Author: Brian Casey

Medicare Payment Pushback to 2026 Physician Rates

Posted on by Brian Casey

CMS gave U.S. medical specialists a fright on Halloween with the publication of its final 2026 Medicare Physician Fee Schedule. The new MPFS rates lock in a controversial “efficiency adjustment” for specialist physicians (including radiologists) and continue a decline in Medicare payment rates for specialists.

Physicians have long complained about low reimbursement rates in the Medicare and Medicaid programs, which are tasked with providing healthcare services to an aging population under a budget that’s, by law, limited to a fixed amount.

  • The situation creates a zero-sum game: increased healthcare spending in one area has to be offset by reductions in another.

Physicians thought they won a victory in summer 2025 with the passage of the One Big Beautiful Bill Act, which included a 2.5% increase in the Medicare conversion factor, the complicated formula governing physician payments.

  • But it didn’t take long for the bill to come due. Within weeks of OBBBA’s passage, CMS issued its proposed 2026 MPFS rates, which included the conversion factor bump but also what the agency called a 2.5% “efficiency adjustment” payment reduction.

CMS justified the reduction by stating that it applied to medical services “that have likely become able to be furnished more efficiently over time but still retain valuations based on outdated assumptions” – including medical image interpretation.

  • But the subtext is that the adjustment continues the agency’s long shift away from medical specialties – which CMS believes are overpaid – and toward primary care physicians.

Organized medicine’s response illustrates the rule’s uneven impact. 

Indeed, an ACR analysis of the final rule estimates an overall impact of the MPFS changes to be -2% for radiology, -1% for nuclear medicine, +2% for interventional radiology, and -1% for radiation oncology.

  • That may not sound like a lot, but the reductions come on top of years of similar declines that some observers have likened to “death by a thousand cuts.”

The Takeaway

By finalizing the 2026 MPFS, CMS is locking in a physician reimbursement schedule that continues to shift payments away from medical specialties like radiology and toward primary care. It’s a trend that’s been happening for decades, and is one that this year’s change in administration has done little to reverse. Radiology should buckle up. 

New CT Protocols Reduce Radiation Dose

Posted on by Brian Casey

With patient safety top of mind these days, radiology professionals are correct to focus on performing CT scans with less radiation. To that end, three recently published research studies highlight new protocols to do just that.

Radiation safety has been one of the top radiology stories in 2025 following several studies underscoring the links between medical radiation and cancer. 

  • The irony is that patient radiation exposure can be reduced dramatically using protocols that already exist – it’s just a matter of applying them consistently in the real world. 

In the first paper, published in European Journal of Radiology, researchers share their MINDS-CAD protocol for coronary CT angiography. 

  • MINDS-CAD relies on tailoring contrast dose to patient weight and CT scanner tube voltage using a five-step process. 

MINDS-CAD was tested with 112 obese patients getting clinically indicated CCTA with Siemens Healthineers’ Somatom Force dual-source CT scanner and Bayer’s Ultravist 370 contrast agent. Researchers found that compared to a conventional tube voltage-adapted protocol, MINDS-CAD…

  • Achieved superior image quality according to cases rated “good” or “excellent” (86% vs. 75%).
  • Generated fewer poor-quality scans (3.5% vs. 8.8%).
  • Produced sharply lower radiation dose (99 vs. 386 mGy•cm).
  • Saw no link between vascular attenuation and BMI or tube voltage.

In a second EJR paper, researchers from India tested the ability of an AI-based reconstruction algorithm to reduce dose in cerebral CTA exams.

  • They used Philips’ Precise Image AI-based reconstruction protocol, which produces images resembling traditional filtered back projection scans while reducing noise like advanced iterative reconstruction methods.

In tests with 68 patients who got cerebral CTA at 100 kVp, compared to iterative reconstruction, Precise Image…

  • Improved contrast-to-noise ratio 26%, signal-to-noise ratio 22%, and visual noise 16%.
  • Generated higher image quality scores from radiologists.
  • Generated an extremely low median effective dose of 0.785 mSv.

Finally, a third study – this one in Clinical Radiology – used a “double low” technique of low-energy 50 keV images on GE HealthCare’s Revolution Apex dual-energy CT scanner with TrueFidelity deep learning image reconstruction on 60 patients with cirrhotic liver disease. 

  • Compared with a conventional protocol, the double-low technique had 48% lower radiation entrance dose (4.10 vs. 7.88 mSv) and 32% lower contrast dose (67.3 vs. 99.1 mL), while image quality was rated higher.

The Takeaway

Taken together, the new papers show that radiology’s radiation dose challenge is eminently solvable thanks to the ingenuity of clinicians and researchers who are pioneering new ways to scan.

Malpractice Reform Linked to Less Imaging Use

Posted on by Brian Casey

We all know it happens – medical imaging scans of questionable clinical value, performed not to improve patient diagnosis but to defend clinicians in the event of malpractice litigation. A new study in AJR supports the idea that defensive medicine is driving up imaging use by finding a link between malpractice reform and lower emergency imaging utilization. 

The proliferation of imaging technology throughout the healthcare enterprise – and especially in the emergency setting – gives clinicians a powerful tool that’s just too tempting not to use.

  • Head CT scans can quickly rule out patients who might have a hemorrhagic stroke, for example, while cardiac CT angiography is showing its value for working up patients with chest pain. 

But with great power comes great responsibility. Unnecessary imaging not only drives up healthcare costs but can expose patients to additional radiation as well as complications from working up suspicious findings.

  • Medical-legal experts speculate that malpractice reform through tools such as damage caps could tamp down defensive medicine by limiting physicians’ legal exposure to lawsuits in the event they make a mistake.

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute tested the idea by analyzing 630k Medicaid encounters for patients with headache presenting to the emergency department in 2019. 

  • They then correlated head and neck imaging volume to various factors that could influence utilization, including whether states had implemented tort reform. 

Their analysis discovered that emergency imaging utilization was less likely to occur…

  • In states with laws on “several liability” (in which parties are only responsible for their own share of damages) (OR = 0.68).
  • In states with malpractice damage caps (OR = 0.79).
  • In states with greater mean malpractice payment (although the effect size was minimal; OR = 0.99).

A couple other interesting findings included…

  • Referring physicians other than emergency medicine were far more likely to order more imaging (OR = 8.45).
  • Facilities with fewer than 100 beds were less likely to order imaging (OR = 0.65).

The Takeaway

The new findings linking malpractice reforms with lower emergency imaging use confirm what many of us have already suspected. Whether they lead to health policy reforms remains to be seen. 

New Cancer Disparity Data Show Socioeconomic Impact

Posted on by Brian Casey

Cancer screening disparities continue to draw scrutiny in radiology. A new study in JAMA Network Open takes a closer look at why some people don’t get screened as often as they should – as well as the factors that contribute to cancer prevalence and mortality. 

There’s extensive research backing the lifesaving potential of the major cancer screening exams, and cancer mortality rates have consistently declined thanks to the combination of screening and better treatments. 

  • But the declines are uneven, prompting researchers to investigate reasons for the disparities, such as in a study earlier this month documenting geographic variations in cancer screening rates. 

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute looked at how 24 measures like lifestyle, socioeconomic status, and environmental background affected breast, prostate, lung, and colorectal cancer, which account for 50% of new cancer cases.

  • In particular, they examined screening completion rates and cancer prevalence and mortality at the county level in a nationally representative sample of 5% of Medicare fee-for-service beneficiaries, of whom 87% were 65 years and older. 

There’s a lot to unpack in the study, but a few highlights are below as they relate to breast and lung cancer, the two cancers for which imaging-based screening is recommended. The top three factors affecting each (in order of importance) are…

  • Breast cancer:
    • Screening rates – Hispanic population share, levels of insufficient sleep, and poverty. 
    • Prevalence – uninsured status, obesity, and housing insecurity.
    • Mortality – non-Hispanic Black race, environmental justice index, and insufficient sleep.
  • Lung cancer:
    • Screening rates – air pollution exposure, lack of access to primary care physicians, and number of poor physical health days.
    • Prevalence – limited access to healthy foods, uninsured status, and severe housing problems.
    • Mortality – smoking, poor physical health days, and environmental justice index. 

While there are some obvious findings in the data (the connection between smoking and lung cancer mortality, for example), the dominance of socioeconomic measures may take some by surprise (or maybe not). 

  • But they do track with previous research finding that socioeconomic factors account for 40-50% of health impacts.

The Takeaway

The new study – as with previous research – reinforces what we know about the strong connection between socioeconomic status and cancer screening disparities. The new data should give clinicians and public health advocates more detail on the specific factors they need to focus on to improve screening compliance and reduce cancer’s burden on society.

Hologic to Go Private in $18.3B Buyout

Posted on by Brian Casey

Women’s imaging vendor Hologic will go private in an $18.3B buyout led by two private equity firms, Blackstone and TPG. The move is easily the largest acquisition in radiology this year – the question is how it will impact one of the biggest corporate success stories in women’s health. 

Hologic has a long history in medical imaging and was founded in 1985 to develop and market bone densitometry systems. It soon expanded into mammography, molecular diagnostics, and women’s health treatments.

  • The company went public in 1990, and has maintained its independence even as radiology underwent a period of consolidation in the 1990s and 2000s that saw most mid-cap firms get acquired by multinational OEMs.

Much of Hologic’s momentum was driven by the conversion of U.S. mammography facilities from standard 2D mammography to 3D digital breast tomosynthesis. 

  • This shift was led by Hologic’s Selenia Dimensions system, which in 2011 was the first DBT system to get FDA approval. Hologic rode its momentum to a U.S. mammography installed base market share approaching 70%. (Signify Research estimates Hologic currently has a 34% market share of the global mammography market.)

But as often happens to many market leaders, Hologic’s position began slipping in recent years. 

  • The multinational OEMs have improved their positions in women’s imaging, releasing DBT systems that are more competitive with Hologic’s offerings while also benefiting from multiyear purchasing agreements with large health systems in which mammography systems can be bundled with CT, MRI, and other equipment. 

Perhaps as a result, Hologic’s Breast Health segment has become a drag on revenue growth due to lower equipment sales. Breast Health revenues for the most recent Q3 period fell 5.8%, following a 6.9% drop in Q2 and a 2.1% decline in Q1. 

  • Indeed, reports began surfacing in May 2025 that Blackstone and TPG were targeting Hologic for acquisition, with Hologic reportedly rejecting a $16.7B offer. 

The bid was apparently sweetened, with an acquisition price of $79 a share, a 46% premium from before the acquisition rumors started, for a total value of $18.3B. The buyout should close in the first half of calendar 2026.

The Takeaway

Hologic built itself into a radiology success story through a combination of technological innovation and an obsessive focus on a single market segment – women’s health. The question is whether that focus will continue under its new PE-led ownership.

Cancer Screening Rates Vary Geographically

Posted on by Brian Casey

Progress has been made in some U.S. regions in boosting adherence rates for cancer screening exams like mammography, but clusters of regional variation remain. That’s according to a new study in JAMA Network Open that offers hope for reducing access disparities in disadvantaged areas.

Disparities in healthcare access remain one of the nagging problems in the U.S. healthcare system. 

  • Previous studies have shown that racial background, socioeconomic status, and geographic location can all affect access to care, and ultimately, patient outcomes.

Nowhere is this more apparent than in cancer screening, where getting patients in for their exams has always been a challenge. 

  • Screening compliance rates (as of 2021) were approximately 76% for breast cancer, 75% for cervical cancer, and 72% for colorectal cancer. 

But how does geography affect screening rates, and has progress been made over time? 

  • To answer these questions, researchers analyzed geographic variations in rates for the three major cancer screening tests (breast, cervical, and colorectal) over a 22-year period. 

Screening data were analyzed at the county level from 1997 to 2019, with screening prevalence estimated over 3-5-year periods. For mammography screening, authors found…

  • Screening rates were highest in the Northeast (Maine, New Hampshire, Vermont, and Massachusetts).
  • Rates were lowest in the Southwest (Texas, New Mexico, and Arizona).
  • Geographic areas that shifted from low to high uptake had lower socioeconomic status and more non-White residents, suggesting the success of efforts to improve screening in disadvantaged areas. 
  • Counties that did not improve had lower socioeconomic status than counties that maintained high screening rates. 
  • Rural areas had persistently low screening rates, reflecting lack of access to facilities as well as transportation. 

The Takeaway

The new study on geographic variation in cancer screening rates offers encouraging news that – at least in some disadvantaged areas – improving screening uptake is possible. But more research is needed to find out why some areas fail to see improvement. 

Doubling Lung Screening Rates with Patient Outreach

Posted on by Brian Casey

Low CT lung cancer screening rates have disappointed medical imaging professionals and public health advocates alike since the test received USPSTF recommendation over 10 years ago. But a new study shows how one health system doubled its lung cancer screening rates – to levels approaching those of more established cancer screening exams. 

USPSTF recommended low-dose CT lung cancer screening in 2013, but 10 years later patient screening rates languished in the mid-teens, compared to rates of around 75% for breast and cervical cancer and above 72% for colorectal cancer. 

  • That means many lung cancer patients are showing up with late-stage disease, when it’s more difficult to cure. Perhaps as a result, lung cancer is expected to cause almost 125k deaths in the U.S. in 2025.

Breaking that cycle was the goal of researchers at the University of Rochester Medical Center in New York, who wrote about their experiences in a study published in NEJM Catalyst. 

  • They wanted to boost lung cancer screening adherence across their network of 42 locations in western New York. 

So how did they do it? Success came through a combination of IT innovation and old-fashioned legwork in patient outreach. Clinicians…

  • Provided evidence on lung cancer screening to primary care providers.
  • Updated their EHR software to identify patients eligible for lung screening based on the daily schedule to provide screening prompts during patient visits.
  • Created dashboards to guide outreach to patients due or overdue for screening exams.
  • Developed an extensive follow-up program with patient navigators to facilitate recall for annual exams.
  • Created a centralized pulmonary team to provide referrals for smoking cessation, conduct shared decision making for screening exams, and manage pulmonary nodules.

The program produced immediate results. In an analysis comparing screening rates in March 2022 to June 2025, researchers found…

  • Lung screening rates doubled (from 33% to 72%).
  • On-time completion of annual LDCT screening exceeded 94%.
  • 78% of lung cancer cases in 2023 and 2024 were diagnosed at an early stage.
  • There were no statistically significant differences in screening rates by patient race.

The Takeaway
The new results match up with recent findings – such as those presented at WCLC 2025 in September – underscoring the importance of reaching out to potential lung cancer screening candidates to bring them into the fold. Despite CT lung screening’s halting history, these studies show that it can be done.

Uneven Access to Brain MRI

Posted on by Brian Casey

Patients from disadvantaged neighborhoods or those traveling farther for brain MRI scans presented in worse clinical condition than patients with better access. That’s according to a new JACR study that reopens the debate over disparities in healthcare access. 

The past several years have seen numerous studies published that document disparities in healthcare access and their impact on clinical outcomes.

Many previous studies have also concentrated on access to care in rural areas, in which long distances make it harder for patients to travel to medical centers.

  • In the current study, researchers led by authors from Emory University flipped the script to examine care access in the Atlanta metropolitan area in an effort to quantify how distance and socioeconomic status might impact patient care. 

They examined the demographic backgrounds of 4.8k patients who got brain MRI scans over a one-year period starting in March 2019, calculating factors like distance from home to imaging facility and socioeconomic status based on the area deprivation index. 

  • They then correlated these data to patient illness severity – also known as acuity – when they presented for their scans, using a three-point scale ranging from normal (level 1) to findings requiring a change in patient management (level 3).

Based on the data, researchers found…

  • Patients in neighborhoods with lower socioeconomic status had 34% higher odds of level 2 acuity versus level 1 for inpatient scans and 27% higher for emergency scans. 
  • Patients living twice the distance from an imaging facility had 6.5% higher odds of level 2 acuity compared to level 1, and 15% higher for level 3.
  • Other factors affecting acuity level included age, race, and insurance status.
  • Medicaid recipients in particular were sicker, with 68% higher odds of acuity level 2 and 81% higher odds of acuity level 3 compared to those with commercial insurance. 

The findings track with other studies that have linked chronic health conditions with brain pathologies, such as the connection between diabetes and stroke. 

The Takeaway

The new findings offer additional details on how patient demographics affect both their health status and their access to care, in particular for advanced imaging scans like brain MRI. Follow-up studies could examine whether a similar phenomenon occurs with CT, which is the workhorse modality for emergency imaging. 

Reducing CT Radiation Dose System-Wide

Posted on by Brian Casey

CT radiation dose has been one of the top radiology headlines this year due to the publication of several studies linking radiation to cancer risk. But new research offers hope that CT radiation dose can be reduced, even across large healthcare systems. 

CT’s link to cancer risk has been controversial, but most established models connect low-level radiation to cancer formation.

There are lots of great technologies for reducing CT radiation dose, from photon-counting CT to adjusting scanner parameters like mA and kVp, while image reconstruction algorithms can upscale noisy low-dose images to look like higher-quality exams.

  • But the problem has always been getting these technologies into the hands of clinicians – and then making sure they use them, especially across large multi-center health systems, where dose can vary even within the same network.  

Taking a crack at the problem were cardiologists from Lee Health Heart Institute in Fort Myers, Florida, in a new paper in JACC: Case Reports. 

  • They specifically looked at radiation dose for coronary CT angiography exams, determining that based on the literature an optimal radiation dose for CCTA should be ≤ 4 mSv – lower than the system’s 6.2 mSv median dose. 

So they implemented several strategies for reducing CCTA dose…

  • Standardizing scanning protocols that emphasized prospective ECG gating, reduced field of view, BMI-tailored tube voltage (kVp), and elimination of redundant imaging phases.
  • Setting parameters for single-source CT at 100 kVp for patients with BMI <30 and 120 kVp for BMI ≥30, with prospective scanning for 60-80% of the cardiac cycle.
  • Using similar kVp settings for dual-source CT scanners, but implementing systolic imaging between 250-450 milliseconds.

How well did it work? After reviewing the program, researchers found…

  • System-wide radiation dose fell 23% (4.8 vs. 6.2 mSv).
  • Diagnostic quality improved as measured by the acceptance rate for FFR-CT exams (93% vs. 91%). 
  • Dose consistency was achieved across locations despite differences in scanner models and practices.

The Takeaway

The new study on CCTA radiation dose shows that dose can be reduced system-wide while maintaining – and even improving – diagnostic image quality. Is it a problem that the research was led by cardiologists and not radiologists? Not if you’re a patient. 

Perils of Missed Mammography

Posted on by Brian Casey

Yet another study is illustrating the perils of missing mammography screening. New research in JAMA Network Open found that women diagnosed with breast cancer who missed their previous screening exam had signs of delayed diagnosis and worse clinical outcomes. 

Mammography screening is generally credited – along with improved treatments – with a steady decline in breast cancer death rates since the start of population-based breast screening.

  • But most studies on mammography’s effectiveness tend to compare women who participated regularly in screening with those who never did. 

That’s not really a realistic comparison these days, as mammography’s relatively high compliance rate means that most women are getting screened at least some of the time.

  • But what happens if women miss a screening exam? In a BMJ study published last month, researchers found that women who missed their first screening exam had a 40% higher risk of breast cancer death.

In the current study, researchers took a slightly different tack, looking at 8.6k women in Sweden whose breast cancer was detected on screening exams starting in 2015. 

  • In all, 17% of women missed the screening exam immediately before their cancer diagnosis. 

Compared to women who attended all screening rounds, those who missed their previous exam had higher adjusted odds ratio for…

  • Larger tumors ≥ 20 mm (AOR = 1.55).
  • Lymph node involvement (AOR = 1.28).
  • Distant metastasis (AOR = 4.64).
  • Worse breast cancer-specific survival (AOR = 1.33).
  • Lower 20-year breast cancer-specific survival (86% vs. 89%). 

What’s more, the program’s cancer detection rate per 1k screenings was sharply higher in the second screening round for women who missed the first round (7.35 vs. 5.59). 

  • This is most likely a sign that cancers that could have been detected in the first round instead were detected in the second round – another sign of delayed diagnosis.

Women who had missed their previous screening tended to be younger, unemployed, unmarried, and born outside of Sweden, and also had lower income. 

  • Women with these characteristics could be targeted for more intensive outreach, such as shorter invitation intervals or outreach after a missed appointment. 

The Takeaway

The new study once again highlights the importance of regular mammography screening in detecting breast cancer. Even one missed exam can have serious clinical consequences – highlighting the importance of identifying and contacting women who might be more prone to missed appointments.

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