Misleading claims about imaging could have damaging ripple effect, radiology experts warn

Misleading claims about medical imaging could have a damaging ripple effect on diagnostic radiology, experts warn in a new editorial published Tuesday. 

Leaders with the Neiman Health Policy Institute made their case in a new editorial published by the Journal of the American College of Radiology. As an example, they cited an editorial from Harvard economist David M. Cutler, PhD, published by JAMA Health Forum in April. 

In it, Cutler claimed that imaging volumes are falling in America, blunting the need to train more radiologists. 

“The assertion, we think, is counter to recent collective experience of the radiology community and ignores a decade of evidence,” imaging experts wrote Oct. 13. 

April’s JAMA article relied heavily on a study examining imaging utilization between 2003 to 2016. The analysis documented a slowdown in growth during this period but failed to account for more recent utilization patterns or growing radiologist workloads. This period also coincided with a timeframe when Medicare coding changes impacted how imaging services were counted.  

Experts highlighted several recent studies from the policy institute that contradict Cutler’s claims. 

“In healthcare policy, influential observations can quickly become accepted wisdom, making it critically important to ensure they are grounded in the best available evidence,” lead author Elizabeth Rula, PhD, executive director of the ACR-backed policy institute, said in a statement Oct. 13. “The Neiman Institute and its collaborators have published much of the recent research on imaging utilization, workforce trends, reimbursement and patient access. Collectively, that evidence paints a very different picture from one of declining demand and adequate workforce capacity.”

In one example of the “growing strain on the imaging system,” researchers cited an August study from the institute. Based on Medicare claims data, imaging interpretation turnaround times have increased about 177% since 2014, rising from about 2 hours up to more than 6. Another study from February also showed that radiologist turnover has increased sharply, coinciding with a period of rising workloads. 

The editorialists compared Cutler’s claims to a previous prediction from Nobel Prize-winning scientist Geoffrey Hinton. He famously forecasted in 2016 that schools should stop training radiologists, because they will be replaced by AI within five years. The prediction never came to fruition, and Hinton later walked back his comments last year in an interview with the New York Times. However, “the damage was done,” with many medical students choosing other specialties, based on this “evidence free prediction.” 

Imaging experts want the public to tread carefully when making sweeping proclamations about the specialty, for fear of the blowback. 

“Broad-based pronouncements contrary to a growing body of literature are concerning,” the authors concluded. “We worry that the opinions of this economic luminary could misleadingly assuage very real concerns and the necessary efforts to ensure appropriate imaging utilization and manage workload. Downplaying the magnitude and urgency of these challenges could, like the prediction of an AI luminary a decade ago, have a ripple effect that compromises patient access to necessary and valuable imaging, particularly for those at the margins.”

Read the rest of the editorial in JACR. Others co-authoring the piece included Neiman Health Policy Institute Research Director Eric W. Christensen, PhD, and radiologists Vijay M. Rao, MD, Gregory N. Nicola, MD, and Richard Duszak Jr., MD.