Teleradiology and Health Equity: Closing the Imaging Gap in Underserved ZIP Codes

A patient’s ZIP code should not determine their access to a cancer diagnosis. It should not influence whether a stroke gets caught in time, whether a mass identified on a preliminary scan can be followed up with contrast-enhanced imaging, or whether a chronic condition is monitored with the frequency it requires. And yet, in the United States in 2026, where you live — and the income level, racial composition, and geographic remoteness of your neighborhood — is one of the strongest predictors of whether you will receive the diagnostic imaging your condition warrants.

The ZIP Code Is the Unit of Inequality

Health equity researchers have long recognized that ZIP code is one of the most powerful predictors of health outcome — more predictive, in some studies, than individual clinical factors. The same logic applies to imaging access.

A study published in Radiology and covered by the Radiological Society of North America examined the relationship between neighborhood socioeconomic disadvantage — measured using the Area Deprivation Index (ADI), a 17-metric federal tool developed originally by HRSA — and access to ACR-accredited imaging facilities. The findings were stark. Regions of the U.S. with extreme socioeconomic disadvantage were significantly less likely to have access to accredited advanced imaging facilities and centers of excellence. The highest concentrations of disadvantaged ZIP codes without accredited imaging access were clustered in the rural South.

Race, Income, and Imaging: What the Research Shows

The imaging equity gap is not evenly distributed across the population. A substantial body of peer-reviewed research documents consistent disparities in imaging utilization across race and income that persist even after controlling for clinical need, insurance status, and other confounders.

Racial disparities in imaging utilization

A nationally representative study published in Radiology using 2015 National Health Interview Survey data found that Hispanic, Black, and Asian participants were significantly less likely to report ever having undergone CT scanning compared to White patients. These findings align with emergency department data showing that non-White patients are ordered imaging at lower rates than White patients across multiple modalities, including radiography, CT, and ultrasound.

Research published in the journal Radiology’s “Narrowing the Gap” series identified a specific mechanism: advanced and resource-intensive modalities like MRI and PET/CT are generally less available at the hospitals and safety-net facilities that disproportionately serve patients of color. When those modalities are available, access is further impeded by longer travel and wait times, and the quality of images and interpretations may be lower due to resource constraints.

Income and insurance as access barriers

Insurance status is among the strongest predictors of imaging access. Uninsured and Medicaid patients face prior authorization delays, higher out-of-pocket costs, and facility-level policies that create friction at every step of the imaging pathway. Research applying the Social Determinants of Health (SDOH) framework to radiology access found that economic instability — including income, debt, food insecurity, and insurance coverage — disrupts timely access to imaging most severely for conditions like cancer and stroke, where imaging is central to diagnosis and treatment decisions.

A 2020 study examining imaging utilization during the COVID-19 pandemic found that patients in the lowest-income ZIP codes, along with patients who were non-White, male, or uninsured, experienced disproportionate declines in outpatient imaging — delays the researchers noted could widen pre-existing disparities if not proactively addressed.

The downstream clinical cost

These disparities do not exist in a vacuum. They translate directly into worse clinical outcomes. Delayed or absent contrast imaging means later-stage cancer diagnoses. It means missed strokes. It means chronic disease managed with less information. The Radiology Health Equity Coalition — a multi-society initiative supported by RSNA and the American Board of Radiology — frames this plainly: every day in America, thousands of life-changing diagnoses start with a radiological image, and too many people are not getting those images taken in time, or at all.

How Teleradiology and Virtual Supervision Address the Gap

Teleradiology — the transmission of radiological images from one location to another for interpretation or supervision — is not a new concept. But its role in health equity has expanded substantially as the regulatory framework has matured and the technology has become more reliable.

For imaging access in underserved communities, virtual contrast supervision represents the most direct application. By enabling a qualified physician to provide real-time, CMS-compliant direct supervision of contrast administration via live audio-visual connection, it allows facilities in medically underserved areas to offer contrast-enhanced CT and MRI without requiring an on-site radiologist. The facility needs a trained technologist, a reliable internet connection, and a contracted virtual supervision provider. The physician oversight that makes the procedure safe and compliant is provided remotely.

What this makes possible in practice

The practical implications vary by facility type, but the common thread is that virtual supervision extends the reach of physician oversight to communities where that oversight has been chronically unavailable.

• A federally qualified health center (FQHC) in a medically underserved urban neighborhood can add contrast-enhanced imaging to its service offerings without recruiting a radiologist onto its already-strained medical staff.
• A rural critical access hospital serving a predominantly low-income or minority community can offer contrast imaging on days when no on-site physician is scheduled, eliminating the referral to a facility 40 or more miles away.
• A safety-net hospital with a thin radiology roster can extend contrast imaging availability into evening and weekend hours without additional physician hires, reducing the disparity between what its patient population can access locally and what is available at better-resourced facilities across town.
• A community health center system operating multiple sites can use a single virtual supervision provider to cover contrast imaging across all locations — creating a level of physician coverage consistency that would be financially impossible to maintain through traditional staffing.

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ContrastConnect supervises over one million contrast exams annually and fulfills 100% of requested coverage hours across imaging facilities that include rural hospitals, outpatient centers, and community-serving facilities in underserved markets. The model is built to scale across sites — which matters in the context of health equity, because the communities most affected by imaging disparities are rarely a single facility. They are entire geographic areas where the gap is systemic.

Imaging Equity as a Shared Responsibility

The Radiology Health Equity Coalition frames the challenge directly: too many people are not getting diagnostic images taken in time, or at all, and the communities most affected are already bearing disproportionate disease burden. By 2060, researchers project that 57% of the American population will be composed of groups currently at highest risk for imaging disparities. This is not a problem that will resolve through demographic change or incremental improvement. It requires deliberate intervention.

For imaging providers, health systems, and the companies that support them, health equity is increasingly both a moral obligation and a strategic imperative. Facilities that expand their service capacity in underserved markets — and the organizations that make that expansion possible — are not simply filling a gap. They are contributing to a redistribution of diagnostic access that has measurable downstream effects on disease outcomes, healthcare system costs, and the communities themselves.

What remains is implementation — facility by facility, community by community, one supervised contrast exam at a time. ContrastConnect is built to support that work. If your facility serves an underserved community and is exploring how virtual supervision can expand your imaging access, we are ready to help.