That “black box” AI algorithm your practice just bought might look sleek on a demo screen—but when something goes wrong, it won’t be the software company signing the report. It’ll be you.

In this episode of Contrast & Clarity, Maddi and Jeff interview Ken Davis, Senior Counsel in Healthcare at Katten Law Firm, for a no-fluff conversation about the intersection of radiology, contract law, and the use of artificial intelligence. Together, we dive into the legal realities of AI implementation – and the due diligence that radiologists can’t afford to ignore.

We explore questions like:

·     What kind of due diligence should practices perform before deploying AI?

·     How do clinical vs. nonclinical AI tools differ from a liability standpoint?

·     Why is it important to try to see beyond the black box nature of an algorithm?

·     What should new radiologists know about the AI their group uses?

If your practice is using AI – or considering it – this episode is your legal reality check.

Find the prior relevant JACR articles here:

https://www.jacr.org/article/S1546-1440(25)00444-2/abstract

https://www.jacr.org/article/S1546-1440(25)00438-7/abstract

Find Ken Davis’ article “Top Ten Legal Considerations forUse and/or Development of Artificial Intelligence in Healthcare”: https://shorturl.at/0CrE5

Find the additional article mentioned on patients’ views on the use of AI in healthcare: https://shorturl.at/iJ7ia

What happens when AI gets it wrong – and who’s actually on the hook?

In this episode of Contrast & Clarity with the JACR, we sit down with Tanya E. Karwaki, JD, PhD, author of the JACR opinion piece “Balancing Artificial Intelligence Risks and Benefits in an Evolving Legal Environment,” to unpack one of the most uncomfortable – but unavoidable topics in radiology AI: legal risk.

AI adoption in radiology is accelerating, with more than a thousand FDA-approved tools already in circulation. But the legal framework governing their use? Still very much under construction. Dr. Karwaki walks us through why increasing lawsuits may be inevitable, how malpractice standards evolve alongside new technologies, and what radiologists should understand about liability when AI recommendations are followed—or ignored.

From informed consent and data privacy to emerging state-level legislation and disclosure requirements, this conversation provides critical context for anyone navigating AI implementation in clinical practice today.

If you’re using AI, thinking about using AI, or wondering where the legal guardrails actually are—this is an episode you don’t want to miss.

Find the JACR article here: https://www.jacr.org/article/S1546-1440(25)00438-7/abstract

How can multidisciplinary teams improve lung cancer screening? What are the primary barriers to lung cancer screening and how can they be addressed?

In this week's episode, Maddi and Jeff catch up with Lauren Groner, DO, MS and Rishikesh Dalal, MD, MPH about their research that used behavioral and implementation science to better understand lung cancer screening barriers and develop a strategy to increase screening rates. Their team also developed LungCheck.org to help serve as a hub of information for both providers and patients!

Claim your CME here: https://shorturl.at/6qr97

Find the JACR original article here: https://www.jacr.org/article/S1546-1440(24)00999-2/fulltext

Are radiologists following the playbook on what to do next when there is an incidental adrenal nodule on a lung cancer screening CT?

Maddi and Jeff interview Aparna Singh, MD about her new study that shows radiologists aren't exactly consistent in handling these unexpected findings - sometimes over-reacting, sometimes under-reacting, and often skipping an important lab test entirely. There is also a special guest appearance by Jared Christensen, MD, MBA and his expert insight on the S modifier.

Find the JACR original article here: https://pubmed.ncbi.nlm.nih.gov/40044307/

Inappropriate medical imaging results in low-value, excess imaging - but what about the environmental impact?

Maddi and Jeff sit down with Gregory Cavanagh, MD, Julia Schoen, MD, MS, and Elizabeth Rula, PhD to discuss how their study estimated excess green house gas emissions that are associated with inappropriate medical imaging in the Medicare Part B population from 2017 to 2021.

Find the JACR article here: https://pubmed.ncbi.nlm.nih.gov/40152841/

Get your CME here: https://cortex.acr.org/Presenters/CaseScript/CaseView?Info=RTWVsH3pWR4iYbD5FO37fw305omFBCsKOef8Wr0foV4%253d

The incidental finding of hepatic steatosis on imaging may present an avenue for opportunistic screening, leading to more efficient identification of metabolic dysfunction-associated steatotic liver disease (MASLD) and risk prediction for fibrosis. How can radiologists best facilitate this?

In this episode, Maddi and Jeff sit down with Emily Schonfeld, MD and Andrea Siobhan Kierans, MD to discuss their recent review article about recommendations for when hepatic steatosis is found on imaging and subsequent noninvasive tests to help predict overall fibrosis staging.

Find the JACR article here: https://pubmed.ncbi.nlm.nih.gov/40044315/

Have you ever wondered what additional screening measures could be implemented by utilizing information from routine CT scans?

In this episode, Maddi and Jeff were joined by Soterios Gyftopoulos, MD, MBA, FACR and Casey Pelzl, MPH to discuss their research about how simple, opportunistic CT bone density screening could transform bone health and healthcare spending.

Find the JACR article here: https://www.jacr.org/article/S1546-1440(24)00837-8/fulltext

The Merit-Based Incentive Payment System (MIPS) is the largest pay-for-performance program that links reimbursement to performance of Medicare clinicians. How have radiologists performed under this program and are there certain predictors of success? In this episode, Maddi and Jeff are joined by YoonKyung Chung, PhD and Lauren Nicola, MD to discuss their findings about radiologists' performance under the 2019 MIPS program and they also gain valuable insight from the experts.

Find the JACR article here: https://www.jacr.org/article/S1546-1440(25)00055-9/fulltext

Join us for the last installment of this three part series about re-imagining the radiology residency! In this episode, Fatima Elahi, DO guest co-hosts with Maddi and Jeff to discuss RadDiscord, which is a free educational digital community that allows equalized access to high-quality education. Available to medical students, radiology residents, as well as attending physicians, the platform allows access to case conferences, crowd-sourced Anki decks, and a supportive community.

Link to RadDiscord: https://www.raddiscord.org/

Claim your CME here: https://cortex.acr.org/Presenters/CaseScript/CaseView?Info=wQDhaBanwKm1w3DGH9WrXdv9Thf1LcnhMqXIoSk5Hqk%253d

Part 2 of Revamping the Radiology Residency! Fatima Elahi, DO joins Maddi and Jeff again to discuss competency-based education and its feasibility for real-world adoption in residencies. Priscilla Slanetz, MD, MPH, FACR gives her insight regarding metrics and standardized radiology residency curricula to enable a competency-based education that is time independent.

Find the JACR articles here: https://pubmed.ncbi.nlm.nih.gov/39612973/

https://pubmed.ncbi.nlm.nih.gov/39612972/

Claim your CME here: https://cortex.acr.org/Presenters/CaseScript/CaseView?Info=bSIRxZHC2JPSCgR0CE01uLu%2fU1lCh%2b%2blG%2fLdV1V0Wj0%253d

If you could build your own radiology residency from theground up, what would be the key ingredients you would include? In this episode, Jeff and Maddi invite Fatima Elahi, DO to join them in a discussion on how they would revamp the radiology residency. They also get insights from MaryScanlon, MD and how she has adapted the radiology residency as the program director at her own institution.  She also discusses navigating challenges such as increasing personalized teaching sessions, tailoring case-based conferences, and establishing specialty residency tracks.

Find the JACR article here: https://pubmed.ncbi.nlm.nih.gov/39612972/

Claim your CME here: https://cortex.acr.org/Presenters/CaseScript/CaseView?Info=bSIRxZHC2JOduKkDvGG1zhX3MuyU7KnFQKj2%2bSwWjZo%253d

Link to the APDR Quarterly Roundtable: Customizing the R4Year https://www.youtube.com/watch?v=WIAOATY9sN4

How do academic radiology chairs view the use of artificial intelligence (AI) in practice and how do they intend on implementing it in their departments? In this episode, Jeff and Maddi catch up with Elizabeth Burnside, MD, MPH, MS and Elizabeth Morris, MD who found in their recent study that radiology chairs have high levels of optimism about implementing AI in clinical practice. Although cost was identified as an obstacle, chairs indicated that they will work to address all manner of problems ranging from "tame" to "wicked."

Find the JACR manuscript here: https://www.jacr.org/article/S1546-1440(25)00041-9/abstract

Claim your CME here: https://cortex.acr.org/Presenters/CaseScript/CaseView?Info=VNwyWkmL0wVebbDKwN8waB7s67dFj%2by%2fEMJQpIw8lDQ%253d

Artificial intelligence isn’t failing radiology. Our healthcareinfrastructure just isn’t ready for it.

In this episode of Contrast & Clarity with the JACR, we cut through the hype to tackle the real reason artificial intelligence hasn’t transformed radiology yet—and it’s not because the algorithms aren’t good enough.

Joined by Michael Bruno, MD, MS and drawing from insightshighlighted at the 2024 Intersociety Summer Conference, Maddi and Jeff unpack the systemic barriers holding AI back: legacy IT systems, fragmented data pipelines, regulatory uncertainty, and workflows that force humans and AI to coexist rather than collaborate.

We discuss:

• Why AI keeps getting treated as a “bolt-on” instead of afoundational tool

• The mismatch between AI’s potential and real-world clinicalworkflows

• Why ROI, governance, and trust—not accuracy—are stalling adoption

• What actually needs to change for AI to move from demo todeployment

This isn’t a conversation about shiny tools or futuristic promises.

It’s about systems, incentives, and the uncomfortable reality that AI won’t fix radiology until we fix the environment it’s deployed into.

If you’ve ever wondered why AI feels simultaneously inevitable and underwhelming—this episode is for you.

Find the JACR article here: https://www.jacr.org/article/S1546-1440(25)00444-2/abstract

Claim your CME credit here: https://shorturl.at/u6Hcj

Now that large language models (LLMs) are widely available, how do radiology program directors view their use among residency applicants to craft their personal statements? In this episode, Maddi interviews Lars Grimm, MD, MHS, FSBI about his recent JACR publication and observations regarding the unwelcome but inevitable use of LLMs by applicants.

Find the JACR manuscript here: https://www.jacr.org/article/S1546-1440(24)00768-3/fulltext

Claim your CME credit here: https://cortex.acr.org/Presenters/CaseScript/CaseView?Info=sc0sNS4DGQwkMIf7LIi2gQuYH6a9BSklSNJx7UBsQZA%253d

What are the projections for the radiologist workforce and imaging volumes in the future? Maddi and Jeff interview Eric Christensen, PhD and Jay Parikh, MD about their two most recent JACR manuscripts where they project future imaging utilization and the radiologist workforce through 2055. They also catch up with Matthew Phelps, MD about his accompanying commentary on ways to streamline the training process and optimize the work environment.

Find the JACR manuscripts here:

Projected US Imaging Utilization, 2025 to 2055: https://shorturl.at/GM3DM

Projected US Radiologist Supply, 2025 to 2055: https://shorturl.at/d617U

Planning for the Future: https://shorturl.at/84iRH

Does imaging price transparency impact downstream patient decision making to receive recommended care? In this episode, Jeff and Maddi interview Gelareh Sadigh, MD about her recent work entitled "Unintended Consequences of Price Transparency Initiatives: Examining Patient Decision Making in Imaging Services."

Find the JACR article here: https://www.jacr.org/article/S1546-1440(24)00831-7/fulltext

What are the overall costs to a radiology department to adequately staff multidisciplinary conferences (MDCs)? Jeff and Maddi discuss the challenges associated with MDCs despite their overall added value to patient care and management. Lindsay Stratchko, DO shares her insights based on her recent manuscript entitled "Unreimbursed Costs of Multidisciplinary Conferences to a Radiology Department: A Prospective Analysis at an Academic Medical Center."

Find the article here: https://www.jacr.org/article/S1546-1440(23)00847-5/abstract

In this bonus episode, Maddi and Jeff revisit the use of nonphysician practitioners (NPPs) in interventional radiology. Will Lindquester, MD and Matt Hawkins, MD share their perspectives as interventional radiologists regarding the increasing use of NPPs for procedures as well as the financial advantages of employing NPPs within a physician-led IR team.

Find the article here: https://pubmed.ncbi.nlm.nih.gov/38964445/

Can an imaging dashboard improve communication between the emergency department and radiology as well as cut down on the number of phone calls? Maddi and Jeff interview Ali Dhanaliwala, MD, PhD and Tessa Cook, MD, PhD, CIIP about their experiences in creating and deploying an Emergency Department-Radiology dashboard. Drs. Dhanaliwala and Cook share their methodology as well as the encouraging subjective feedback they received on their endeavors.

Find the JACR article here: https://www.jacr.org/article/S1546-1440(24)00939-6/abstract

In the last installment of NPPs in radiology series, Maddi and Jeff interview Sharon D’Souza, MD, MPH for her insights into nonphysician practitioner (NPP) scope of practice and patient safety.  Dr. D’Souza serves as an executive board member of the Physicians for Patient Protection (PPP) and shared her experiences with both radiology advocacy and as an active member in the ACR.

Find the JACR article here: https://www.jacr.org/article/S1546-1440(24)00843-3/fulltext

Patients at Risk Podcast: https://podcasts.apple.com/us/podcast/patients-at-risk/id1539719940

Physicians for Patient Protection Website: https://www.physiciansforpatientprotection.org/

In the second installment of a three-part series, Maddi and Jeff continue to discuss nonphysician practitioners (NPPs) in radiology. Richard Duszak, MD shares his perspective as a radiologist on how disruptive innovation has played a part in the increasing share of office-based NPP imaging interpretation.

Find the article-in-press here: https://www.jacr.org/article/S1546-1440(24)00843-3/abstract

In the first episode of a three-part series, Maddi and Jeff explore nonphysician practitioners (NPPs) in the field of radiology. In this first episode, they interview Eric Christensen, PhD about his most recent article "Office-Based Diagnostic Imaging Interpreted by Nonphysician Practitioners: Characteristics, Recent Trends, and State Variation" to help get a lay of the land of the current state of NPPs and billing for office-based radiology services.

Find the article-in-press here: https://www.jacr.org/article/S1546-1440(24)00843-3/abstract

In this episode, Maddi and Jeff discuss their thoughts on direct patient access to radiology reports in electronic medical records, and how radiologists may need to tailor their reports to the non-medical consumer for better comprehension.

Inspired by the systematic analysis performed by Mohammad Alarifi PhD, MS and co-authors entitled "Patient, Referring Physician, and Radiologist Opinions Over Time on Providing Access to Radiology Reports: A Systematic Review." Find the JACR article in the December issue here: https://www.jacr.org/article/S1546-1440(24)00697-5/fulltext

Unlocking JACR Opportunities for Radiology Trainees: a Panel Discussion Recording: https://www.youtube.com/watch?v=3Y0GsjJuv5Q

What happens when the dream of remote radiology becomes a nightmare for practice culture?

Tune in as Maddi and Jeff are joined by Ivan DeQuesada, MD and Andrew Moriarty, MD to discuss onsite staffing concerns and the tensions between productivity, patient care, and the modern radiologist's desire for flexibility. From empathetic accountability to equitable hybrid scheduling and strategic work-from-home incentives, this discussion reveals why balancing autonomy and presence is crucial for private practice radiology.

Find the JACR article here: https://shorturl.at/0J0gI

In this episode, Maddi and Jeff discuss upcoming changes to radiology residency with the re-introduction of oral certifying board examinations and the potential challenges it introduces to residents and teaching attendings. An interview with Judah Burns, MD provides background on the evolving trends in trainee participation in radiologists' workload from 2008 to 2020 based on his and his co-authors' recent article-in-press.

Find the JACR article here: https://www.jacr.org/article/S1546-1440(24)00772-5/abstract

How can virtual multidisciplinary team meetings be used to promote global health and empower residencies that lack teaching resources? Maddi explores the virtual team meetings that have been established between the radiology department at UNC-Chapel Hill and Kamuzu Central Hospital in Lilongwe, Malawi with Katrina McGinty, MD, Benjamin Brown, MD, and Amarylis Mapurisa, MD.

Find the article in the November 2024 issue of the JACR: https://www.jacr.org/article/S1546-1440(24)00683-5/abstract

In this episode, Maddi and Jeff explore current medical 3D printing trends and get a chance to discuss the RSNA-ACR 3D Printing Registry with Kenneth Wang, MD, PhD and Frank Rybicki, MD, PhD, co-chairs of the 3D Printing Registry Committee. The registry seeks to collect case data about 3D printing that is performed to enable benchmarking and quality improvement. Drs. Wang and Rybicki gave us insight into the rationale behind the registry, aspirations for future directions, and interesting 3D printing applications.

Find the article in the November 2024 issue of the JACR: https://www.jacr.org/article/S1546-1440(24)00684-7/abstract

In this episode, hosts Maddi and Jeff debate the use of whole body MRI screening, inspired by the published opinions of Daniel Sodickson, MD, PhD and Saurabh Jha, MBBS, MRCS, MS in the November issue of the JACR. In the second segment, Maddi talks with Robert Optican, MD, MHA, FACR about the seven challenges in radiology practice that were described by Bettina Siewert, MD and co-authors from the 2023 ACR Intersociety Meeting in their recent article-in-press.

Join us for the inaugural episode of "Contrast and Clarity with the JACR," where Maddi and Jeff invite you to explore the dynamic world of radiology. This debut episode kicks off this enlightening series and sets the stage for future discussions.

How has the traditional radiology resident readout evolved in the post-pandemic era?

In this week's episode, Maddi and Jeff are joined by Shanna Matalon, MD, Sophia O'Brien, MD MSEd, and Scott Simpson, MD MSEd to talk about what trainees and faculty really think about side-by-side, remote, and asynchronous readouts, why feedback gaps persist, and how programs can improve the educational experience in hybrid environments. A must-listen for anyone involved in radiology training!

Find the JACR article here: https://shorturl.at/NOjj2

Claim your CME here: https://cortex.acr.org/Presenters/CaseScript/CaseView?Info=6U95sEWo3jaJM3JERvUep1s27mel6%2b%2bZUPcxFIuv1ms%253d

When USMLE Step 1 went pass/fail, the goal was to lower stress and level the playing field. Instead, it may have just moved the goalposts.

In this week's episode, Ruth Carlos, MD, MS, FACR and Megan Worthington, MS join Maddi and Jeff to talk about how the change to pass/fail for the USMLE Step 1 examination has reshaped the residency match - especially for competitive specialties like radiology. Although the move to pass/fail was supposed to fix student stress, it instead shifted the spotlight (and pressure) to Step 2, school prestige, and the alphabet soup of rankings.

Find the JACR article here: https://pubmed.ncbi.nlm.nih.gov/40541763/

Women make up half of the medical school graduates, but only a quarter of radiology residents.

In this episode, Maddi and Jeff are joined by Amy Patel, MD and Shiva Yagobian, BS to go beyond the statistics and explore the social, institutional, and policy-level barriers that shape the "leaky pipeline" from training to leadership. Whether you're a trainee wondering where all the women in leadership are - or a department leader looking to make real, sustainable change - this episode offers both the data and the direction to help close the gap.

Find the JACR article here: https://pubmed.ncbi.nlm.nih.gov/40216284/

As health systems and radiology practices continue to consolidate, education often ends up as collateral damage.

In this episode, Charlotte Taylor, MD joins Jeff and Maddi to discuss how radiology educators can adapt - and even thrive - when clinical demands and financial pressures are rising. From incentive scorecards and creative teaching models to intentional early resource allocation to enable tailored training, this conversation explores practical, scalable ways to preserve excellence in training the next generation of radiologists.

Find the JACR article here: https://pubmed.ncbi.nlm.nih.gov/40543532/

Claim your CME here: https://shorturl.at/LVxwh

What happens when hackers meet PACS? Nothing good for patient care.

Join us this week as Maddi and Jeff get insight from Po-Hao Chen, MD, MBA and Christoph Wald, MD, PhD, MBA on their brand-new ACR-SIIM white paper on radiology cybersecurity. We will explore ransomware, downtime drills, and the unglamorous but essential world of cyberhygiene.

Read the full JACR manuscript: https://www.jacr.org/article/S1546-1440(25)00409-0/fulltext

Want more cybersecurity resources? Visit: https://www.acr.org/Data-Science-and-Informatics/Informatics/cybersecurity-resources

Do labor unions really change the residency experience - or just the perception of it?

This week, Maddi and Jeff explore radiology residents' perspectives on labor union participation with Erica Kinne, MD, Elliot Varney, MD, PhD, and Lars Grimm, MD based on their most recent research. From vacation days and housing stipends to duty hours and wellness, radiology residents weighed in on both the perks and pitfalls of unionization.

Find the original JACR article here: https://www.jacr.org/article/S1546-1440(25)00203-0/fulltext