Black Book RSNA Flash Poll: 3 in 4 Imaging Leaders Have No Clear ROI for AI - Yet Adoption Marches On
Per-Study and Bundled Deals Dominate as Imaging AI Remains a Discretionary Spend
CHICAGO, December 4, 2025 (Newswire.com) - A new flash poll from Black Book Research finds that imaging artificial intelligence (AI) has moved firmly into routine radiology workflow, even as most organizations still lack a rigorous financial proof point that it is paying for itself.
In a survey of 212 hospital and radiology leaders conducted around the Radiological Society of North America (RSNA) Annual Meeting, only 24% of organizations using imaging AI report a clear, quantified positive financial ROI. The remaining 76% either believe ROI is positive but unquantified, see neutral or negative impact, or have not formally measured it.
"On the RSNA show floor, AI is everywhere," said Doug Brown, Founder of Black Book Research. "But when you talk to CFOs and imaging leaders, you hear a different story: they're paying for AI, but often can't point to a clean line on the P&L that proves it's paying them back."
Imaging AI Economics: ROI Still Opaque
Among organizations with imaging AI live or in pilots (n=187), the financial model is fragmented and often indirect: Only 24%: report a quantified positive financial ROI from imaging AI.
Per-study & bundles dominate:
36% pay primarily on a per-study basis.
25% obtain AI bundled with modality or PACS/enterprise imaging contracts.
20% use enterprise-wide licenses.
11% use per-user pricing.
Reimbursement remains the exception:
Just 14% see direct incremental reimbursement clearly tied to AI (e.g., AI-specific codes or fee supplements).
39% report indirect upside such as increased throughput, new service lines, or fewer denials - typically not captured in a formal financial model.
31% see no revenue impact attributable to AI; 16% cannot attribute revenue to AI at all.
Workforce & Productivity: Capacity Over Cost Cutting
Despite strong vendor narratives about automation and efficiency, staffing savings are limited and under-measured:
12%: have reduced radiologist FTE or locum spend and retained those savings due to AI.
24%: avoided hiring or redeployed staff to growth areas, but without net cost reduction.
42%: report no measurable staffing impact from AI.
22%: say it is too early to tell or metrics are not tracked.
"Most organizations are using AI to keep up with rising volumes rather than to shrink their workforce," Brown noted. "The return is often deferred hiring or capacity expansion, which is harder to quantify and even harder to communicate to boards and payors."
Measurement Gap: AI Deployed, ROI Under-Reviewed
Structured financial review is lagging behind AI deployment:
30%: conduct a formal financial review within 12 months of AI go-live.
32%: wait more than a year.
38%: have no defined AI financial review process at all.
As a result, improvements such as faster report turnaround, reduced repeats, and incremental imaging volume often remain anecdotal, even as AI becomes embedded in everyday PACS/RIS workflow.
Where Imaging AI Is Delivering Value Today
When asked for the top real-world impacts of imaging AI so far, respondents cited:
59% - faster reporting turnaround times.
44% - improved lesion detection or diagnostic performance.
33% - increased patient throughput in CT, MR, and other high-volume modalities.
21% - fewer repeat scans and avoidable errors.
27% - report no measurable impact yet.
This pattern reflects an industry in which AI's economic value is often indirect, cross-functional, and realized over a multi-year horizon.
Barriers to Scale and Budget Posture
The main brakes on scaling imaging AI beyond pilots are operational and financial:
47% - integration with PACS / RIS / VNA and clinical workflow.
41% - IT resource constraints.
35% - vendor pricing and total cost of ownership.
28% - lack of radiologist buy-in.
19% - regulatory or medico-legal concerns.
Under budget pressure, respondents are most likely to cut:
34% - new AI tools (first to go).
22% - analytics programs.
17% - cloud imaging.
15% - modality upgrades.
12% - staffing.
This signals that, in many imaging budgets, AI remains a discretionary rather than protected line item.
Bright Spots: Vendors Proving Imaging AI ROI
Despite the uncertainty, a growing cohort of imaging AI vendors is demonstrating tangible ROI. Respondents pointed to solutions that:
Integrate natively into PACS and structured reporting, minimizing workflow friction.
Align pricing with value through per-study, volume-based, or outcomes-linked models.
Provide robust before-and-after analytics on turnaround time, detection performance, denials, and downstream revenue.
These vendors are helping radiology service lines open new subspecialty offerings, absorb higher exam volumes without proportional staffing increases, and lift quality metrics that matter to payors and health system leadership. As more contracts are anchored in measurable operational and financial outcomes, these early exemplars are defining what "proven ROI" looks like for imaging AI at scale.
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Methodology: The Black Book RSNA Imaging AI Flash Poll was conducted online and by phone from November 25-30, 2025, with 212 qualified respondents from hospitals, health systems, radiology practices, and imaging centers across North America and select international markets. Respondents included: 27% - CFOs and senior finance leaders; 25% - imaging service line leaders; 24% - radiology practice executives. and 24% - imaging IT / PACS leaders. Approximately 88% represented facilities with 200+ beds or equivalent imaging volume. The margin of error is ±6.0 percentage points.
About the 2026 Black Book Healthcare AI Research Series
Launching in Q2 2022, the Black Book Healthcare AI Research Series is a multi-report program tracking how AI is adopted, funded, governed, and evaluated across the health enterprise, including imaging, inpatient and ambulatory care, revenue cycle, population health, and administrative automation. Each report applies Black Book's double-blind methodology and standardized ROI and satisfaction measures to provide a consistent view of how AI is reshaping clinical and business performance. Download complimentary AI reports at www.blackbookmarketresearch.com
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Source: Black Book Research
