Are we measuring the wrong problem in radiology?

When we talk about pressure in radiology, we tend to talk about numbers.

More examinations. Longer worklists. Growing backlogs. Too few radiologists. And, inevitably, the need to increase productivity.

All of those pressures are real. But I believe we are overlooking another important factor: the mental effort radiologists expend simply navigating their working environment.

Radiology has changed dramatically. A radiologist may report for their own organisation, support colleagues elsewhere in a regional network, participate in multidisciplinary team discussions and contribute to remote or teleradiology services, sometimes within the same day. Yet many systems supporting them were designed for a much more contained model of care.

We need to talk about cognitive load

A radiologist’s workload is not simply the number of studies waiting to be reported. It also includes the small tasks surrounding every interpretation. For example, where are the priors? Is there relevant imaging in another organisation? Which worklist should I be looking at? Where is the clinical history? Which case should I tackle next? Each decision may take only seconds. Multiply them across hundreds of interactions, however, and the picture changes.

This is cognitive load: the mental effort required not only to interpret the study, but to navigate the environment in which interpretation takes place. If we ask highly trained clinicians to spend a meaningful portion of their day searching, switching, clicking and coordinating, we cannot solve the capacity problem simply by asking them to work faster.

Radiology has changed. Has its infrastructure?

Traditional PACS environments were largely designed around departments and organisations. That is increasingly disconnected from the way imaging services operate today.

Across the NHS, collaboration between trusts and imaging networks is becoming increasingly important. Distributed reporting lets expertise be shared, while subspecialists can support patients beyond their own organisation’s boundaries. But creating a networked clinical model on top of fragmented technical infrastructure is dangerous. If radiologists still have to bridge gaps manually by logging into different systems, locating studies, finding patient context, and coordinating work outside the workflow, we may have simply distributed the friction as well.

This is where enterprise imaging needs to become more than a replacement for departmental PACS. Its value lies in creating the connected clinical environment modern imaging services require: bringing the imaging record, relevant context, workflow, and insights together in a unified workspace, while enabling work and expertise to move more easily across sites and organisational boundaries.

A clinician-first approach to Enterprise Imaging should go beyond connecting systems or providing more information. The goal is to organise information and workflows around the clinician, enabling technology to handle more of the coordination so radiologists can remain focused on interpretation, diagnosis and patient care.

Stop measuring efficiency only in minutes

This also requires us to rethink what we mean by efficiency. Healthcare technology has traditionally focused heavily on speed: how quickly an examination opens, how many clicks a process requires, or how many studies can be reported in an hour. Those measures have value, but a better question might be: How much unnecessary thinking does the system require from the clinician?

The best workflow is not necessarily the one that makes a radiologist perform the same sequence slightly faster. It is the one that removes unnecessary steps altogether.

An urgent case should surface appropriately without the radiologist searching for it. Relevant patient information and prior imaging should be available within the reporting context. Work should be intelligently distributed so expertise and capacity can be used across a network rather than constrained by organisational boundaries.

A unified Enterprise Imaging workspace can bring images, clinical context and insights together around the radiologist, while workflow orchestration helps ensure the right work reaches the right clinician. Instead of asking radiologists to navigate the complexity of the imaging enterprise themselves, the platform should absorb more of that complexity for them.

AI can help – but only if it reduces complexity

There is understandable enthusiasm about AI’s potential to address growing imaging demand. But adding more technology does not automatically reduce workload.

If an AI application requires another login, screen, alert or set of results to reconcile, it risks becoming one more source of cognitive load. The real test should be simple: does it make the radiologist’s job easier?

When intelligence is embedded into the Enterprise Imaging workflow, AI can help prioritise cases, identify potential findings and surface relevant information at the point of interpretation. It is not another destination for the radiologist to visit; it becomes part of the environment supporting them.

We should not judge innovation solely by what an algorithm can do. We should also ask what adopting it requires of the clinician.

Design for the difficult day

We should design systems not for the ideal working day, but for the difficult one. Consider the radiologist managing a busy worklist, urgent cases, interruptions from colleagues and an approaching MDT meeting. That is when unnecessary choices and fragmented systems become particularly costly.

Technology should reduce decisions that do not require clinical expertise and ensure the information needed for those that do is readily available. When Enterprise Imaging mirrors how clinicians think, decide and act, such as bringing the imaging record, context, workflow and embedded intelligence into one environment, it can help protect clinical flow even as care becomes more distributed and complex.

I think of this as designing for cognitive reliability. It is not about removing clinical judgement. Quite the opposite. It is about protecting it.

The capacity conversation needs to change

There is no single technology that will solve the pressures facing UK radiology. Imaging demand will continue to grow, workforce shortages will remain a challenge, and NHS organisations are at different stages of digital maturity.

We need more radiologists and appropriate investment in diagnostic capacity. But we also need to make better use of the expertise we already have.

Every unnecessary search, login, click, interruption and workaround consumes a small amount of that capacity. Across a department, a network and an entire NHS working day, those inefficiencies become significant.

Enterprise Imaging cannot create more radiologists. But it can create a better environment for the radiologists we have; one in which imaging, context, workflow and intelligence come together more seamlessly, expertise can be shared across organisational boundaries, and clinicians spend less of their finite attention managing technology.

The next phase of radiology should therefore not be defined simply by how many more studies clinicians can read. It should be defined by how effectively we design the environment around them.

Because if we want radiologists to focus on the complex decisions that only they can make, we first need to stop asking them to make so many decisions that technology should be making for them.

The content on this page is provided by the individuals concerned and does not represent the views or opinions of RAD Magazine.