications for radiologists and patients in an era of expanding shared decision making","volume":"209","author":"Sadigh","year":"2017","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2022.07.014_bib6","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jacr.2021.11.009","article-title":"Financial burden of advanced imaging in radiology (FAIR Study)","volume":"19","author":"Sadigh","year":"2022","journal-title":"J\u00a0Am Coll Radiol"},{"key":"10.1016\/j.jacr.2022.07.014_bib7","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacr.2017.12.010","article-title":"Out-of-pocket costs for advanced imaging across the US private insurance marketplace","volume":"15","author":"Rosenkrantz","year":"2018","journal-title":"J\u00a0Am Coll Radiol"},{"key":"10.1016\/j.jacr.2022.07.014_bib8","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.21347","article-title":"Out-of-pocket costs of diagnostic breast imaging services after screening mammography among commercially insured women from 2010 to 2017","volume":"4","author":"Lowry","year":"2021","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.jacr.2022.07.014_bib9","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.5499","article-title":"Trends in out-of-pocket healthcare expenses before and after passage of the Patient Protection and Affordable Care Act","volume":"4","author":"Vangipuram Suresh","year":"2021","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.jacr.2022.07.014_bib10","doi-asserted-by":"crossref","DOI":"10.1016\/j.msard.2021.103037","article-title":"Longitudinal changes of financial hardship in patients with multiple sclerosis","volume":"53","author":"Sadigh","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"10.1016\/j.jacr.2022.07.014_bib11","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1177\/1352458520913977","article-title":"Patient-reported financial toxicity in multiple sclerosis: Predictors and association with care non-adherence","volume":"27","author":"Sadigh","year":"2021","journal-title":"Mult Scler"},{"key":"10.1016\/j.jacr.2022.07.014_bib12","first-page":"217","article-title":"Correlates of financial toxicity in adult cancer patients and their informal caregivers","volume":"30","author":"Sadigh","year":"2022","journal-title":"Support Care Cancer"},{"key":"10.1016\/j.jacr.2022.07.014_bib13","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1200\/JCO.2015.64.6620","article-title":"Financial insolvency as a risk factor for early mortality among patients with cancer","volume":"34","author":"Ramsey","year":"2016","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.jacr.2022.07.014_bib14","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.jacr.2017.03.004","article-title":"Changes in\u00a0emergency department imaging: perspectives from national patient surveys over two decades","volume":"14","author":"Rosenkrantz","year":"2017","journal-title":"J\u00a0Am Coll Radiol"},{"key":"10.1016\/j.jacr.2022.07.014_bib15","doi-asserted-by":"crossref","first-page":"364","DOI":"10.2214\/AJR.17.18214","article-title":"Changing utilization of noninvasive diagnostic imaging over 2 decades: an examination family-focused analysis of Medicare claims using the Neiman imaging types of service categorization system","volume":"210","author":"Rosman","year":"2018","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2022.07.014_bib16","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.jacr.2016.08.025","article-title":"Recent trends in imaging use in hospital settings: implications for future planning","volume":"14","author":"Levin","year":"2017","journal-title":"J\u00a0Am Coll Radiol"},{"key":"10.1016\/j.jacr.2022.07.014_bib17","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1001\/jama.2019.11456","article-title":"Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000-2016","volume":"322","author":"Smith-Bindman","year":"2019","journal-title":"JAMA"},{"key":"10.1016\/j.jacr.2022.07.014_bib18","article-title":"Diagnostic imaging trends in the emergency department: an extensive single-center experience","volume":"8","author":"Juliusson","year":"2019","journal-title":"Acta Radiol Open"},{"key":"10.1016\/j.jacr.2022.07.014_bib21","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.jacr.2019.01.028","article-title":"Breast screening utilization and cost sharing among employed insured women after the Affordable Care Act","volume":"16","author":"Carlos","year":"2019","journal-title":"J\u00a0Am Coll Radiol"},{"key":"10.1016\/j.jacr.2022.07.014_bib22","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.2214\/AJR.13.11504","article-title":"Financial impact of Medicare code bundling of CT of the abdomen and pelvis","volume":"202","author":"Levin","year":"2014","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2022.07.014_bib23","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.0157","article-title":"Association of the US Affordable Care Act with out-of-pocket spending and catastrophic health expenditures among adult patients with traumatic injury","volume":"3","author":"Liu","year":"2020","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.jacr.2022.07.014_bib24","doi-asserted-by":"crossref","first-page":"m40","DOI":"10.1136\/bmj.m40","article-title":"Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study","volume":"368","author":"Gotanda","year":"2020","journal-title":"BMJ"},{"key":"10.1016\/j.jacr.2022.07.014_bib25","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1146\/annurev-publhealth-031816-044555","article-title":"The Affordable Care Act\u2019s impacts on access to insurance and health care for low-income populations","volume":"38","author":"Kominski","year":"2017","journal-title":"Annu Rev Public Health"},{"key":"10.1016\/j.jacr.2022.07.014_bib26","series-title":"Health coverage by race and ethnicity, 2010-2019","author":"Artiga","year":"2021"},{"issue":"1 Pt A","key":"10.1016\/j.jacr.2022.07.014_bib27","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jacr.2021.09.028","article-title":"Effect of out-of-pocket costs on subsequent mammography screening","volume":"19","author":"Tran","year":"2022","journal-title":"J\u00a0Am Coll Radiol"},{"key":"10.1016\/j.jacr.2022.07.014_bib28","first-page":"100","article-title":"Time to add screening for financial hardship as a quality measure?","volume":"71","author":"Bradley","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"10.1016\/j.jacr.2022.07.014_bib29","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/1475-6773.13258","article-title":"Accounting for the burden and redistribution of health care costs: who uses care and who pays for it","volume":"55","author":"Carman","year":"2020","journal-title":"Health Serv Res"},{"key":"10.1016\/j.jacr.2022.07.014_bib30","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.5888\/pcd12.140388","article-title":"Chronic condition combinations and health care expenditures and out-of-pocket\u00a0spending burden among adults, Medical Expenditure Panel\u00a0Survey, 2009 and 2011","volume":"12","author":"Meraya","year":"2015","journal-title":"Prev Chronic Dis"},{"key":"10.1016\/j.jacr.2022.07.014_bib31","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1586\/14737167.2015.1091730","article-title":"Multiple chronic conditions and healthcare costs among adults","volume":"15","author":"Sambamoorthi","year":"2015","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"key":"10.1016\/j.jacr.2022.07.014_bib32","first-page":"80","article-title":"Financial toxicity, Part I: a new name for a growing problem","volume":"27","author":"Zafar","year":"2013","journal-title":"Oncology (Williston Park)"},{"key":"10.1016\/j.jacr.2022.07.014_bib33","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1634\/theoncologist.2012-0279","article-title":"The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience","volume":"18","author":"Zafar","year":"2013","journal-title":"Oncologist"},{"key":"10.1016\/j.jacr.2022.07.014_bib34","doi-asserted-by":"crossref","first-page":"djv370","DOI":"10.1093\/jnci\/djv370","article-title":"Financial toxicity of cancer care: it\u2019s time to intervene","volume":"108","author":"Zafar","year":"2016","journal-title":"J\u00a0Natl Cancer Inst"},{"key":"10.1016\/j.jacr.2022.07.014_bib35","first-page":"505","article-title":"Medical costs and productivity losses of cancer survivors--United States, 2008-2011","volume":"63","author":"Ekwueme","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"6 Suppl 5","key":"10.1016\/j.jacr.2022.07.014_bib36","doi-asserted-by":"crossref","first-page":"S489","DOI":"10.1016\/j.amepre.2015.09.002","article-title":"Healthcare expenditure burden among non-elderly cancer survivors, 2008-2012","volume":"49","author":"Guy","year":"2015","journal-title":"Am J Prev Med"},{"key":"10.1016\/j.jacr.2022.07.014_bib37","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1001\/jamaoncol.2020.1475","article-title":"Assessment of parking fees at national cancer institute\u2013designated cancer treatment centers","volume":"6","author":"Lee","year":"2020","journal-title":"JAMA Oncol"},{"key":"10.1016\/j.jacr.2022.07.014_bib38","doi-asserted-by":"crossref","first-page":"E388","DOI":"10.1016\/j.ijrobp.2020.07.2418","article-title":"Rideshare services for patients undergoing daily radiation therapy","volume":"108","author":"Damico","year":"2020","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.jacr.2022.07.014_bib39","doi-asserted-by":"crossref","first-page":"S99","DOI":"10.1016\/j.ijrobp.2020.07.2274","article-title":"The impact of rideshare transportation in radiation oncology","volume":"108","author":"Manning","year":"2020","journal-title":"Int J Rad Oncol Biol Phys"}],"container-title":["Journal of the American College of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1546144022007104?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1546144022007104?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T06:28:16Z","timestamp":1761546496000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1546144022007104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["S1546144022007104"],"URL":"https:\/\/doi.org\/10.1016\/j.jacr.2022.07.014","relation":{},"ISSN":["1546-1440"],"issn-type":[{"value":"1546-1440","type":"print"}],"subject":[],"published":{"date-parts":[[2023,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Out-of-Pocket Expenditures for Imaging Examinations: Perspectives From National Patient Surveys Over Two Decades","name":"articletitle","label":"Article Title"},{"value":"Journal of the American College of Radiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacr.2022.07.014","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 American College of Radiology","name":"copyright","label":"Copyright"}]}}