Following the recent BIR live event Imaging explosion across the pond – causes and solutions in which the UK and USA radiology and healthcare systems were compared, DMC Radiology Reporting co-director Professor Simon Padley reflects on the UK position.

The USA often provides a window into our own future

In the application of imaging technology, we often follow trends that emerge in the US – the rise in CT and MRI utilisation are two examples, and more recently the growth of outsourcing is following a similar trajectory.

With different healthcare models, the US does not rely on central funding to replace or add to CT and MRI capacity. NHS funding comes from the government’s general revenue, and healthcare services are provided to all residents of the UK, regardless of their ability to pay. In contrast, the US medical system is a mixed system of public and private funding. It includes a combination of private health insurance, employer-based insurance, individual out-of-pocket payments, and public programs like Medicare and Medicaid, which are funded through federal and state taxes.

In 2022 there were 6.6 million CT studies on NHS funded patients according to NHS Digital, at a time when the population was reported to be 55 million. This equates to 121 studies per 1000 of the population. In the USA  this figure is more than double at 278 CT studies per 1000 of the population (84 million CT studies in a population of about 333 million CT Scans Each Year – iData Research).

And that is just CT! Official data for 2021/22 shows that between April 2021 and March 2022, NHS services in England carried out 43.8 million imaging tests across all modalities Ref. This reflects an ever-growing requirement for imaging studies to be undertaken and reported.

At the same time, the workforce needed for this activity has fallen far behind that required. We bump along the bottom of the league table for radiologists per 100,000 of the population (8.5). Europe has 13, the US 11. Couple this with complexities of pension taxation, IR35 and COVID related burnout all nudging older highly skilled and efficient radiologists towards the exit door and we have a perfect storm. Even today we have 2000 full-time consultant clinical radiologist posts unfilled across the UK. The RCR predicts a 39% workforce shortfall by 2026 (equating to 3166 full time radiologists).

This may create stress in the radiology department, but rest assured it also causes grey hair and sleepless nights for those that inhabit the carpeted management corridors. Hidden amongst every backlog of reporting there is serious pathology lying undiagnosed. When that report is provided, and the treatment options are discussed, some options will have closed, tumours will have stage shifted and outcomes will be less good. This constitutes a chief executive’s nightmare but has caught the medicolegal world’s attention. So, what are we to do?

Teleradiology and the NHS

Almost all acute trusts have turned to the services of the teleradiology community, now playing a vital role in helping to address this capacity shortfall. In the past 10 years the market has grown with a compound annual growth rate of about 10-15%.

Who are all these extra radiologists and where do they come from? Well of course, by-and-large, they are you and me. But we are a limited pool, the market rates for reporting (set by the NHS) are not great and there are only so many hours in the day.

So where can we look for additional workforce capacity and will we be allowed to access it? To allow this to happen the NHS will need to engage more readily with the solutions that are now emerging and examine the detail of how we, in the teleradiology world, are already addressing data governance and medicolegal concerns.

At DMC Radiology Reporting, we already work in partnership with many NHS Trusts. We strive to deliver fast, accurate radiology reporting with innovation and efficiency. We have a rigorous commitment to clinical governance, and we are proud of our work force of GMC-registered/FRCR-radiologists with sub-specialty interests.  Like many others, we are interested in how these problems are being addressed in the US.

About Professor Simon Padley

In 2013 Simon co-founded DMC-Radiology Reporting, which has been growing and developing ever since, focusing on sub-specialist high quality outsourced reporting.

Simon is a cardiothoracic and interventional radiologist, appointed in 1994. As a previous imaging director in the NHS for many years he developed a range of new services, most recently as lead radiologist for Royal Brompton Hospital Diagnostic Imaging Centre, opened in 2022. This facility incorporates one of the only combined interventional bronchoscopy and radiology facilities in the country.

As a Professor of Practice (Diagnostic and Interventional Radiology) since 2016, at the National Heart & Lung Institute, Imperial College London, he maintains an active academic career, publishing widely with over 220 articles in peer reviewed journals.