By Matt Skoufalos
If the landscape for diagnostic imaging demand in the United States were depicted as a topographical map, it might resemble nothing less than a steep, sharp peak, climbing skyward into a cloud bank.
A February 2025 study published in the Journal of the American College of Radiology (JACR) by Eric W. Christensen, et al., which sampled 348 million medical records, projected utilization rates for medical imaging in the United States to increase as much as 45 percent over current levels by 2030, if recent trends hold. Although population aging accounts for as much as 12 to 27 percent of that figure, population growth accounts for three-quarters to 88 percent of it.
To that end, the industry is left to determine how to manage these demands, which are on the increase, even as the workforce to manage them is on the decline.
Murat Gungor, senior vice-president and head of diagnostic imaging North America at Siemens Healthineers of Malvern, Pennsylvania, observes three primary, overarching trends shaping medical imaging demand at present and into the near future. Foremost among these is a growing demand for imaging driven by increasingly medically complex patients burdened by chronic diseases.
In September 2024, an American Hospital Association (AHA) analysis of clinical data from more than 1,300 hospitals showed that inpatient discharges at the end of 2024 are still up 1.6 percent over fourth-quarter baseline data from the end of 2019, while patient acuity is up 3 percent over data from that same period four-and-a-half years ago. Nonetheless, the same study showed that risk of mortality in the first quarter of 2024 was down nearly a quarter from 2019 levels.
This data, AHA reported, showed that “while caring for sicker patients, hospitals’ efforts to improve safety led to 200,000 Americans hospitalized between April 2023 and March 2024 surviving episodes of care they wouldn’t have in 2019.”
In part, that survivability itself points to the greater demands placed upon imaging services, as the same study showed that expanded access to screenings for breast, cervical, and colon cancer has qualified more people for earlier testing, thereby allowing for earlier life-saving interventions into their care needs.
“Increasing efforts to promote and facilitate screenings has further boosted participation rates, emphasizing the importance of early detection and its role in improving cancer care and outcomes,” the study reported.
Parallel to that experience is another dominant trend in the medical imaging space, Gungor said: the advancement of personalized medicine, particularly in the fields of oncology and neurology, where surgeries, therapies, and radiopharmaceuticals are all guided by diagnostic and interventional imaging studies.
“That’s a massive trend we’re following,” he said. “Innovations in that field impact the landscape of the imaging space.”
A study on the diagnostic imaging of brain tumors published in the January 2024 issue of Advances in Neuro-Oncological Imaging enumerated the various applications of MRI technologies to specific strategies, including perfusion, spectroscopy, elastography, intra-operative ultrasound, and fingerprinting techniques.
Alongside those, researchers pointed out advancements in PET/MRI, PET tracers, and radiomics as “delineat[ing] the pivotal role of imaging within the field of neurology,” significantly in “the diagnosis, prognostication, and evaluation of treatment responses for central nervous system (CNS) tumors.”
“These advancements have not only improved the accuracy of tumor diagnosis but have also addressed challenging clinical scenarios, including the evaluation of treatment-related changes, responses to novel therapies like immunotherapy, and the early detection of disease progression,” study authors Paniz Sabeghi, et al, wrote.
“The knowledge of both the capabilities and limitations of these emerging imaging technologies is essential for providing a higher level of personalized care to patients with neuro-oncological conditions.”
Successes like these, or like the recent disease-modifying drug therapies for Alzheimer’s disease and theranostics treatments for patients with prostate cancer, thyroid cancer, and neuroendocrine tumors, push OEMs like Siemens Healthineers “to innovate continuously for better treatments,” Gungor said, “because providers are pushing us to think differently.”
“Drug therapies are making us be partners in the field and provide the blended treatments to the customers that drive this business,” he said. “We’re trying to align our portfolio with this in the back of our mind.”
To that end, he highlighted investments in photon-counting CT technologies, which support “the ambitions of personalized treatment and how we can make an impact,” whether through dose reduction, better image capture, or limiting unnecessary interventions. Eventually, Gungor said, elements of these technologies, no matter how novel, should make their way throughout the roster of diagnostic imaging technologies.
“The goals of improving the diagnosis and the treatment of patients are driving all our investments,” Gungor said. “Ultimately, all this technology will trickle down the portfolio.”
How it gets there, however, is itself another state-of-the-union issue; namely, that of access, which can involve various barriers to clear, be they issues of technology portability, innate dependency, or facility construction. MR “is not a very installation-friendly modality,” Gungor said, so manufacturers can focus on ways to make it easier to situate in a facility.
“How can you make it easier to install, available in every location, more affordable, more compact?” he said. “Maybe even eliminate certain dependencies – like helium-based magnet-cooling technologies – to simplify the installation all over the place.
“Being able to make scanners more autonomous, more user-friendly, will all help our customers,” Gungor said. “You have to be able to install the box and train customers how to use it.”
So, too, will advances in elements of the patient experience that improve health outcomes by addressing environmental concerns like atmospherics and comfort, whether in a pediatric setting, in which the scanning experience is improved by creating better audio-visual experiences, or wider-bore scanners that accommodate adult patients who might be obese or claustrophobic.
“All these things are changing the dynamics, improving access to the technology, and increasing the number of patients who can benefit from the technology,” Gungor said. “Better image capture leads to better diagnosis and treatment.”
In general, technological improvements lead to gains in operational efficiency, and eventually, greater productivity. In an environment of increasing demand, hardware innovations can take many forms, from mobile scanners to high-end patient tables that support bedside imaging, or modular upgrades that allow base model systems to be tailored to specific institutional needs.
Advancements like these add up wherever they are found in an overall health system, and reflect how manufacturers are forever pushing themselves to improve upon existing processes, Gungor said.
“We are re-inventing ourselves as an organization,” he said. “How we can adapt our identity to help our customers and make a bigger impact in the marketplace? We have to be there continuously because the needs are changing, and we have to understand our customers and speak their language.”
Another fundamental challenge for the medical imaging space remains its ongoing workforce shortage, a confluence of several compounding factors, including the effects of the post-novel coronavirus (COVID-19) pandemic “Great Recession” and a failure to cultivate a pipeline of radiologists, technologists, and other related professionals to replenish the depleted workforce.
Parag Paranjpe is the founder and CEO of HealthLevel, a software company in Mountain View, California that produces the radiology business platform, Foundations. It’s designed to drive operational efficiencies throughout the imaging life cycle by alleviating a confluence of issues that are showing up in the imaging space, from workforce shortfalls to reimbursement challenges to revenue recapture.
“Investment and cost pressures are always going to be there,” Paranjpe said. “We are seeing more and more customers saying, ‘Is there technology we can adopt that improves efficiency but also improves the revenue? Can we find effective technology solutions, get up and running quickly?’”
“That’s where we’ve been able to help our customers,” he said. “That helps the cost basis, helps them on their margins. They’re also finding ways to improve the revenue to get all the money they’re worth.”
At the same time as improving workflow and throughput efficiencies, Paranjpe sees opportunities for imaging entities that are willing to support patient services while they’re shoring up operational challenges on the back end of the business. He observes challenges in the unevenness of some patient experience issues; to wit, he said, they may be able to get an appointment quickly, but not the results of the scan.
As imaging utilization rates for Americans dwarf those in other countries – 245 CT scans per 1,000 people and 118 MR scans per 1,000 people, according to Ohad Oren of the Mayo Clinic, Electron Kebebew of the Stanford University School of Medicine, and John P.A. Ioannidis of Stanford University in the Journal of the American Medical Association – the question of value derived from all that diagnostic imaging becomes more salient.
“We are doing more imaging than the rest of the world,” Paranjpe said. “Do we need to do so much imaging? If we’re more efficient, we may need to do less.”
Moreover, if the systems that gather imaging data don’t work in concert with those which host and manage it, HealthLevel foresees a business opportunity solving interoperability challenges – or at least removing barriers to them – in order to generate insights that improve functionality and, hopefully, recapture revenues.
“The entire world [of consumer devices] operates on plug-and-play solutions; for family healthcare, it is maddening to have these interoperability issues,” Paranjpe said. “It’s doing the customers a disservice. The clinical application may be very good, but if it is not talking to anyone else, it is not as good. We can reduce healthcare costs significantly through technology efficiency.”
One of the biggest hurdles HealthLevel works to clear is the siloing of information. Paranjpe said that he frequently sees organizations limit their partners’ access to data, primarily because of perceived concerns related to security or loss of patients. He points to proven technology standards that provide a secure approach to data management that can drive operational efficiency and derive better health outcomes. Paranjpe traces much of it back to interoperability issues across best-of-breed systems, and across the industry itself.
“What we should be thinking about is, if I want to grow my business, I want to be at an interoperability standard to make it easier for my customers to make a better hospital, a better imaging center, to increase the margins for everyone in radiology,” Paranjpe said. “If you give them information at once place, that helps them make decisions, it’s a massive time-saver, and it increases their actual revenue.”
Jason Theadore, vice president and chief operating officer, radiology, at AdventHealth Medical Group Central Florida, said that he observes one of the most significant challenges in imaging as being related to its inadequate labor force. As practitioner burnout from short staffing gives way to turf wars between non-radiologists and non-physicians, specialists are expanding their scopes of practice, and advance practice providers (APPs) try to help absorb the increasing workload – not always successfully.
“The need for APPs in our space has drastically increased as we don’t have enough radiologists to handle the current workload,” Theadore said. “In various organizations, we have non-radiologists providing exam interpretations: NPs, radiological assistants, physician assistants. They’ve begun to provide interpretation, and I’m not sure if that’s a good thing or a bad thing yet.”
According to the Christensen study from JACR, researchers observed office-based diagnostic imaging interpretations by non-physician practitioners (NPPs) in Medicare environments up 9 percent annually from 2013 to 2022, across all modalities.
“In various organizations, we have non-radiologists providing exam interpretations: NPs, radiological assistants, physician assistants,” Theadore said. “I think it actually decreases the value of the radiologist at the local and national level.”
“As an industry, we need to raise the awareness of the radiologist’s value and why it’s important for them to provide the interpretation at those kind of facilities,” he said. “In radiology, there’s actionable findings. If a radiologist finds something that needs action, and that may not have been in the normal course of the patient’s care, we do not yet have strong systems to make sure that patient is properly flagged and followed up on.”
As patient volumes move from inpatient to outpatient environments, physician-owned imaging practices still command high levels of investment, but differences in ownership and owner priorities may be exacerbating that scope-of-practice concern.
Even as advancements in technology can help radiologists provide care and push back against burnout or exhaustion, Theadore is most concerned with how institutions like his are managing the changes implicit in offloading these challenges to automated software solutions.
“I think of going from paper charts to EMR; we went through PACS. Now we’re going from no AI (artificial intelligence) to lots of AI,” Theadore said. “We need to have a lot of strong change-management processes for that, both institutionally and as individual entities.”
The bottom line, he said, is that “it’s just going to be so important for us all to make sure that we have the agility and adaptability and accountability to adjust as it evolves.
“If we miss this, things can get off-track,” Theadore said. “But if we’re agile, we can have the best interests of all involved.”
