Should Nurse Practitioners Be Allowed to Read X-Rays? Pros, Cons, and the Path Forward

A contentious question is stirring in healthcare: Should nurse practitioners (NPs) and physician assistants (PAs) be allowed to interpret X-rays? The debate intensified when the CDC/NIOSH suggested expanding its “B-Reader” program beyond physicians. The American College of Radiology (ACR) pushed back hard, warning that patient safety and diagnostic quality could be at risk.

This issue matters for urgent care centers, where staffing shortages and rising volumes make efficiency essential. But when it comes to diagnostic imaging, cutting corners can have serious consequences.

What’s at Stake in the NP X-Ray Debate

Reading an X-ray is more complex than spotting a fracture or confirming pneumonia. It requires years of training and the ability to detect subtle abnormalities that could indicate life-threatening disease. Even experienced thoracic radiologists consider occupational lung disease scans among the most difficult images to interpret.

For urgent care providers, the risks of missed findings are real. Misreads can cause delayed treatments, incorrect diagnoses, and greater liability exposure for clinics. Accuracy and consistency must remain the priority.

The B-Reader Program and Federal Proposal

The conversation centers on the CDC/NIOSH B-Reader Program, which certifies clinicians to classify chest radiographs for dust-related lung diseases. The certification demands specialized training and ongoing calibration.

Recently, the CDC issued a Request for Information (RFI) asking whether NPs and PAs could be added to the program to address shortages. Only 35 states and two territories currently have certified B-Readers, which limits access in some regions. The ACR, however, strongly objected, arguing that the existing pool of physician B-Readers is sufficient and that lowering standards could jeopardize patient safety.

The Case for Expanding NP and PA Roles

Supporters of expanding NP and PA scope argue that doing so could help close gaps in access and reduce costs. They also point out that some nonphysicians already have relevant experience in occupational health and imaging.

• Improved Access: In areas without enough radiologists or B-Readers, expanding the pool could shorten turnaround times for patients
• Existing Experience: Many NPs and PAs already play a role in imaging workflows and could extend their expertise with additional training
• Cost Efficiency: In under-resourced or rural areas, shifting some responsibilities to nonphysicians could reduce administrative and staffing costs

The Case Against Allowing Nonphysicians to Read X-Rays

Opponents, led by the ACR, caution that even small changes to who can interpret X-rays could have major consequences for patient care. Their concerns focus on quality, safety, and trust.

• Quality and Safety Risks: Chest radiograph interpretation for lung disease is one of the most challenging areas of radiology, and subtle findings could be missed
• Inconsistent Standards: Expanding roles could reduce consistency and accuracy in imaging reads across different providers
• Legal and Liability Concerns: Misdiagnoses raise the risk of lawsuits and regulatory pushback
• Patient Trust: Many patients expect physician-level expertise when it comes to imaging, particularly for high-stakes diagnoses

What the Data Suggests About Safety and Access

The available data highlights why this debate is so heated. While there are gaps in coverage, there is also strong resistance to expanding nonphysician roles.

• Certified B-Readers are spread across 35 states and two territories, leaving shortages in others
• The CDC’s RFI drew more than 500 public comments, showing the depth of concern across the medical community
• The ACR recommends alternative solutions such as incentivizing radiologists to pursue certification, extending certification periods, funding AI-assisted tools, and improving outreach to underserved regions

These numbers highlight not just the access challenges but also the caution in the medical community, paving the way for the ACR’s ideas on how to close the gaps without turning to nonphysician roles.

ACR’s Proposed Alternatives

While the CDC’s proposal sought feedback on expanding B-Reader eligibility to NPs and PAs, the American College of Radiology argued that patient safety would be better protected by strengthening the existing physician pathway.

According to the ACR, solutions should focus on:

• Incentivizing more physicians to become B-Readers, ensuring geographic coverage without lowering standards
• Extending certification periods from five to ten years, reducing the administrative burden on qualified readers while maintaining competency requirements
• Funding AI-assisted tools to support radiologists in reading and classifying chest radiographs more efficiently
• Improving outreach and education to expand awareness of the program and encourage participation in underserved areas

These recommendations keep radiographic interpretation within physician oversight while addressing access concerns through policy changes, technology support, and expanded participation.

The Case for Specialized Teleradiology

Rather than expanding NP and PA roles into X-ray interpretation, another solution is to leverage specialized teleradiology services. Teleradiology ensures that every image is read by a board-certified radiologist, regardless of a clinic’s location.

Experity Teleradiology was built specifically for urgent care and is the only partner that delivers:

• 99% accuracy from board-certified, Joint Commission-accredited radiologists
• AI-assisted reads that reduce error and deliver industry-leading turnaround
• Radiologists include Certified B readers who deliver with the same speed and accuracy
• Seamless PACS integration for efficient image access and storage
• Flexible contracts with no monthly minimums or hidden storage fees
• $45 per B read — no markups, no middlemen
• Audit-ready documentation to support legal and regulatory compliance
• Seamless integration into your existing patient flow

With this approach, urgent care teams can focus on patient care while ensuring that imaging interpretation remains in expert hands.

Conclusion: Balancing Access and Safety

For urgent care leaders, the message is straightforward: patient safety and diagnostic integrity depend on keeping radiographic interpretation in the hands of trained physicians — supported by better tools and policies to expand access where needed.

Your patients trust you for answers. Trust Experity Teleradiology to deliver reliable imaging interpretations that help you provide the best care, every time.

Learn About Experity Teleradiology