The New Backbone of Urgent Care Imaging: Why POCUS Matters Now
Urgent care centers are built on access, efficiency, and rapid diagnostics. For decades, X-ray has been central to that model. Yet many operators are finding that maintaining consistent radiography is becoming increasingly difficult. A nationwide shortage of radiologic technologists has pushed wages upward and made staffing unpredictable. [1] Imaging volumes are often too low to justify the cost of full-time personnel. Reimbursement structures rarely offset the true expense of equipment, inspections, overreads, and service contracts. As a result, X-ray, once a dependable service line, is now one of the most operationally fragile components of urgent care. [2]
It is important to recognize that there is still a strong role for X-ray in centers with consistently high imaging volume or significant orthopedic demand. In those environments, radiography remains essential. The challenge is that radiography alone cannot meet the operational and workforce pressures facing urgent care today. When staffing is unreliable, imaging availability becomes inconsistent, and that inconsistency affects patient flow, provider confidence, and payor relationships.
Why POCUS Is Emerging as a Critical Complement
Point-of-care ultrasound (POCUS) offers a practical and increasingly necessary counterpart to radiography. Clinicians can perform ultrasound directly at the bedside. It is available every hour the clinic is open, and it does not rely on a separate technologist. Most importantly, it produces immediate diagnostic information that supports faster clinical decisions and reduces unnecessary referrals.
POCUS fills the gaps left by radiography, particularly during off-hours or periods when technologist coverage is difficult to secure. It ensures that the clinic always has a reliable imaging option available.
Clinical Advantages That Strengthen Urgent Care Practice
POCUS enhances the diagnostic toolkit for many of the most common urgent care presentations.
• Lung ultrasound has greater sensitivity than chest X-ray for pneumonia, pneumothorax, and pulmonary edema. [3-5]
• Soft tissue ultrasound differentiates abscess from cellulitis better than physical exam alone and detects radiolucent foreign bodies that X-ray cannot visualize. [6, 7]
• Musculoskeletal ultrasound supports rapid assessment of long bone injuries and real-time confirmation of shoulder dislocations. [8-10]
These are everyday urgent care complaints. For many of them, ultrasound provides faster, clearer, and more actionable information than radiography.
Operational Stability When X-ray Cannot Be Staffed
One of the most significant advantages of ultrasound is reliability. When imaging availability fluctuates because staffing is inconsistent, the clinic loses diagnostic capability. That affects everything from length of stay to patient satisfaction and downstream revenue.
POCUS restores consistency. It allows centers to maintain a broader scope of practice regardless of staffing gaps. Reliable imaging also strengthens a clinic’s position in payor negotiations, especially in case-rate contracts where diagnostic capability directly influences reimbursement.
A More Sustainable Financial Model
A complete POCUS program, including a high-quality handheld device, training, workflow integration, and archiving, typically costs about $20,000 per clinic. Annual expenses usually range from $1,000 to $10,000, depending on education and archiving needs.
In comparison, an X-ray program can exceed $120,000 each year once staffing, equipment maintenance, inspections, overreads, and compliance requirements are included.
Ultrasound is not only a cost-efficient alternative to radiography, but it also generates revenue from direct billing. By performing only one to two exams per day, centers may capture $30,000 to $90,000 annually, creating a sustainable service line that supports both clinical quality and financial performance. Our ROI calculators offer conservative projections based on the Medicare fee schedule that help operators estimate the impact based on their own visit volume and payer mix.
Training requires commitment. Most clinicians reach strong proficiency within six months to one year. Once those skills are in place, they permanently expand the clinic’s diagnostic capacity and reduce reliance on external imaging. The long-term return far outweighs the initial investment.
POCUS and X-ray Together Form a Modern Imaging Strategy
The future of urgent care imaging is not a choice between ultrasound or radiography. It is a hybrid strategy that uses both modalities where they are most effective.
Centers with high radiography volume will continue to use X-ray as a primary tool, while ultrasound enhances workflows by providing immediate insight and expanding the range of conditions managed on-site. Centers with lower or inconsistent imaging volume will find that ultrasound provides a stable and sustainable diagnostic foundation that is not dependent on technologist staffing patterns.
The Path Forward for Urgent Care
Urgent care has always excelled by adapting quickly to workforce pressures, financial constraints, and shifting patient expectations. Today, the adoption of clinician-performed ultrasound is not simply a technological upgrade. It is a strategic response to the realities shaping urgent care operations.
POCUS strengthens clinical care, enhances operational resilience, and creates a financially sustainable imaging model. Most importantly, it ensures that urgent care centers can continue to deliver on their promise of fast, accessible, high-quality care in an environment where traditional radiography is increasingly difficult to maintain.
Ready to take the next step with POCUS? Hello Sono helps practices roll out high-quality, compliant, and profitable POCUS programs.
References:
McKee J. Radiologic technologist shortage. RSNA News. Published October 24, 2024. Accessed December 10, 2025. https://www.rsna.org/news/2024/october/radiologic-technologist-shortage
Ayers A. Why X-ray is vanishing from urgent care centers. Published June 13, 2021. Accessed December 10, 2025. https://www.linkedin.com/pulse/why-x-ray-vanishing-from-urgent-care-centers-alan-ayers/.
Padrao EMH, Caldeira Antonio B, Gardner TA, et al. Lung Ultrasound Findings and Algorithms to Detect Pneumonia: A Systematic Review and Diagnostic Testing Meta-Analysis. Crit Care Med. 2025;53(11):e2271-e2281. doi:10.1097/CCM.0000000000006818
Chan KK, Joo DA, McRae AD, et al. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst Rev. 2020;7(7):CD013031. Published 2020 Jul 23. doi:10.1002/14651858.CD013031.pub2
Chiu L, Jairam MP, Chow R, et al. Meta-Analysis of Point-of-Care Lung Ultrasonography Versus Chest Radiography in Adults With Symptoms of Acute Decompensated Heart Failure. Am J Cardiol. 2022;174:89-95. doi:10.1016/j.amjcard.2022.03.022
Gottlieb M, Avila J, Chottiner M, Peksa GD. Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-analysis. Ann Emerg Med. 2020;76(1):67-77. doi:10.1016/j.annemergmed.2020.01.004
Pierce JL, Anand P, Glazebrook KN, et al. ACR Appropriateness Criteria Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update. J Am Coll Radiol. 2022;19(11):S473-S487.
Caroselli C, Zaccaria E, Blaivas M, Dib G, Fiorentino R, Longo D. A Pilot Prospective Study to Validate Point-of-Care Ultrasound in Comparison to X-Ray Examination in Detecting Fractures. Ultrasound Med Biol. 2020;46(1):11-19. doi:10.1016/j.ultrasmedbio.2019.09.006
Kozaci N, Ay MO, Avci M, et al. The comparison of point-of-care ultrasonography and radiography in the diagnosis of tibia and fibula fractures. Injury. 2017;48(7):1628-1635. doi:10.1016/j.injury.2017.04.010
Gottlieb M, Patel D, Marks A, Peksa GD. Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis. Acad Emerg Med. 2022;29(8):999-1007. doi:10.1111/acem.14454