ABSTRACTIntroductionMedical imaging in acute settings is increasing. This study aimed to quantify the utilisation of medical imaging in inpatient (IP) and emergency department (ED) settings, indexed against ED presentation/inpatient separation numbers.MethodsData of IP and ED studies (XR, CT, US) performed at Western Health (Melbourne, Victoria, Australia) over 6 years from 2017 to 2023 were collated. Linear regression analyses were used to assess trends in acute workload, amount of imaging performed and rate of imaging per 1000 ED presentations/IP separations. Data from three hospital campuses were analysed. CT and US studies were allocated to body region/study type sub‐categories to assess relative numbers.ResultsStatistically significant trends of increasing study numbers and studies per 1000 acute encounters for most modalities and campuses were observed. A minor trend of falling ED presentation and IP separation per 1000 population was observed. COVID‐19 pandemic events temporarily reduced acute hospital workload, but changes were transient and did not affect imaging rates.ConclusionsGrowth in acute medical imaging is multifactorial, driven by increased acute hospital workload and compounded by increased rates of imaging per 1000 acute presentations. Healthcare services will need to rationalise the use of imaging, become more efficient and expand to meet growing demand.