A Call for Diagnostic Stewardship in Modern Radiology
By Office of the President | Mar 3, 2026
Advanced imaging has become routine in modern medicine. With technology evolving rapidly
and access expanding, it is essential to ensure that every scan we order truly helps
the patient in front of us. A recent review in the Cureus Journal of Medical Sciences,
co-authored by Stephen Waite, M.D., FACR, Professor of Clinical Radiology, explores how the field can refocus on its central
purpose: strengthening clinical decision-making and delivering measurable benefit
to patients.
When used appropriately, imaging helps clinicians test a hypothesis, narrow a differential diagnosis, and guide next steps in care. Dr. Waite and colleagues from Downstate, Penn State, University of Cork, and Seton Hall Law School posit that this focus on diagnostic clarity has shifted as ordering thresholds for advanced imaging have declined.
The authors note a growing volume of studies that may offer limited value when ordered without a straightforward diagnostic question or without a likely impact on management. Contributors include discomfort with uncertainty, medicolegal concerns, and expectations that incidental findings require extensive follow-up, even when risk remains low.
The review emphasizes that increased detection does not automatically translate into better health outcomes. Imaging can lead to additional testing, higher costs, patient anxiety, and treatment of findings that may never have caused harm.
To strengthen radiology’s value, the authors call for a shared definition of quality that considers how imaging influences clinical decisions, patient outcomes, and system performance. They reference the Fryback and Thornbury hierarchical model of imaging efficacy, which evaluates technical quality, diagnostic accuracy, impact on decision-making, effect on outcomes, and broader societal benefit.
The paper outlines practical strategies for imaging stewardship. These include enhanced clinical decision support, stronger communication between radiologists and referring clinicians, and transparent reporting of diagnostic certainty to support informed next steps.
For an academic medical center like Downstate, where imaging supports emergency care, inpatient services, specialty programs, and medical education, this focus carries direct implications for patient safety and quality. Imaging stewardship reduces unnecessary radiation exposure, limits avoidable testing, and preserves timely access to advanced studies. It affirms radiology’s role in guiding care through careful interpretation and clinical collaboration.
Our patients in Central Brooklyn come to Downstate for clear answers and thoughtful guidance during some of the most critical moments in their lives. Thoughtful imaging reduces unnecessary tests, limits radiation exposure, eases financial strain, and minimizes anxiety related to incidental findings. It also helps ensure prompt access to imaging when it is needed. This approach keeps the focus on sound decisions and care that support the health of our patient community.
Tags: Radiology