"Radiology AI. Two paths," described AI that assists radiologists (Smart Impression drafting impressions from the radiologist's findings) and AI that aims to interpret on its own (RP's Mosaic). RadNet's October 27 investor call on its ONRAD acquisition adds a useful wrinkle: the most profitable teleradiology company in the conversation got there without either one.
What ONRAD actually automated
ONRAD reports adjusted EBITDA margins above 30%. CEO Dave Engert credited the plumbing, not the reading: image ingestion, pulling priors, worklist assignment and report delivery. When ONRAD absorbed Direct Radiology, a low-margin operation, it brought it to roughly 30% margins with that same workflow technology. No AI reads required. ONRAD handles about 8,000 reads a day, including roughly 250 strokes with a seven-minute average turnaround.
Prices are going up, not down
Engert said ONRAD has raised customer prices to cover rising radiologist pay, and expects that pressure to continue. Radiologist scarcity still buys pricing power.
Radiologists may enjoy the rising income, but it comes with a catch. Every raise makes the radiologist a bigger line item, and the biggest line item is always what management tries to shrink. Scarcity doesn't protect radiologists. It supports the effort to replace them.
Then comes the AI
RadNet CEO Howard Berger wants every exam routed through RadNet's AI workflow, with draft reports for radiologist review, and projects 50% or more productivity gains, with 50 to 60% of imaging passing through AI by early 2027. These are projections, not results. Note the CFO's point: ONRAD's expected $60 to 65 million in EBITDA doesn't depend on any of it. RadNet is buying a business that already works and betting AI makes it work with fewer radiologists.
The number to watch
Not the percentage of exams "touched by AI." Watch paid radiologist-hours per completed read. That ratio is the clock in this site's tagline.