In this issue of JAMA, Smith-Bindman et al1 report findings from a study of advanced imaging utilization in 3 US integrated health care programs, in 4 US mixed-model insurance plans, and in individuals living in Ontario, Canada. Using electronic health record data from 2000 to 2016, the authors retrospectively characterized more than 135 million medical imaging examinations for 16 million to 21 million individuals annually, including segmenting utilization by both imaging mode and body region.