Essay 03 · Writing · The Missing Ledger series

Speak to the radiologist

A position paper on direct consultation as the missing outcome in preventative imaging

the report, spoken

The person who knows the most about your scan is the one you are least likely to meet. In the standard imaging pathway the radiologist interprets the study, writes the report, and sends it to the referring doctor; the patient receives the findings second-hand, filtered through a clinician who did not see the images. For a fractured wrist this is a reasonable division of labour. For preventative imaging — where the whole proposition is a well person seeking to understand their risk — it is a design flaw at the centre of the product.

What the evidence says direct consultation does

When patients are actually given the radiologist, the effect is consistent. In a controlled study, patients offered the chance to discuss their MRI findings with the radiologist overwhelmingly valued it: 81% regarded that conversation as a marker of a good radiology service, against 14% of those sent away without it. The same patients bonded more strongly with the department and rated it as more competent [S14]. In a cancer-surveillance clinic where the radiologist met patients directly, understanding of findings and next steps improved in 70–93% of cases and 96% found the consultation helpful; afterwards, more patients wanted to hear from the radiologist directly rather than only from the referrer [S15].

This is not merely a satisfaction story. Understanding is itself an outcome. A result the patient cannot interpret has not truly been delivered — it has been transmitted. The gap shows up in the data: across a 22-country patient survey, a third were dissatisfied with the availability of radiologists for consultation and 36% were not satisfied with the information they received about the risks and benefits of their procedures [S7]. Patients are telling us, in the aggregate, that the current pathway under-delivers the very thing preventative imaging is supposed to provide — clarity about their own risk.

Why this matters most in prevention

Preventative imaging has a specific problem that direct consultation is unusually well suited to solve: it generates a large volume of findings that are real but low-risk. Structured frameworks now grade whole-body MRI findings by actual cancer risk rather than treating every anomaly as equally alarming, and most flagged findings fall in the lowest-risk tiers [S17]; whole-body MRI in a high-risk surveillance population reached 95.5% specificity and a 97.4% negative predictive value, while still producing a benign incidental finding requiring work-up in 27.4% of scans [S16]. Those are reassuring numbers to a radiologist. To a well person reading a report cold, "indeterminate lesion, likely benign, recommend follow-up" is a threat, not a comfort.

This is where the radiologist who can say this is benign, here is why I am confident, and here is the single thing worth rechecking in twelve months creates value that no PDF can. They convert a source of alarm into a genuine, defensible reassurance — the confident all-clear that is one of the few clearly real economic benefits of screening. Remove that conversation and preventative imaging manufactures anxiety at scale; include it and the same scan produces informed calm.

The counter-case, stated plainly

Direct consultation is not free, and the honest objections are structural. Radiologist time is the scarcest and most expensive input in the entire imaging chain; a model that routes every screened patient to a personal consultation will not scale, and may divert radiologists from reading, where their marginal clinical value can be higher. The supporting studies are mostly small and single-centre [S14][S15], and they measure experience and understanding rather than survival or total cost — consultation clearly improves how care feels, but the evidence that it changes hard outcomes or saves money is not yet established.

The defensible conclusion is therefore selective, not universal. Direct radiologist consultation earns its cost precisely where preventative imaging is most ambiguous and highest-stakes: the incidental finding, the anxious well person, the borderline result. Designing which patients meet the radiologist — rather than defaulting everyone to a report or defaulting everyone to a consultation — is the real decision, and it is a decision about clinical governance and economics, not bedside manner.

What I argue for

Any WBMRI screening entity building the consumer preventative-imaging category is, whether it says so or not, making a bet about the radiologist's place in the customer relationship. Treat the radiologist as a hidden reader and the product is a document and an anxiety. Put the radiologist in front of the patient for the findings that genuinely warrant it, and the product becomes a consultation with imaging attached: a more defensible, more valuable, and frankly more ethical thing. The economics of preventative imaging will be decided, in part, by that single design choice — and I argue it should be decided in the patient's favour.

References

Dr Lisa Sorger is a consultant radiologist, healthcare executive, medical administrator, company director and founder of myradiologist.ai. She writes on the economics and ethics of preventative imaging and diagnostic radiology. Every claim in this paper is sourced to the public record.

All views expressed here are my own personal opinions and are not medical advice. General information only — not clinical or financial advice. myradiologist.ai · ABN 29 692 758 115 · ACN 692 758 115