Diagnostic Imaging Insights
Radiology strategy always has been a means, not an end. It’s a foundational capability that enables service line growth, physician alignment, patient access, and market differentiation. What’s changing is that health systems are increasingly treating it as a strategic enterprise capability rather than a departmental function.
Radiology contributes approximately 5-15% of overall health system EBITDA, which means health system leaders must evaluate their own unique environmental factors and competitive dynamics to create a business case for radiology that aligns clinical, operational, and financial objectives across the system. Those who don’t will find themselves misaligned with enterprise strategy, capital allocation decisions, and clinical growth priorities, potentially leading to more cost and lost imaging revenue and less downstream volume.
Environmental forces are accelerating the need for a fundamentally different imaging strategy. Increasing transparency around hospital outpatient department (HOPD) pricing, rising patient cost sensitivity, and growing commercial payer engagement are pushing imaging volume toward lower-cost freestanding sites with better access. At the same time, loosening certificate of need regulations and the expansion of competitors—including national outpatient imaging platforms—are reshaping market dynamics around convenience, affordability, and access. These pressures create a growing strategic tension for health systems.
Expanding outpatient radiology access risks cannibalizing higher-margin hospital-based volumes, yet failing to do so risks losing patients, referrals, and downstream service line growth to competitors. As radiologist and technologist workforce shortages intensify, health systems must balance short-term imaging margin protection against the long-term strategic value of strengthening priority service lines such as oncology, cardiology, neuroscience, and orthopedics. The question is no longer whether radiology strategy will evolve, but whether health systems will proactively realign imaging access themselves—or allow competitors to capture the market first.
Growth is uneven by specialty and shaped by demographic change, disease prevalence, innovation, and site-of-care migration. Systems are evaluating their communities to determine which specialties must be strengthened or defended as they decide where to invest for future growth.
As a result, health systems are no longer growing the hospital; they’re growing specialty oncology programs, heart and vascular institutes, neuroscience centers, and musculoskeletal care pathways. Strategic planning, capital deployment, and physician recruitment are increasingly organized around service lines rather than departments. Currently, radiology demand follows those decisions—when it should be leading them.
Radiology is foundational in nearly every high-growth specialty, including:
According to the Vizient 2026 Impact of Change forecast, these service lines are expected to have robust outpatient growth across over the next 10 years.
| Service line | 10-year forecast |
|---|---|
| Cancer | 16% |
| Cardiovascular | 38% |
| Neurosciences | 10% |
| Orthopedics | 13% |
When access, capability, or throughput for imaging exams lags, service line growth stalls, referrals leak, physician satisfaction declines, and downstream procedural capacity goes underutilized. Radiology doesn’t merely support these service lines, rather, it determines whether their strategies are executable.
Traditional radiology strategy focused on modality-first planning, such as aiming for more CT, MR, interventional, or ultrasound exams, which often can lead to:
This framing obscures the real strategic question: What clinical growth is the organization trying to enable?
Health systems should be strategizing a plan to enable oncology growth, for example, across outpatient sites with subspecialized protocols, faster access, and integrated interpretation. This includes aligning radiology capacity and technology to ensure that advanced oncology procedures, such as biopsies and therapy simulation scans, are completed, standards are consistently met, and results are streamlined—possibly even the same day for the patient.
Health systems can no longer treat radiology as a one-dimensional department. It is a key enabler of the highest-growth service lines and a direct determinant of enterprise competitive positioning.
Roughly 40–50% of U.S. radiology volume now occurs in outpatient or freestanding settings. This shift is driven by service line expansion into ambulatory clinics and ambulatory surgery centers (ASCs).
According the 2026 Impact of Change, outpatient standard imaging volume is projected to grow about 14% and advanced imaging to grow by nearly 17% over the next 10 years.1 Standard imaging has nearly four times the volume of advanced imaging and is further integrated across ambulatory sites, while advanced imaging’s capital-intensive and operational constraints continue migration even as facility requirements and workforce shortages occur.
Key areas such as orthopedics, cardiology, and oncology increasingly expect embedded or proximate radiology to support same-day diagnosis and care planning.
Systems that fail to align radiology deployment with outpatient service line growth often own advanced technology that is geographically or operationally mismatched to where growth is occurring, resulting in revenue loss.
Radiologist supply growth2 is projected to only roughly keep pace with rising imaging demand through 2055—leaving today’s shortage unresolved—while technologist vacancy rates remain elevated, with American Society of Radiologic Technologists reporting 2025 vacancy rates of 15.6% for radiography, 19.4% for CT, 17.4% for MRI, and 11.4% for mammography. At the same time, reimbursement and policy shifts, such as recent changes affecting cardiac CT economics, can rapidly increase demand for specific imaging capabilities tied to a health system’s priority service lines.
Together, these forces mean imaging capacity and expertise must be intentionally allocated to enterprise priorities. Strategy based on aggregate utilization alone misallocates scarce clinical and human resources.
For health systems pursuing oncology, cardiac, and orthopedic growth, imaging access ranks among the top enterprise constraints—alongside physician supply and operating room capacity. The consequences are measurable: delayed time-to-diagnosis, referral leakage to competitors, and underutilized downstream procedural capacity.
Technology is rarely the limiting factor. Visibility is. But a claims-based approach can help change the equation.
Health systems should conduct a full-spectrum claims analysis approach—combining leakage detection, full-journey analytics, and patient loyalty metrics—to protect high-value service lines. It reveals where patients exit the system, exposes gaps across the care continuum, and identifies at-risk patients before attrition occurs. The result is actionable intelligence that retains patients, protects margin, and creates cross-functional alignment across strategy, finance, network development, and clinical operations.
Step 1: Start with service line intent: Radiology strategy must begin with clarity on enterprise priorities:
Step 2: Map imaging to clinical pathways: Imaging should be mapped directly to diagnosis, treatment selection, intervention, and follow-up pathways for priority specialties. This reveals where imaging accelerates and constrains care.
Step 3: Translate strategy into technology: Only after service line needs are defined should technology decisions follow. Modalities, software, AI, and staffing become responses to strategy—not proxies for it.
Step 4: Optimize across sites of care: Service line growth increasingly occurs outside the inpatient hospital. Radiology strategy must account for outpatient centers, ASCs, mobile units, and hybrid models, ensuring the right capability exists at the right site for the right patient.
Step 5: Radiology requires collaboration: Execution requires partnership among radiology, service line leaders, supply chain, finance, and administration. Strategy must be evaluated based on its ability to enable enterprise growth—not departmental utilization alone.
The radiology strategy question is no longer: How do we grow radiology?
But rather: How does radiology enable the growth our system has already chosen?
The health systems that recognize this and plan accordingly will enable oncology expansion, unlock cardiovascular growth, accelerate neuroscience access, and strengthen musculoskeletal care pathways. With reimbursement and other financial pressures, health systems’ capital allocation decisions need to be guided by both mission and financial objectives. Any decision to improve radiology access and support service line growth can’t be made in a vacuum. Each health system should evaluate its own unique market dynamics to develop a business case that supports the investment. In doing so, they will reposition radiology not as an insulated revenue or cost center, nor solely as a volume engine—but as strategic infrastructure for enterprise success. When these approaches align with service line strategies, the result is sustainable growth for all, and most especially, in radiology.
Vizient forecasting intelligence reinforces that oncology growth is both outpatient-led and imaging-intensive. Projections show overall outpatient oncology volumes will grow faster than inpatient discharges over the next decade (20% outpatient vs. 2% inpatient). Advanced imaging such as CT, MRI, and PET scans are a sustained contributor to that outpatient growth, driven by the aging population, increased survivorship, and pre- and post-treatment management.
The strategic implication is straightforward: Oncology growth plans that don’t explicitly account for radiology access, sub-specialization, and outpatient proximity are structurally incomplete. Radiology shouldn’t be a downstream consideration in cancer, cardiology, or neurology strategy—it’s a prerequisite for speed to diagnosis, treatment selection, and longitudinal care.
Senior Director, Capital Equipment Solutions
Adam Fairbourn is a senior director of contract services on the Capital Equipment Solutions team at Vizient. In this role, Adam leads a team of category experts focused on maximizing spend performance in medical equipment and diagnostic imaging categories. In addition to managing a robust portfolio of national GPO agreements, Adam’s team facilitates the Vizient Member Diagnostic Imaging...
Consulting Director, Capital Equipment Solutions
Gurmeet Bawa is a consulting director on the capital strategic sourcing team within the indirect spend business unit at Vizient. In his current role, he advises health care organizations on capital spend by partnering with suppliers and providing insights into emerging trends and innovations in care delivery, enabling clients to make informed long-term strategic capital decisions...
Senior Vice President
Andre Maksimow is a Senior Vice President of Kaufman Hall and a member of the firm’s Partnerships, Mergers, and Acquisitions practice. He has over 25 years of experience, including mergers and acquisitions, private equity, finance, and operations. He provides strategic financial advisory services related to merger, acquisition, sale and divestiture, joint venture, and minority interest transactions in addition to valuations,...
