OBJECTIVES: Appropriate use of medical imaging tests is a growing area of policy discussion. Quantitative methods can characterize benefits and risks of medical imaging tests and distinguish necessary from unnecessary utilization. Our objective was to assess the extent of quantitative benefit-risk analyses (BRA) published in medical imaging testing. METHODS: Using PubMed and the Cochrane Library, a computerized search was performed to identify studies published between January, 1979 and January, 2013. The search was limited to include only studies that quantified benefits and risks/harms of ionizing radiation imaging in screening or diagnostics. RESULTS: Seventy-eight studies called for the need to weigh benefits and risks associated with medical imaging tests but only seven studies quantified at least one benefit and one risk/harm.  Of these, two studies reported BRA of mammography. Three studies addressed positron emission tomography (PET): two studies assessed BRA of full body PET in cancer screening and one study assessed BRA of PET in lung cancer diagnosis. The remaining two studies reported BRA of computed tomography colonography. Of the four studies published in English, benefits were reported in terms of life extension, and harms were reported as radiation-related cancer risk or loss of life-years. Studies used micro-simulation modeling, epidemiological or survey methods. CONCLUSIONS: This review illustrates that a gap exists between the number of studies referring to the need for assessing the benefit-risk balance in medical imaging and the number of studies measuring that balance. Challenges such as translating imaging information into impacts on patient outcomes, multiple applications of imaging tests, difficulty in measuring harms from ionizing radiation and additional procedures spurred from false positive results hinder the necessary movement toward using quantitative methods. Meeting the goals of patient-centered outcomes and understanding areas of appropriate use, overutilization and underutilization requires further development of a framework for quantitative BRA of medical imaging tests.