Keeping Pace with Volume: 7 Strategies from ASNR 2025

This week weary neuroradiologists descended upon the City of Brotherly Love for the annual meeting of the American Society of Neuroradiology (ASNR). The field is facing mounting pressure as increasing imaging volumes continue to outstrip radiologists’ capacity. 

Dealing with growing volume was a recurring theme throughout ASNR 2025, with a range of proposed solutions, including the seven strategies below:

  1. Acquisition automation for higher efficiency and reduced technical requirement: A talk by Lawrence Tanenbaum, MD, featured a number of AI solutions to ease technologist training requirements, including smart protocoling, automated patient positioning, one-touch exams without parameter adjustments, and on-device quality assurance and motion correction to cut down repeat exams.
  2. Accelerated acquisitions as the standard-of-care: Every manufacturer – from established vendors to emerging startups – showcased deep learning-based reconstruction. As Suzie Bash, MD, put it, “Deep learning reconstruction is becoming standard-of-care across the industry.”
  3. Improving radiologist reading efficiency with AI and workflow management: A noticeable trend at ASNR 2025 was fewer talks focused solely on algorithm accuracy and more emphasis on how AI impacts reading efficiency. Accuracy remains critical, but adoption increasingly hinges on demonstrating workflow efficiency.
  4. Streamlining new algorithm rollout using integrated platforms: In a session on AI adoption and evaluation, Reza Forghani, MD, PhD, called for increased use of integrated platforms to allow for easier algorithm deployment, validation, and monitoring.
  5. Rising reliance on international medical graduates (IMGs): Mina Hesami, MD, presented on the rising contribution of IMGs to US radiology, noting a steady increase in the proportion of residency slots, fellowships, and leadership roles held by international graduates – with radiology seeing faster growth than most other medical specialties.
  6. Expanding the radiology workforce with mid-level providers: Another proposed strategy is offloading specific tasks to mid-level providers. While still controversial in radiology, this model is gaining traction in response to workforce shortages.
  7. Sustainability by reducing emissions and environmental impact: Several ASNR sessions addressed environmental sustainability. From simply turning off idle scanners to using AI to reduce contrast doses, radiologists are beginning to reckon with the environmental impact of rising scan volumes.

The Takeaway

The sessions at ASNR 2025 indicate that while there’s a lot of buzz around AI, radiologists are considering every tool at their disposal to keep up with rising imaging volumes. AI will play a role, but likely won’t be sufficient alone to keep up with increasing volumes.

T. Campbell Arnold is a research scientist at Subtle Medical and the managing editor of RadAccess.

Real-World Stroke AI Implementation

Time is brain. That simple saying encapsulates the urgency in diagnosing and treating stroke, when just a few hours can mean a huge difference in a patient’s recovery. A new study in Clinical Radiology shows the potential for Nicolab’s StrokeViewer AI software to improve stroke diagnosis, but also underscores the challenges of real-world AI implementation.

Early stroke research recommended that patients receive treatment – such as with mechanical thrombectomy – within 6-8 hours of stroke onset. 

  • CT is a favored modality to diagnose patients, and the time element is so crucial that some health networks have implemented mobile stroke units with ambulances outfitted with on-board CT scanners. 

AI is another technology that can help speed time to diagnosis. 

  • AI analysis of CT angiography scans can help identify cases of acute ischemic stroke missed by radiologists, in particular cases of large vessel occlusion, for which one study found a 20% miss rate. 

The U.K.’s National Health Service has been looking closely at AI to provide 24/7 LVO detection and improve accuracy in an era of workforce shortages.

  • StrokeView is a cloud-based AI solution that analyzes non-contrast CT, CT angiography, and CT perfusion scans and notifies clinicians when a suspected LVO is detected. Reports can be viewed via PACS or with a smartphone.  

In the study, NHS researchers shared their experiences with StrokeView, which included difficulties with its initial implementation but ultimately improved performance after tweaks to the software.  

  • For example, researchers encountered what they called “technical failures” in the first phase of implementation, mostly related to issues like different protocol names radiographers used for CTA scans that weren’t recognized by the software. 

Nicolab was notified of the issue, and the company performed training sessions with radiographers. A second implementation took place, and researchers found that across 125 suspected stroke cases  … 

  • Sensitivity was 93% in both phases of the study.
  • Specificity rose from the first to second implementation (91% to 94%).
  • The technical failure rate dropped (25% to 17%).
  • Only two cases of technical failure occurred in the last month of the study.

The Takeaway

The new study is a warts-and-all description of a real-world AI implementation. It shows the potential of AI to improve clinical care for a debilitating condition, but also that success may require additional work on the part of both clinicians and AI developers.

PET’s Milestone Moment

In a milestone moment for PET, CMS has ended its policy of only paying for PET scans of dementia patients if they are enrolled in a clinical trial. The move paves the way for broader use of PET for conditions like Alzheimer’s disease as new diagnostic and therapeutic agents become available. 

CMS said it was rescinding its coverage with evidence development (CED) requirement for PET payments within Medicare and Medicaid. 

  • Advocates for PET have chafed at the policy since it was established in 2013, claiming that it restricted use of PET to detect buildup of amyloid and tau in the brain – widely considered to be precursors to Alzheimer’s disease. The policy limits PET payments to one scan per lifetime for patients enrolled in clinical trials. 

But the landscape began changing with the arrival of new Alzheimer’s treatments like Leqembi, approved in January 2023. CMS telegraphed its changing position in July, when it announced a review of the CED policy, and followed through with the change on October 13. The new policy…

  • Eliminates the requirement that patients be enrolled in clinical trials
  • Ends the limit of one PET scan per Alzheimer’s patient per lifetime
  • Allows Medicare Administrative Contractors (MACs) to make coverage decisions on Alzheimer’s PET
  • Rejects requests to have the policy applied retroactively, such as to when Leqembi was approved

CMS specifically cited the introduction of new anti-amyloid treatments as one of the reasons behind its change in policy. 

  • The lifetime limit is “outdated” and “not clinically appropriate” given the need for PET for both patient selection and to potentially discontinue treatment if it’s ineffective or if it’s worked to clear amyloid from the brain – a key need for such expensive therapies. 

The news was quickly applauded by groups like SNMMI and MITA, which have long advocated for looser reimbursement rules.

The Takeaway

The CMS decision is great news for the PET community as well as for patients facing a diagnosis of Alzheimer’s disease. The question remains as to what sort of reimbursement rates providers will see from the various MACs around the US, and whether commercial payers will follow suit.

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