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Sept. 1, 2026— A new study from the Harvey L. Neiman Health Policy Institute found that the odds of imaging following an office visit were 188% higher when ordering clinician self-interpreted the imaging they ordered versus referring interpretation to a radiologist. Practices that routinely referred imaging to a radiologist also demonstrated lower imaging use following office visits. The study, based on 24.2 million Medicare office visits, was published in the Journal of the American College of Radiology (JACR).
Comprehensive Study
The study examined imaging within 30 days of patient office visits using a 5% sample of Medicare fee-for-service beneficiaries from 2021-2023. The authors found that 13.6% of office visits had associated imaging and that ordering providers interpreted 33.2% of this imaging.
Practices that referred 100% of imaging to radiologists had between 5% (MR) to 41% (ultrasound) lower odds of imaging following an office visit compared with practices that don’t refer to radiologists. This effect was observed for all imaging modalities except CT. Stronger associations were observed for self-interpretation by the ordering clinician. Office visits with solely self-interpreting clinicians had 188% higher odds of imaging overall compared with clinicians who do not self-interpret. The effect was significant across every modality studied, ranging from 54% higher odds for MR to 251% higher odds for ultrasound.
“We found that ordering-clinician self-interpretation was a potent predictor of imaging utilization following an office visit,” explained Dr. Rao, the David C. Levin Professor and Chair Emeritus, Department of Radiology at Thomas Jefferson University, and study senior author. “The magnitude and consistency of the association across imaging modalities suggest that who interprets imaging may influence clinical decision-making in important ways. Like the related phenomenon of self-referral that has been associated with more imaging, the role of self-interpretation warrants greater attention in promoting appropriate, patient-centered care.”
“Our results point to the importance of radiologists as part of the care team to ensure that imaging is necessary, appropriate, and aligned with clinical need,” said Dr. Eric Christensen, PhD, research director at the Neiman Institute and study lead author. “Policy that establishes more stringent standards for non-radiologist interpretation may reduce inappropriate imaging that increases economic burdens and poses patient-safety risks. In fact, our analyses indicate that office-based imaging could potentially be reduced by 17% in the absence of self-interpretation.”
“Concerns about self-interpretation are not about returning interpretation to radiologists. The concern is ensuring that imaging is performed for clinically appropriate reasons and are interpreted by physicians with the training and expertise to provide high-quality care,” stated Dr. Rao. “Who interprets imaging is consequential for patient outcomes and healthcare spending.”
“The American College of Radiology is committed to reducing inappropriate imaging,” stated Dana Smetherman, MD, CEO of the American College of Radiology. “This study identifies self-interpretation as an important factor associated with higher imaging utilization and underscores the need for evidence-based tools that help ensure imaging is ordered for the right patient, at the right time, for the right clinical indication. This is among the reasons the American College of Radiology supports passage of the Patients First Act (H.R. 9693), legislation that includes a section requiring physicians ordering advanced imaging to consult appropriate use criteria prior to those studies being performed.”
August 26, 2026 
