AbstractBackgroundThis study examines the impact that the COVID‐19 pandemic has had on computed tomography (CT)‐based oncologic imaging utilization.MethodsWe retrospectively analyzed cancer‐related CT scans during four time periods: pre‐COVID (1/5/20–3/14/20), COVID peak (3/15/20–5/2/20), post‐COVID peak (5/3/20–12/19/20), and vaccination period (12/20/20–10/30/21). We analyzed CTs by imaging indication, setting, and hospital type. Using percentage decrease computation and Student'st‐test, we calculated the change in mean number of weekly cancer‐related CTs for all periods compared to the baseline pre‐COVID period. This study was performed at a single academic medical center and three affiliated hospitals.ResultsDuring the COVID peak, mean CTs decreased (−43.0%,p< 0.001), with CTs for (1) cancer screening, (2) initial workup, (3) cancer follow‐up, and (4) scheduled surveillance of previously treated cancer dropping by 81.8%, 56.3%, 31.7%, and 45.8%, respectively (p< 0.001). During the post‐COVID peak period, cancer screenings and initial workup CTs did not return to prepandemic imaging volumes (−11.4%,p= 0.028; −20.9%,p= 0.024). The ED saw increases in weekly CTs compared to prepandemic levels (+31.9%,p= 0.008), driven by increases in cancer follow‐up CTs (+56.3%,p< 0.001). In the vaccination period, cancer screening CTs did not recover to baseline (−13.5%,p= 0.002) and initial cancer workup CTs doubled (+100.0%,p< 0.001). The ED experienced increased cancer‐related CTs (+75.9%,p< 0.001), driven by cancer follow‐up CTs (+143.2%,p< 0.001) and initial workups (+46.9%,p= 0.007).Conclusions and relevanceThe pandemic continues to impact cancer care. We observed significant declines in cancer screening CTs through the end of 2021. Concurrently, we observed a 2× increase in initial cancer workup CTs and a 2.4× increase in cancer follow‐up CTs in the ED during the vaccination period, suggesting a boom of new cancers and more cancer examinations associated with emergency level acute care.