Original Research
Policy, Quality, and Practice Management
December 21, 2022

Pediatric Outpatient Noncontrast Brain MRI: A Time-Driven Activity-Based Costing Analysis at Three U.S. Hospitals


Please see the Editorial Comment by Marla B. K. Sammer discussing this article.
Chinese (audio/PDF) and Spanish (audio/PDF) translations are available for this article's abstract.
BACKGROUND. MRI utilization and the use of sedation or anesthesia for MRI have increased in children. Emerging alternative payment models (APMs) require a detailed understanding of the health system costs of performing these examinations.
OBJECTIVE. The purpose of this study was to use time-driven activity-based costing (TDABC) to assess health system costs for outpatient noncontrast brain MRI examinations across three children's hospitals.
METHODS. Direct costs for outpatient noncontrast brain MRI examinations at three academic free-standing pediatric hospitals were calculated using TDABC. Examinations were categorized as sedated MRI (i.e., sedation or anesthesia), nonsedated MRI, or limited MRI. Process maps were created to describe patient workflows based on input from key personnel and direct observation. Time durations for each process activity were determined; time stamps from retrospective EMR review were used when possible. Capacity cost rates were calculated for resource types within three cost categories (labor, equipment, and space); cost was calculated in a fourth category (supplies). Resources were allocated to each activity, and the cost of each process step was determined by multiplying step-specific capacity costs by the time required for each step. The costs of all steps were summed to yield a base-case total examination cost. Sensitivity analysis for sedated MRI was performed using minimum and maximum time duration inputs for each activity to yield minimum and maximum costs by hospital.
RESULTS. The mean base-case cost for a sedated brain MRI examination was $842 (range, $775–924 across hospitals), for a nonsedated brain MRI examination was $262 (range, $240–285), and for a limited brain MRI examination was $135 (range, $127–141). For all examination types, the largest cost category as well as the largest source of difference in cost between hospitals was labor. Sensitivity analysis found that the greatest influence on overall cost at each hospital was the duration of the MRI acquisition.
CONCLUSION. The health system cost of performing a sedated MRI examination was substantially greater than that of performing a nonsedated MRI examination. However, the cost of each individual examination type did not vary substantially among hospitals.
CLINICAL IMPACT. Health systems operating within APMs can use this comparative cost information for purposes of cost reduction efforts and establishment of bundled prices.


Key Finding
Across three pediatric hospitals, the mean base-case cost for outpatient noncontrast brain sedated MRI was $842 (range, $775–924), for nonsedated MRI was $262 ($240–285), and for limited MRI was $135 ($127–141). The greatest influence on the overall cost of sedated MRI at each hospital was MRI acquisition duration.
The findings highlight potential substantial cost savings from reduced use of sedation for pediatric brain MRI examinations.

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Information & Authors


Published In

American Journal of Roentgenology
Pages: 747 - 756
PubMed: 36541593


Submitted: September 2, 2022
Revision requested: September 20, 2022
Revision received: November 14, 2022
Accepted: December 8, 2022
Version of record online: December 21, 2022


  1. anesthesia
  2. cost
  3. MRI
  4. pediatric
  5. sedation



Shireen E. Hayatghaibi, PhD, MPH [email protected]
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229.
Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
Cecilia G. Cazaban, MD, DrPH
Center for Health Care Data and Department of Management, Policy, & Community Health, UTHealth School of Public Health, Houston, TX.
Sherwin S. Chan, MD, PhD
University of Missouri School of Medicine, Kansas City, MO.
Department of Radiology, Children's Mercy Kansas City, Kansas City, MO.
Jonathan R. Dillman, MD, MSc
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229.
Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
Xianglin l. Du, MB, MS, PhD
Division of Epidemiology, University of Texas Health Science Center, UTHealth School of Public Health, Houston, TX.
Yu-Ting Huang, PhD
The University of Texas MD Anderson Cancer Center, Houston, TX.
Osama I. Mikhail, PhD
University of Texas Health Science Center, UTHealth School of Public Health, Houston, TX.
John M. Swint, PhD
University of Texas Health Science Center, UTHealth School of Public Health, Houston, TX.


Address correspondence to S. E. Hayatghaibi ([email protected]).
Version of record: Mar 15, 2023
The authors declare that there are no disclosures relevant to the subject matter of this article.

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