The New Rules of Radiology

By Dr Farzana Rahman, Dr Amy Davis, and Jaymin Patel, Co-founders of Hexarad

Radiology is still governed by rules written for a system that no longer exists. Rules written for a time when demand was predictable and workflows were linear. When imaging volumes were manageable and diagnosis, however delayed, could afford to wait. Those conditions are gone, yet the rules, largely, remain. 

This is not a criticism of the people working within radiology. The radiologists, radiographers, service managers and clinical leads working across the NHS are exceptional. The expertise has never been the problem.  

The problem is the architecture around it; the systems, structures, and assumptions designed for a bygone era. The legacy system has not kept up with the demands of modern healthcare, meaning that every system is being asked to do more with less; with finite resources, dwindling workforces and increasing waiting lists.  

We founded Hexarad because we saw this from the inside. As radiologists who trained and worked in the NHS, we experienced first-hand what it looks like when a system built for yesterday tries to meet the demands of today. The bottlenecks, the backlogs, the cases that don't reach the right expert in time - not because that expert doesn't exist, but because the system wasn't designed to connect them swiftly and seamlessly.  

We didn't just build Hexarad to process more scans. We built it to rewrite the modern rules of radiology, creating a smarter, more connected and coordinated system that can unlock diagnosis faster for healthcare systems and patients alike. 

Because behind every delayed report is a patient waiting for an answer that could change everything. 

When complexity increases, humans build systems that move. 

Every era of significant pressure has produced a response not of more effort, but of better design. 

When darkness fell, we switched on the lights. When the skies became crowded, we built air traffic control. When roads became dangerously congested, we invented traffic signals. In each case, the solution wasn't to demand more from the people already in those systems. It was to build smarter infrastructure around them that could absorb complexity, anticipate pressure, and keep things moving forwards efficiently. 

Healthcare is no different, and radiology - as the diagnostic engine at the heart of almost every clinical pathway - urgently needs this kind of radical rethinking. 

The NHS faces a 31% shortfall in consultant radiologists, projected to reach 40% by 2028, even as imaging demand continues to grow ¹. The instinct is to treat this as a workforce problem, but adding people to a system not designed to use them optimally will not close this widening gap. What closes the gap is orchestration, intelligence and a unified layer that can help to align people, technology, and timing so every case reaches the right expert without delay. 

Diagnosis isn't delayed by lack of skill. It just needs to be unlocked from an outdated system. 

The rules radiology needs now. 

Rewriting the rules does not mean abandoning rigour; it means restoring it. It means building a system where excellence is the baseline, not the ambition. It means aspiring to a system where quality is visible, measured, reviewed, and continuously improved rather than assumed and occasionally audited. 

It means accepting that speed is achieved through quality, not by cutting corners. It’s understanding that the fastest route to a diagnosis is the right radiologist reading the right scan, not the nearest available one. A CT for rectal cancer follow-up routed to a GI radiologist. A lung cancer follow-up scan routed directly to a chest specialist. Subspecialist insight needs to be the standard - not the exception. 

This requires recognising that capacity does not necessarily equate to performance, and that performance is defined only by the outcome. A department can report a high volume of scans and still leave patients waiting too long for their results; still miss the pressure building in the system; still react to crises rather than preventing them.  

Operational clarity is a clinical advantage that enables departments to see demand, capacity and performance in real time so that they can anticipate where the system is about to break rather than discover it after the fact. This clarity leads to faster, better and more informed decisions that can benefit patients and their treatment directly. 

It means understanding that expertise should never be limited by location. The right radiologist for a given scan should not be determined by geography, surges in demand or shift patterns. Technology exists to close that gap, and it should be used, not to replace clinical judgement, but to put that judgement exactly where it is needed, exactly when it is needed. 

And tackling this head-on involves being honest about something the system has too long avoided: delays are not inevitable, they are solvable. "Good enough" has never been good enough when it comes to diagnosis. Patients should not wait in uncertainty when the tools to minimise that uncertainty are readily available. 

This is what we built. 

Hexarad operates as a unified diagnostic layer that combines subspecialist teleradiology through ReportRad with operational intelligence through OptiRad. Every scan is routed by clinical expertise. Urgent cases are peer-reviewed within two hours and quality tracked in real time to give departments visibility to act early - and before it’s too late. 

We alleviate capacity pressure before it becomes a crisis. We re-engineer workflows so radiologists can do what they are trained to do. And we do it at a scale that moves the whole system, not just one department. 

The results are measurable: fourteen hours of A&E time saved every night at North West Anglia; a 12% increase in reporting output and £150k saved annually at Mid and South Essex; a 75% reduction in admin burden at University Hospitals Dorset. But behind every number is something that cannot be measured in data alone: a concerned patient who got their answer when it mattered; a family who were lying awake, waiting with worry, finally able to get some sleep.  

The new rules. 

Radiology, at its best, is the moment uncertainty ends and action begins. It is the turning point in a patient's journey. The point at which decisions can be made, treatment can begin, and care can progress. Every subsequent treatment pathway depends on it. 

But that moment arrives only when the system is designed to deliver it. When the right expert is available, when the workflow connects rather than fragments and when quality is not assumed but demonstrated. With Hexarad, we support in helping to make the whole pathway visible - not just the next scan. 

These are the rules radiology needs now. Not the ones we inherited, but the ones we choose.  

Diagnosis comes first. Everything else follows. 

Excellence isn't a target. It's the baseline. 

When diagnosis is unlocked, care begins. 

Rewrite the rules. Unlock diagnosis. See more. Do more. Imagine better. 

This is Hexarad. 

References 

1. Clinical Radiology Workforce Census 2023, State of the Wait, The Royal College of Radiologists