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Radiology is in crisis; so what should we do about it?

It’s no secret that there is an enormous shortfall in the radiologist workforce, but the consequences of this are much more far-reaching than most people realise. Radiology sits at the heart of almost every clinical pathway and impacts practically every area of medicine, which means that any delays in radiology ripple out across the whole healthcare system.

The demand for diagnostic services has soared in recent years, driven by our ageing population and a growing focus on early diagnosis for long-term conditions and more population health screening. The push for more screening combined with huge pressure to cut down COVID-19-related backlogs means that the demand for imaging services is only going to grow.

The real-world consequences of the radiology crisis for patients are sometimes catastrophic. Days, hours, and minutes matter hugely when it comes to diagnosis, and delays to diagnosis slow down treatment and lead to poorer outcomes. To put that into perspective, for cancer patients, the consequence of every month of delayed treatment is a 10% increased risk of death.1 The number of patients waiting longer than six weeks for a scan has grown by 20% since 2019, and 90% of clinical directors say they are concerned that workforce shortages will patient safety.2

We are now in a situation where we have had a rapid increase in the number and complexity of scans but not enough radiologists to report them. Organisations like the Royal College of Radiologists (RCR) have been calling for greater investment to grow the radiologist workforce for years, but these calls have mostly fallen on deaf ears. The radiologist workforce grew by just 3% in 2022, whilst the RCR estimates that there is currently a 29% shortfall of clinical radiologists in the UK.3

Attempts to increase the consultant radiologist workforce are underway, but improvements are simply not keeping up with demand. Last year there were 44 million imaging tests reported in England alone – an increase of 26% on the previous year. This huge pressure on radiology services not only means that patients are waiting longer for their scan results, but also that there is an increased risk of reporting errors. Only 24% of clinical directors currently think that their radiology department has enough clinical radiologists to provide safe and effective patient care.4

So, with efforts to grow the radiologist workforce stalling, what can we do to alleviate some of this pressure and make sure that patients do not suffer?

We all know that when resources are constrained, it is vital that they are used as efficiently as possible. Getting the right scan, to the right radiologist, at the right time can speed the reporting process and boost overall reporting capacity, but if you look at most radiology departments in the UK they are relying on old, outdated systems that make this impossible.

Radiology services are logistically complicated to deliver. Despite being perceived as a ‘high tech’ specialty, radiology lacks the technical tools to streamline its logistics. This manifests as suboptimal rostering of staff, the inability to predict ebbs and flows in capacity and demand (and plan accordingly) as well as the inefficient allocation of scans. This can lead to a high administrative burden across a radiology department with clinical time being spent on administrative tasks. If we want to relieve the pressure on the UK’s radiology services, cutting down this admin burden and freeing up radiologists to report on scans has to be a priority.

Technology certainly has a role to play in boosting efficiency across radiology services, and there are easily accessible radiology logistic tools that can have a significant beneficial impact on the productivity of the existing workforce. However, the development and implementation of these technology tools must be driven by radiologists who understand the complexities of delivering imaging services and know the key areas to focus on. Similarly, we have a fantastic opportunity to demonstrate the value of new AI technologies, but the effective deployment of this technology requires application and monitoring by skilled clinical staff.

The UK’s radiology services have been in a state of crisis for years, and it is tempting to wonder whether anything will ever change. But, it’s vital to remember that there are interventions we can make right now to improve efficiency and boost capacity, and these will have a real-world impact on patients waiting for their scan results. And, with more than 7.4 million people now on the NHS waiting list, there has never been a more important time to focus on improving our radiology services.

1 BMJ 2020;371:m4087 doi:
2 RCR Clinical Radiology Workforce Census 2022
3 RCR Clinical Radiology Workforce Census 2022
4 NHS England Diagnostic Imaging Dataset Annual Statistical Release 2021/22

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