Radiologists’ inpatient workload increases significantly despite dip in disease severity

Radiologists’ inpatient workload has increased significantly over the last decade despite a drop in disease severity, according to a new single-center study published Thursday. 

The uptick is largely attributable to “substantial” growth in CT and MRI, replacing lower-cost modalities such as X-ray and ultrasound, experts wrote in JACR. Massachusetts General Hospital radiologist Tina Shiang, MD, and co-authors believe the COVID-19 pandemic may have motivated these trends, shifting inpatient care toward advanced modalities. 

Whatever the reason, their findings warrant further exploration, as imaging leaders seek to curb rising costs and relieve overworked staff members. 

“Increasing inpatient imaging utilization and radiology workload pose significant challenges for healthcare systems, including constrained inpatient CT and MRI capacity, which coupled with radiologist shortage[s] and burnout, may contribute to longer inpatient stays,” Shiang and colleagues advised. “These trends have implications for quality of care and clinical operations and may be a driver of increased healthcare costs.”

Researchers conducted the study at an 866-bed academic medical center in the Northeast. They gathered data on adults hospitalized between 2012 and 2023, adjusting for disease severity. Women admitted for childbirth were excluded, since they typically undergo minimal imaging. 

The total number of annual imaging exams among inpatients increased from over 102,000 in 2012 to nearly 119,000 by the end of the study period. However, when adjusting for case mix—accounting for different patient characteristics across differing providers, so that the study compared apples to apples—total imaging exams decreased, due to drops in X-ray, ultrasound and nuclear medicine use. Meanwhile, radiologists’ workloads (professional, technical and global) increased “significantly.” This was mainly attributable to greater CT and MRI utilization, the authors reported.

During the study period, case-mix-adjusted computed tomography volumes leapt 19% while magnetic resonance imaging was up 21%. At the same time, professional RVUs (relative value units, used to measure radiologist productivity) climbed almost 81% for CT and 91% for MRI. Average hospital length of stay also increased 32% between 2012–2023, from about 5.6 days up to 7.4.  

Shiang and co-authors hypothesized on possible reasons behind their findings. Sicker and more medically complex inpatients often require longer recovery periods and continue to occupy hospital beds, limiting new admissions and imaging capacity. Also, imaging intensity is typically highest at the initial stages of diagnostic workup, decreasing during the rest of the hospital stay as a patient’s condition stabilizes. They also speculated that outmigration and volumes shifting from hospitals to outpatient settings, along with weaker financial incentives to image in inpatient settings, could have led to these adjusted volume decreases.

There also are several potential reasons why hospital care teams are moving to more costly advanced imaging modalities. These include shifting practice patterns amid the pandemic, faster acquisition times for CT, “defensive medicine” tactics, expanded indications for imaging, and the rise of advance practice providers who may order more exams than physician colleagues. Increased use of inpatient imaging “appears to be associated” with longer hospital stays, they added, though the study did not attempt to establish this connection. 

“These data have several implications for the future,” the authors concluded. “First, it would be helpful to better understand the increases in CT and MRI and whether all these examinations are needed and are delivering value, and if not, how to encourage providers to use them more effectively. Second, it is vital to understand CT and MRI capacity in the inpatient setting and whether delays in getting examinations are increasing [lengths of stay]. Third, artificial intelligence is likely to change radiology in many ways and how that interacts with all these factors must be explored.”

Read much more, including potential study limitations, in the Journal of the American College of Radiology.