The judgment of intensive care unit (ICU) providers is difficult to measure using conventional structured electronic medical record (EMR) data. However, provider sentiment may be a proxy for such judgment. Utilizing 10 years of EMR data, this study evaluates the association between provider sentiment and diagnostic imaging utilization. We extracted daily positive / negative sentiment scores of written provider notes, and used a Poisson regression to estimate sentiment association with the total number of daily imaging reports. After adjusting for confounding factors, we found that (1) negative sentiment was associated with increased imaging utilization (p < 0.01), (2) sentiment's association was most pronounced at the beginning of the ICU stay (p < 0.01), and (3) the presence of any form of sentiment increased diagnostic imaging utilization up to a critical threshold (p < 0.01). Our results indicate that provider sentiment may clarify currently unexplained variance in resource utilization and clinical practice.