Brian Casey, Author at The Imaging Wire

Radiology Report Turnaround Slows

Posted on August 5, 2026August 5, 2026 by Brian Casey

Radiologists are taking longer to interpret medical images than they did 10 years ago … and it’s a problem that appears to be getting worse. New data from the ACR’s Neiman HPI group, published in JACR, show that report turnaround times rose 27% between 2023 and 2024.

Report turnaround time (commonly referred to as TAT) is a closely watched barometer of radiologist productivity, and longer TAT could indicate radiologists are struggling to keep up with growing imaging volumes.

Another Neiman HPI study on TAT released earlier this year discovered a “hockey stick” effect, with turnaround times jumping sharply starting in 2022.

But that study only tracked TAT through 2023. Meanwhile, anecdotal reports have surfaced of a “rapid increase” in turnaround times in late 2024.

So the updated research adds more recent data, analyzing newly available Medicare fee-for-service claims from 2024.

Researchers analyzed data from 2.9M office and hospital outpatient claims from 2014 to 2024, finding that TAT…

Grew just 14% in seven years from 2014 to 2021 (0.091 to 0.104 days).
But then rose at double-digit annual rates in 2023 (60%) and 2024 (27%).
Reached 0.251 days by the end of 2024, a 177% increase over 10 years.
Increased at different rates by modality over the 10-year period, including CT (381%), MRI (278%), ultrasound (267%), and X-ray (126%).

Why did TAT growth decelerate in 2024 over the year before? The Neiman HPI authors weren’t sure, but they said practice leaders may have taken steps to meet higher demand, like moonlighting and reactivating retired staff.

But these aren’t long-term measures that can meet the mismatch between supply and demand, suggesting instead that “the radiology workforce may be operating at or near maximum capacity.”

The Takeaway

The new data on slower radiology report turnaround times confirm fears that radiologists are struggling under rising imaging volumes and a stagnant workforce. While slower TAT growth in 2024 is a bit of a silver lining, it does little to hide the growing storm clouds on the horizon.

Rads Flee VA After Agency Banned Remote Work

Posted on August 2, 2026July 31, 2026 by Brian Casey

A new report claims that radiologists fled the U.S. Department of Veterans Affairs health system after the agency eliminated policies allowing remote work in 2025. While the VA has since rescinded the ban, the article in The American Prospect claims that plummeting morale continues to plague the health system’s radiologists.

The VA’s Veterans Health Administration operates one of the largest health systems in the U.S., serving some 9.1M veterans through 170 VA medical centers and affiliated outpatient sites across the country.

While there are no official figures, estimates suggest the VA employs at least 1.5k radiologists, or 4%-5% of all active U.S. radiologists.

While radiologist salaries at the VA don’t approach levels found in the private healthcare sector, many imaging specialists are drawn to the system thanks to perceptions that it offers more job security and stability, as well as its mission in serving the nation’s veterans.

But the VA’s image of stability began changing in January 2025, the article claims, when the Trump Administration ordered federal employees to return to working in offices.

The order hit VA radiology particularly hard. Thanks to PACS and teleradiology, remote image interpretation has become a staple of the average radiologist’s workday.

Remote reading is even seen as a possible solution to radiology’s rising imaging volume and stagnant workforce.

So it’s no surprise that VA radiologists recoiled against the new policy, which “ignored the realities of radiology work” and caused morale to plummet among the health system’s imaging specialists.

The VA eventually recognized its mistake and rescinded the in-office requirement for radiologists. But by then the damage was done.

The article claims that VA radiology has experienced ongoing repercussions from the turmoil…

Many radiologists have left for the private sector, where average salaries are over 40% higher.
Workloads for the remaining VA radiologists have skyrocketed.
Primary care physicians are reporting it now takes “days, not hours,” to get imaging results.
VA medical centers are being forced to outsource some specialized scans like amyloid PET exams, for which turnaround times are stretching to two or three months.

The Takeaway

It’s hard to tell exactly how many radiologists have left the VA health system, but any job loss is significant for a provider with a mission as important as the VA’s. While the agency’s turnaround on remote work is welcome, it’s likely that the country’s veterans will bear the brunt of the VA’s misguided policy change for years to come.

CT Radiation Dose Drops in Nationwide Survey

Posted on July 29, 2026July 29, 2026 by Brian Casey

Some good news arrived this week in the campaign to reduce CT radiation dose. A new nationwide survey in Radiology found that radiation dose from CT scans has fallen markedly over the past decade in the U.S.

CT has been radiology’s workhorse modality since the 1980s thanks to its winning combination of cost-effectiveness and diagnostic power.

But radiation dose has always been the modality’s Achilles heel. That was highlighted by a controversial 2025 paper claiming that routine CT could cause over 100k cancers in a year in the U.S.

There are plenty of technologies that effectively reduce CT radiation dose, but the trick has always been getting clinicians to use them.

Another problem is standardizing best-practice CT protocols, so there’s less variation in radiation dose between CT scanners in the same health system or institution. The key to standardization is establishing best-practice benchmarks.

A landmark study published almost 10 years ago got the ball rolling by tracking radiation dose in 2014, producing key metrics like diagnostic reference levels (DRLs) and achievable doses (AD) for 1.3M exams at 583 U.S. CT sites.

DRLs represent the 75th percentile of dose distribution, while ADs are set at the 50th percentile, and both numbers represent targets for dose optimization efforts that are dynamic and can change over time.

In the current study, researchers updated the radiation knowledge base with new data from 5.2M CT exams at 592 U.S. facilities, a 4X larger sample than in 2014, finding…

Overall radiation dose fell by 22% as measured by volume CT dose index (CTDI_vol) and by 20% using dose-length product, another common radiation measure.
The largest dose reductions came in chest CT with contrast (-31%) and chest CT without contrast (-27%), while head CT without contrast fell 3.5%.
New levels of achievable dose benchmarks were set for a variety of CT exams, giving CT facilities new targets for radiation dose reduction that are in some cases as much as 19% lower than 2014 targets.

The Takeaway

The new findings on CT radiation dose reduction are a welcome counter to recent studies that have whipped up hysteria around medical radiation. But now is no time to take the foot off the pedal – radiology must continue to drive dose lower through a combination of new technologies and judicious protocol standardization.

AI Closes Mammo Gap Between Generalists, Specialists

Posted on July 26, 2026July 24, 2026 by Brian Casey

Mammography screening exams are some of the most challenging medical images to interpret, but due to staffing issues many mammograms are read by general radiologists rather than specialists. A new study in Radiology found that an AI-based workflow helped close the gap, leading to a 25% improvement in the cancer detection rate for general radiologists.

Most of the big population-based studies on mammography AI have been conducted in Europe, where breast screening is performed under a double-reader paradigm that has two radiologists interpreting exams.

In this scenario, studies have shown that AI can eliminate the need for a second reader, cutting workforce requirements with the same or even better cancer detection rates.

But U.S. breast screening programs don’t use double-reading, leaving many to wonder where AI fits into the single-reader paradigm – especially when that reader is a general radiologist with no breast fellowship training.

The new study offers some clarity. Researchers developed an AI-based workflow that integrated DeepHealth’s ProFound Pro 2.x deep-learning application into DBT-based screening programs.

They set up AI as a “safeguard review.” After a radiologist’s initial interpretation, AI analyzed non-recalled mammograms for suspicion of cancer. Exams that exceeded ProFound’s risk threshold were flagged and routed to an expert reviewer.

If the reviewer agreed with AI, the original interpreting radiologist was consulted and had final authority on whether to recall the case.

The safeguard review concept was tested at 109 breast imaging facilities that saw 578k DBT mammography exams from 2021 to 2022. In particular, researchers focused on the impact the safeguard review had on interpretation accuracy of both specialists and general radiologists, finding…

The cancer detection rate of generalists improved 25%, from 3.76 to 4.99 cancers per 1k exams.
The CDR of specialists did not change at a statistically significant level (from 4.47 to 4.76, p = 0.33).
There was no statistically significant difference between AI-aided generalists and specialists.
Generalists became more efficient at cancer detection, as evidenced by 15% improvement in their positive predictive value (from 3.38% to 3.89%).
Although generalists’ recall rates did increase with AI (from 9.06% to 10.4%).

The Takeaway

The new study offers an intriguing look at how AI can be integrated into U.S. breast screening programs without dramatically disturbing workflow. It also shows how diagnostic performance can be improved in an environment where general radiologists are being asked to fly solo in an area they didn’t train in.

Lung Cancer Mystery in Non-Smokers

Posted on July 22, 2026July 22, 2026 by Brian Casey

One of the emerging mysteries around lung cancer is why it occurs so often in people who don’t smoke – particularly in Asia. A new paper in JAMA Network Open investigates the phenomenon by presenting results from South Korea indicating that established screening criteria would have missed nearly two-thirds of lung cancer patients.

From its earliest days, CT lung screening has been targeted at heavy smokers who have the greatest chance of developing lung cancer.

Risk-based criteria determine who should be screened, usually based on some metric of smoking history (such as the USPSTF’s 20-pack-year threshold).

But many countries that have had national lung screening programs in place for a while – mostly in Asia – are learning that lung cancer also occurs in people who have never smoked at all.

Whether and how to screen these individuals has become the subject of debate.

In the current study, researchers from South Korea examined 89.9k patients who were diagnosed with lung cancer from 2013 to 2018, just before the country started its national lung screening program in 2019.

Researchers focused on whether patients would have been eligible for screening under established criteria, such as from the USPSTF, ACS, and NCCN.

Among people diagnosed with lung cancer…

65% would not have been eligible for lung screening under international guidelines.
44% had no smoking history.
Screening eligibility differed sharply by sex, with men eligible at far higher rates than women (57% vs. 2.3%).
Smokers who weren’t eligible for screening had 5% lower rates of all-cause mortality and 4% lower lung cancer-specific mortality than smokers who were.
People who had never smoked had 14% lower rates of both all-cause and lung cancer-specific mortality.

The data point out an interesting dilemma inherent in CT lung cancer screening, which from the outset was set up to be risk-based rather than population-based like mammography to avoid many of screening’s downsides, like overdiagnosis.

But that approach is missing many people who would otherwise benefit from screening, especially as we learn more about the elevated risk among many non-smoking populations, such as East Asian women.

The Takeaway

The new study shows momentum building toward broader CT lung cancer screening criteria that go beyond smoking status. The question is how quickly such criteria are adopted, and whether they gain traction outside of Asia, where recognition of lung cancer among non-smokers is growing.

Ultrasound and DBT Screening — Time to Call It Quits?

Posted on July 19, 2026July 19, 2026 by Brian Casey

Ultrasound long ago carved out a role in breast cancer screening as a complementary tool to conventional 2D mammography. But is ultrasound still needed, now that U.S. breast screening programs have largely switched over to 3D digital breast tomosynthesis (DBT)? A new study in Academic Radiology raises questions.

Conventional 2D mammography has well-known shortcomings, particularly in women with dense breast tissue that can obscure lesions. So alternative modalities like ultrasound, breast MRI, and contrast-enhanced mammography (CEM) are called in to help when needed.

Past research has shown that supplemental ultrasound can improve the cancer detection rate (CDR) in a 2D mammography screening program by 3-4 cancers per 1k women.

But those studies were performed before the switch to DBT, which can often see around overlapping structures thanks to a gantry head that acquires multiple images as it pans across the breast.

So is ultrasound still needed in screening programs using DBT? Researchers from Weill Cornell Medicine at New York-Presbyterian Hospital tested the hypothesis by examining 103k screening exams from 2014 to 2024 in which both DBT and ultrasound were used.

In the study, researchers found that screening ultrasound after a negative DBT result…

Generated 1.9k biopsies, or 19 biopsies for every cancer the modality detected.
Produced an additional cancer detection rate of 1.0 per 1k women, compared to an additional CDR of 3-4 cancers for ultrasound in the 2D mammography era.
Had an overall false-positive screening rate of 98.5%, a false-positive biopsy rate of 94.8%, and a positive predictive value of biopsies performed (PPV3) of just 5.2%.
Generated $652k false-positive screening ultrasound costs and $1.16M in ultrasound-guided biopsy costs.

The numbers are sobering and indicate that the days of ultrasound as a supplemental screening modality to DBT screening could be coming to a close.

Instead, the researchers recommended that ultrasound screening be replaced by more sensitive modalities like breast MRI or CEM, both of which are fortunately more available now than during the 2D mammography era.

The Takeaway

The new study answers the question – in the negative – of whether supplementary ultrasound is still needed in the era of DBT screening. The positive subtext here is that the research confirms the improved detection performance of 3D compared to 2D mammography.

MRI for Prostate Cancer Staging

Posted on July 15, 2026July 15, 2026 by Brian Casey

Digital rectal exams for prostate cancer staging could become a thing of the past thanks to MRI. A new study in JAMA Network Open found that MRI performed as well as digital exams in determining the extent of prostate cancer disease.

Prostate cancer screening is moving closer to becoming a more widely accepted test, and MRI has played a major role in that evolution by enabling more precise workup of men with high PSA levels.

But what about other aspects of prostate cancer diagnosis and treatment, such as staging men found to have clinically significant disease? It turns out MRI has a role to play there as well.

To learn more, researchers from Germany looked at data from 4.4k men with a median age of 66 and median PSA level of 7.4 ng/mL (anything over 3 ng/mL is typically referred for additional workup). All patients were scheduled for radical prostatectomy.

Patients received digital rectal exams to assign clinical T stage and assess characteristics of cancer severity, such as local tumor extent, extracapsular extension, and seminal vesicle invasion.

This was compared to multiparametric MRI scans on 1.5T or 3T systems, with data reported using the PI-RADS scale. The study’s primary outcome was distant metastasis-free survival.

Among the patient cohort, researchers found…

MRI staging was slightly more accurate than digital exams for predicting biochemical recurrence-free survival (C index = 0.62, with 0.5 representing chance-level prediction and 1 indicating perfect prediction).
And MRI was also better at predicting distant metastasis-free survival (C index = 0.67).
But MRI and digital exams were comparable when using four of the major prostate cancer risk classification systems in Europe.

What to make of the results? MRI didn’t have a huge advantage over digital rectal exams, but it was good enough for the authors to suggest that digital exams could be eliminated in favor of MRI workup instead.

That would enable clinicians to avoid many of the digital exam’s shortcomings, such as subjectivity, operator dependency, and restricted ability to assess extracapsular extension or seminal vesicle invasion.

The Takeaway

This week’s study shows that MRI’s role in prostate cancer diagnosis and treatment goes beyond just screening, and the digital rectal exam’s role for patient staging could soon become a thing of the past in all but a few cases.

Top 6 Radiology Trends for the First Half of 2026

Posted on July 8, 2026July 8, 2026 by Brian Casey

The first half of 2026 is now in our rear-view mirror. As we do every year, we’ve compiled a list of the top six stories – one for each month – to help recap what was important in medical imaging.

Radiology Reporting Booms as Microsoft Sunsets PowerScribe 360
Microsoft’s announcement in February that it would be sunsetting its PowerScribe 360 radiology reporting software set off a scramble for market share that continues months later. While PowerScribe was instrumental in moving radiology to speech recognition-based reporting, many radiology facilities are seeing the announcement as a chance to adopt more modern AI-powered reporting solutions.

Radiology Dominates List of New AI Approvals
The FDA regularly updates its list of AI-enabled medical devices with marketing authorizations, and our coverage of the agency’s decisions was the second most-popular story of 2026’s first half. As with previous updates, radiology dominated the list, garnering 76% of all authorizations since the agency began keeping count and 75% in the fourth quarter of 2025.

Residency Push Skips Radiology
Workforce shortages are a hot story across healthcare, and radiology is no exception. But the specialty won’t be getting much help from a federal initiative to add more resident training slots. Of the more than 400 residency programs awarded funding so far, only two diagnostic radiology programs were selected.

Radiologist Quit Rates Double in a Decade
Having to do more work with less personnel could be convincing many radiologists to leave the profession. Our readers paid close attention to a February story on a JACR study that documented a doubling of the radiologist quit rate over 10 years, and the exact point in terms of case workload when rads were most likely to leave.

Data Is Lacking on AI’s ROI
As radiology AI slowly moves from pilot projects to widespread clinical adoption, a new survey reveals a paradox: The technology is popular with radiologists, but few imaging facilities using AI have collected hard data showing its return on investment. That’s according to another popular story from April.

Study Finds Variation in Radiologist Workload
Our sixth and final top story of 2026 addressed the growth in imaging volume since the COVID-19 pandemic, and how radiologists responded. Researchers found that volume did indeed grow faster than the supply of radiologists, but some imagers were doing more than others in picking up the slack.

The Takeaway

Our readers have apparently been interested in workload issues so far this year, as evidenced by the fact that three of the top six stories on The Imaging Wire for the first half of 2026 had something to do with radiology’s rising exam volume and its ramifications. The other half broadly addressed AI and imaging IT issues. See a connection?

Mammo Modality Face-Off for Early Breast Cancer

Posted on July 1, 2026July 1, 2026 by Brian Casey

When it comes to early breast cancer detection, which medical imaging modality is best: full-field digital mammography, digital breast tomosynthesis, or breast MRI? A new study in Clinical Radiology picks winners – and brings the receipts.

Breast imagers are fortunate to have many technologies at their disposal, each with its own strengths and weaknesses.

X-ray-based mammography tools like FFDM and DBT are easily available and relatively low cost, while breast MRI delivers the highest resolution but is expensive, less available, and more time-intensive to perform.

So when does it make sense to use each modality? Researchers from China tested four techniques – FFDM, DBT, and breast MRI at 1.5T with accelerated and full protocols – in 329 patients with early-stage breast cancer (maximum tumor diameter ≤ 2 cm).

They also analyzed results according to breast tissue density, as dense breast tissue is not only a cancer risk factor but can also obscure lesions on X-ray-based modalities.

Across the study sample, researchers found…

There was little difference in sensitivity between the four techniques for women with non-dense breast tissue, with FFDM, DBT, and accelerated breast MRI achieving 91% compared to 94% for full-protocol breast MRI.
But breast MRI pulled ahead in sensitivity for women with dense breast tissue, both with accelerated and full protocols (95% and 94%) beating DBT and FFDM (90% and 83%).
Accelerated breast MRI had performance comparable to the full protocol regardless of breast density, but at almost half the median scan time (8 vs. 15 minutes).
Accelerated and full-protocol breast MRI had the same specificity (94%), ahead of both DBT and FFDM (88% and 83%).

What to make of the results? Researchers said the findings in women with non-dense breast tissue reinforce that X-ray-based modalities are sufficient.

For women with dense breast tissue, accelerated breast MRI offers performance close enough to the full protocol that breast imaging practices can feel comfortable offering the faster exam.

The Takeaway

It’s no surprise that breast MRI beat both FFDM and DBT mammography for early breast cancer detection in women with dense breast tissue. But it is intriguing that there wasn’t much difference between breast MRI with either accelerated or full protocols. That’s good news for practices that want to make this powerful modality accessible to more women.

Interventional Radiology’s Practice Evolution

Posted on June 28, 2026June 25, 2026 by Brian Casey

Interventional radiology has proven benefits for patient care, enabling life-saving procedures to be performed less invasively than open surgery. But interventional radiology procedures are being concentrated among fewer radiologists, based on findings from a new study in JVIR by researchers from the ACR’s Neiman HPI group.

From its origins in pioneering work conducted in the 1960s by Charles Dotter, MD, in image-guided minimally invasive procedures, interventional radiology has evolved into a field with one foot in diagnostic radiology and another in therapy.

The field achieved a major milestone in 2012, when it was recognized as an independent, primary medical specialty, and shortly thereafter an integrated IR/DR pathway was adopted that gives trainees additional dedicated interventional training.
This replaced the previous practice of just tacking an extra interventional fellowship on to a diagnostic radiology program.

Has the new training structure changed who’s performing interventional procedures in the U.S.? Neiman HPI researchers examined this issue by analyzing Medicare claims from 2008 to 2023 for 46k radiologists.

They focused on the volume of interventional procedures being performed by radiologists, and any shifts in volume that could have resulted from changes in the training program.

Over the study period, researchers found…

The percentage of all radiologists who performed at least some interventional work fell (from 67% to 50%).
But the percentage of super-specialists – those who spent more than 90% of their time doing interventional work – more than doubled (from 4.1% to 8.8%).
Among radiologists who primarily performed interventional work, more were younger compared to older (25% vs. 12%).
And super-specialists tended to be younger as well (9.2% vs. 6.8%).

The changes are most likely due to the new IR/DR training pathway. But they also raise new questions, such as whether interventional radiology should completely separate from diagnostic radiology in both training and practice settings.

The authors weren’t ready to go that far, noting that the integrated IR/DR pathway was designed to ensure dual competency in both image interpretation and procedures, and such flexibility is still valuable in today’s healthcare environment.

The Takeaway

The new findings on the concentration of interventional radiology practice generally reflect the trend toward increased specialization that’s being seen in both radiology and healthcare. Patients are benefiting, as their procedures are more likely to be performed by specialists who not only received more training but also have more experience than in the past.

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