by
Gus Iversen, Editor in Chief | April 07, 2025
Nearly 44% of office-based medical imaging exams are interpreted by the same non-radiologist providers who ordered them, according to a new study from the Harvey L. Neiman Health Policy Institute.
The findings raise questions about diagnostic accuracy and potential financial incentives linked to self-referral practices.
The analysis, published in the
American Journal of Roentgenology, examined over 1.6 million 2022 Medicare fee-for-service claims for imaging ordered in outpatient settings by non-radiologists. Researchers found that 43.6% of these studies were interpreted by the ordering provider, and 58.5% were read within the ordering provider’s practice.
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Interpretation rates varied by modality. Self-reads were most common for ultrasound (52.0%) and radiography or fluoroscopy (50.4%). In contrast, only 5.3% of CT scans and 6.1% of MRIs were interpreted by non-radiologist ordering providers.
Specialty also played a significant role. Self-interpretation occurred in 75.7% of imaging ordered by orthopedic or sports medicine physicians, 30.5% by non-physician practitioners, and 19.9% by primary care providers.
Practice size was another factor. Small practices (1–9 providers) had nearly double the self-interpretation rate compared to the largest practices (48.9% vs. 24.2%).
“Whether or not there was a radiologist in the ordering provider’s practice was highly correlated with self-interpretation of imaging by the ordering provider,” said Eric Christensen, Ph.D., research director at the Neiman Health Policy Institute. Practices with an in-house radiologist were about half as likely to self-interpret and two to three times more likely to refer imaging internally.
Dr. Vijay Rao, senior vice president of enterprise radiology at Jefferson Health, noted the potential implications for patient care. “Non-radiologist specialties, aside from cardiology, lack the rigorous and comprehensive training in imaging interpretation that occurs during the 4 years of a radiology residency program,” she said.
Rao added that the results point to a policy gap in the federal Stark Law. While originally designed to reduce self-referral, the law’s in-office ancillary services exception has limited its impact on curbing self-interpreted imaging.
