imaging access Archives - The Imaging Wire

Amid concerns about equitable access to healthcare, questions have arisen about imaging deserts – U.S. regions without any access to radiology services. A new study in Academic Radiology probes the issue, finding that it may not be as bad as originally feared – for reasons unique to radiology.

Uneven access to healthcare – particularly in rural regions – has become a common refrain in analyses of the U.S. healthcare system.

In radiology, the issue has reached into the debate over workforce shortages as open jobs go unfilled in rural areas while urban positions are snapped up quickly – a trend one job board dubbed “geographic inconvenience.”

But how common is a complete lack of access to imaging? And what are the correct public policy tools to address it?

In the new study, researchers assessed imaging availability in U.S. counties by determining whether imaging equipment, local radiologists, or both were available.

In their analysis of 3.1k U.S. counties covering 340.1M residents, researchers found…

Only 1.9% of Americans (6.4M people) lived in true imaging deserts, where there was neither installed imaging equipment nor a local practicing radiologist.
7.6% of Americans (25.9M people) lived in counties with an installed scanner but no local radiologist.
0.1% lived in a county with a local radiologist but no equipment.
90% (307.4M) were considered “fully served” by imaging, with local image acquisition available and some kind of remote interpretation possible.

The statistics point to radiology’s advantage over other medical specialties that require doctors to be physically present to deliver care.

Thanks to teleradiology, images can be acquired locally with installed equipment and then transmitted to central hubs for interpretation.

But even if less than 2% of the population lacks access, 6.4M Americans is a lot of people. How does living in an imaging desert affect their access to radiology?

Researchers found that imaging use rates were 6% lower in imaging deserts compared to fully served regions, while Medicare payments per beneficiary were 8.9% lower.

The Takeaway

The new findings on regional access to imaging show that while most Americans have good access to radiology services, more work is needed to improve care for those who don’t. This is particularly true for services like interventional radiology that require radiologists to be present.

The Lancet Commission on Diagnostics just put a spotlight on the developing world’s alarmingly low access to diagnostics and how this situation can be addressed.

The LMIC Gap – An unbelievable 47% of the global population has little to no access to diagnostics, with the vast majority of this diagnostic gap concentrated in low and middle-income countries (LMICs). This problem is greatest through LMICs’ primary care facilities (19% of people can access PCs w/ diagnostics), but also exists in hospitals (60%-70% of people can access hospitals w/ diagnostics).

The Impact – About 50% of people living with any of six key conditions in LMICs are undiagnosed (hypertension, type 2 diabetes, HIV, tuberculosis, syphilis & hepatitis B virus infection in pregnant women), making diagnostic access the world’s single greatest barrier to care. If undiagnosed rates for these six conditions were reduced to 10% in LMICs, it would avoid 1.1m premature deaths annually.

The Imaging Gap – There is a significant lack of imaging access in LMICs. Imaging access is lowest in primary care where only 5% of basic facilities and 12% of advanced facilities have ultrasound (never mind more advanced imaging). Meanwhile only 36% to 87% of hospitals in LMICs have working X-ray systems and just 2% to 29% of hospitals have a CT scanner (depending on the country).

The Problem – The authors largely blamed the developing world’s diagnostic gap on a lack of visibility and prioritization, although there’s a long list of other factors (corruption, costs, infrastructure, workforce).

The Solutions – The Lancet Commission believes that recent technology and informatics innovations could accelerate government efforts to improve diagnostic access. Until then, they recommend that LMICs develop national diagnostics strategies, ensure that standard diagnostic tests are available at various healthcare tiers (e.g. ultrasound at all primary care facilities), and prioritize improving diagnostic access through primary care facilities.

One Takeaway – Half the world doesn’t have access to diagnostics. This is mainly an economic problem, but imaging could play an outsized role in the solution considering that many of the latest imaging innovations are well suited for low-resource areas (e.g. handheld POCUS, AI diagnostics/guidance, portable MRI, teleradiology, etc.).

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