Should Radiology AI Be Free? The Economics and Ethics Debate

June 2, 2025

Industry expert examines whether radiology AI should be free or bundled with imaging services.

Key Details

  • Some large radiology groups currently charge patients an extra $40 for AI second opinions in breast imaging.
  • The U.S. market features over 600 FDA-cleared imaging AI vendors; about three-quarters may not survive long-term.
  • Conventional x-ray AI is expected to cost under $5 per case, and CT under $20 per case, as reimbursement pressures increase.
  • AI add-on reimbursement like NTAP initially offered high returns (up to $1,000/study), but few vendors qualified and payouts were often far lower.
  • Bundling AI costs within PACS or study reimbursement, rather than separate line items, is proposed as the likely future model.
  • Industry debate centers on fairness, transparency, standard of care, and return-on-investment for both AI companies and radiologists.

Why It Matters

As AI grows integral to diagnostic imaging, determining who pays and how access is managed raises practical and ethical issues for radiology departments, vendors, and patients. Bundled reimbursement models and the evolving standard of care may shape the future landscape of imaging AI adoption and sustainability.

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