Kudu E, Hizli N, Danış F, Altun M. Defensive medicine and advanced imaging overuse in emergency departments: A focused review of imaging stewardship and overcrowding. World J Radiol 2026; 18(10): 127912 [DOI: 10.4329/wjr.127912]
Corresponding Author of This Article
Emre Kudu, MD, Associate Professor, Researcher, Department of Emergency Medicine, Marmara University School of Medicine, Muhsin Yazıcıoğlu Caddesi No. 10, İstanbul 34899, Türkiye. ekudu@marmara.edu.tr
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Kudu E, Hizli N, Danış F, Altun M. Defensive medicine and advanced imaging overuse in emergency departments: A focused review of imaging stewardship and overcrowding. World J Radiol 2026; 18(10): 127912 [DOI: 10.4329/wjr.127912]
World J Radiol. Oct 28, 2026; 18(10): 127912 Published online Oct 28, 2026. doi: 10.4329/wjr.127912
Defensive medicine and advanced imaging overuse in emergency departments: A focused review of imaging stewardship and overcrowding
Emre Kudu, Naz Hizli, Faruk Danış, Mustafa Altun
Emre Kudu, Mustafa Altun, Department of Emergency Medicine, Marmara University School of Medicine, İstanbul 34899, Türkiye
Naz Hizli, Department of Pediatrics, Marmara University Pendik Training and Research Hospital, İstanbul 34899, Türkiye
Faruk Danış, Department of Emergency Medicine, Bolu Abant İzzet Baysal University Medical School, Bolu 14030, Türkiye
Author contributions: Kudu E designed overall concept, outline, and design of the manuscript, led the writing of the manuscript, and performed the literature investigation; Hizli N, Danış F, and Altun M aided in the literature search, engaged in the interpretation and discussion of the findings, and meticulously revised and refined the manuscript; and all authors read and approved the final version of the manuscript to be published.
AI contribution statement: Artificial intelligence tools were used solely for English language editing of the manuscript and for the preparation of Figure 1. The authors reviewed and verified all text and assume full responsibility for the integrity, accuracy, originality, and scientific validity of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Emre Kudu, MD, Associate Professor, Researcher, Department of Emergency Medicine, Marmara University School of Medicine, Muhsin Yazıcıoğlu Caddesi No. 10, İstanbul 34899, Türkiye. ekudu@marmara.edu.tr
Received: September 10, 2026 Revised: September 26, 2026 Accepted: October 12, 2026 Published online: October 28, 2026 Processing time: 48 Days and 15.9 Hours
Core Tip
Core Tip: Advanced imaging overuse in emergency departments is driven by diagnostic uncertainty, time pressure, malpractice concerns, patient expectations, consultant requests, and system-level workflow constraints. This narrative review synthesizes current evidence linking defensive medicine and low-value imaging to radiology bottlenecks, prolonged emergency department throughput, unnecessary costs, incidental findings, and clinician workload. It also proposes a conceptual reciprocal-pressure framework, in which crowding and defensive imaging reinforce each other, that has not been tested experimentally. It also summarizes reported mitigation strategies, including clinical decision rules, computerized clinical decision support, Choosing Wisely initiatives, shared decision-making, audit and feedback, and multidisciplinary imaging stewardship.
