Rising Imaging Volume in Radiology: Current Perspectives on Understanding and Addressing the Issue

Studies and surveys continue to reflect the challenges of dealing with spiraling imaging volume and the toll it is taking upon radiologists.

Recently published research in the Journal of the American College of Radiology (JACR) demonstrated a 110 percent increase in turnaround times for radiology reports over a 10-year period with 87 percent of that increase occurring in 2022 and 2023, the last two years of the study.¹

While physician burnout rates are reportedly decreasing according to a recent American Medical Association (AMA) report, the same research indicated that radiologists are the fifth highest specialty affected by burnout with over 45 percent of surveyed radiologists noting burnout.²

Andrew Del Gaizo, MD, Nicholas Galante, MD and David Larson, MD, MBA, recently shared their perspectives with Diagnostic Imaging on this research, the gravity of these challenges and potential paths forward to address these issues.

Q: What is your take on the aforementioned JACR study and the increased turnaround times for radiology reports?

David Larson, MD, MBA:This is an excellent study. The article systematically establishes what everyone in radiology is feeling acutely (in) that volumes of studies are increasing faster than our capacity to read them, resulting in increased turnaround times in the past few years. Unfortunately, this walks back a significant accomplishment by the field in the past decade: consistently fast report turnaround times.

In the short term, I think most referring clinicians see the herculean efforts of their radiologist colleagues (as well as the lack of an alternative) and are generally sympathetic. But in the long run, if practices can’t keep up with the volumes, they risk losing relevance, not to mention burning out their people.

It’s important to remember that being chronically behind on interpretations is not only a problem for patient care, it’s also a problem for radiologist well-being. It’s incredibly demoralizing to walk into an interminable stack of studies that are several days (or even weeks) old, knowing that no matter how hard you work, you’re going to walk out the door at the end of the day with a list that’s just as long. It’s crushing. Behind the (study) authors’ graphs of increasing turnaround times is an emotional toll that is real and non-trivial.

Nicholas Galante, MD: I think it's the reality that I see every day and that I've been living for the past year, 11 years in private practice. It's really deep and structural (with) this trend of supply demand mismatch. We don't have enough radiologists, and image utilization is only going up and to the right. By structural trends, I mean this is multifactorial. This is everything from health care policy to payment to just demographics with the baby boomer cohort. (These are) deep structural trends that are not going to abate anytime soon. I hear (those numbers) and it completely tracks with the day-to-day reality of private practice, academic, any practice that you're in. It's unfortunate and I wish that it wasn't the case, but it makes sense.

Andrew Del Gaizo, MD: We've seen a bit of a perfect storm, right, where volumes have gone up, case complexity has gone up, (and) the number of images in each study have gone up. Simultaneously, the number of radiologists has stayed flat or even gone down between attrition and the number of new slots for trainees has been relatively flat.

In that environment … we've seen this unequivocally. Anyone who's practicing radiology has seen that the amount of work, the amount of that each radiologist, each practice, is taking on has exceeded that threshold. Something has to give. You don't want to cut corners. You don't want to give up any quality, right? There's real patients behind every image. So the unfortunate impact there is that turnaround time is is going to suffer.

One of the unique things about being in my role is that I do get to meet with radiologists from all over the country and they're feeling this. They are feeling this impact on the volume and the impact on turnaround time, and they're not satisfied with that either. This is where we can leverage some of the technological advances. If we can lead to some efficiency gains, whether that's through AI or other operational activities, but really leveraging those opportunities to meet the demands without having to compromise on quality, that's the key.

Q: What are some strategies or solutions for addressing rising workload volume and perhaps addressing efficiencies with turnaround times?

Dr. Larson: Unfortunately, there is no silver bullet. It’s not as if we weren’t already operating efficiently before this recent surge in volumes. That’s the challenge: there’s not a lot of readily identifiable slack in the system that can be easily addressed.

The initial approach has been to expect radiologists to just work harder. That can help up to a point, if they are compensated accordingly (e.g. internal moonlighting), but we’ve hit the limits of that approach as burnout becomes a real issue.

Beyond adding capacity (in the form of more person-hours), I would say the solutions comes down to four general approaches: 1) productivity-enhancing technology, 2) minimizing wasted radiologist time and effort, 3) intelligent assignment of cases, and 4) effective teamwork. The right combination looks different in every practice so it requires group members to work constructively to solve the problem together.

Dr. Galante: I'm fond of saying the only way out is through. … Training more radiologists is not a big part of that solution. It takes too long. It's constrained by just the number of educational spots that are open. You don't just spin up new med schools like an online course and new residency programs.

So you're going to have to leverage AI. For a long time — and this goes back to the comments about AI replacing radiologists — it was thought that AI was going to be the full stack, and it was going to be like Skynet, and just read the report or read the images, generate the report, and completely replace the radiologist.

But what we're seeing, and everyone has now realized this, it's the non-interpretive space (where AI is) much more immediately impactful and deployable. That gets (to) the reporting, and you'd be surprised. I think most radiologists are still dictating the way they've always dictated. If you move to a platform that's slightly faster, slightly more stable, slightly more accurate, you can't expect to have massive efficiency gains. You need something completely different. You need to reimagine the way you're dictating. You would be surprised how much friction is in your day-to-day work that you're unaware of until it actually goes away.

Then to Andrew's point, (there is) the eye movement between multiple screens, clicking, dragging, typing, using your voice to navigate, say, between fields, or using a button on a dictaphone to navigate between fields. It's easy to explain this to a radiologist in terms of, say, image load speed. You know if it takes one or two seconds for X-rays to load, and you're reading hundreds of X-rays a day. It's very easy to conceptualize that that's going to be a massive time penalty, but we ignore the same time penalty involved in all those micro-steps or micro- aggressions, with regard to the clicks and the drags and the head movement.

I think that massive efficiency gains are going to come from that. I've already experienced that by dabbling with next-generation reporting, and it does take some getting used to. It is change management. Muscle memory is definitely there, but once you embrace it, it's part of the solution and a significant part.

Dr. Del Gaizo: I do think there's a lot of opportunity with AI. There's a lot of potential with AI. What I've seen in some health systems is that they've somewhat taken a disorganized approach to how they've adopted AI, you know, purchasing a range of solutions that maybe they hope will come together and in reality, maybe even leading to more chaos or less integration.

If AI is leading to more clicks, if it's leading to more time for the radiologist to take their eyes off of an image, that's not going to help us out of this issue that we're facing. We can't have more fragmentation. We really have to figure out a way for these tools to work together. That’s where I see a lot of value in AI. It's in orchestrating that workflow. It's in reducing the cognitive load, making the system work more efficiently, whether that's taking a measurement on a PACS and having that measurement automatically show up in my radiology report, or being able to perform calculations within my report. If I need to calculate an adrenal washout, I don't have to type that up. I don't have to go to a calculator. That's all within my reporting solution.

Anything that keeps me from having to hop from one system to another, anything that keeps the systems working together — more connected, more integrated — that's just where we need to go. I think we're at that threshold where there's not an alternative. If we want to continue to provide adequate patient care, we need better workflow orchestration.

Dr. Del Gaizo is an abdominal radiologist and chief medical information officer for Rad AI.

Dr. Galante is the medical director for informatics at Radiology Associates of North Texas.

Dr. Larson is the executive vice chair of the Department of Radiology at the Stanford University School of Medicine and medical director of performance improvement at Stanford Health Care.

References

1. Christensen EW, Drake AR, Rula EY, et al. National turnaround time trends for Medicare fee-for-service beneficiaries, 2014-2023. J Am Coll Radiol. 2026 Mar 31:S1546-1440(26):00148-1. doi: 10.1016/j.jacr.2026.02.038. Online ahead of print.
2. Berg S. These 9 physician specialties report highest burnout rates. American Medical Association. Available at: https://www.ama-assn.org/practice-management/physician-health/these-9-physician-specialties-report-highest-burnout-rates . Published April 16, 2026. Accessed April 24, 2026.