RadNet, which describes itself as the largest operator of outpatient imaging centers in the United States, has agreed to acquire ONRAD, a provider of teleradiology and in-hospital radiology staffing. Announced on October 26, 2026, the deal calls for $350 million in cash, 5 million RadNet shares and an earnout of up to $210 million. RadNet, which has used teleradiology mainly inside its own network, will now sell it at scale to outside hospitals, putting it in direct competition with Radiology Partners.
The Imaging Wire framed the transaction as evidence that the radiologist shortage is reshaping the imaging services market. Its headline figure of “up to $560 million” adds only the cash and the maximum earnout. The 5 million shares come on top, and their value will depend on RadNet’s stock price when the deal closes, which is expected in early 2027.
Deal terms and ONRAD’s numbers
The figures below come from RadNet’s press release, also filed with the SEC. The earnout is tied to a 2027 EBITDA target for ONRAD and can be paid in cash, stock or both, at RadNet’s option. The seller is private equity firm Housatonic Partners.
Phoenix-based ONRAD works with more than 130 contracted radiologists and supports more than 225 hospital facilities across 26 states. It provides remote final reads and places radiologists on-site, including for interventional radiology. RadNet expects ONRAD to add $190 million to $200 million in revenue and $60 million to $65 million in adjusted EBITDA in its first year after closing. According to the release, ONRAD’s revenue has grown 10% to 20% a year over the last several years, with adjusted EBITDA margins above 30%, in a business that needs little capital to grow.
Some quick arithmetic puts the price in context. The cash portion alone is roughly 5.4 to 5.8 times projected first-year adjusted EBITDA; adding the full earnout lifts that to about 8.6 to 9.3 times, before counting the shares. After closing, ONRAD will anchor a third reportable segment called Radiology Professional Services, alongside RadNet’s imaging centers and its DeepHealth digital health division.
“This is the next step in building an imaging company with comprehensive solutions that brings technology, radiology professional services and imaging operations together,” RadNet President and CEO Howard Berger, MD, said in the release.
From first DeepHealth customer to acquisition target
The relationship began as a customer contract. In November 2024, ONRAD was named the first customer for DeepHealth OS, the cloud-native operating system built by RadNet’s AI subsidiary. At the time ONRAD said it handled more than 1.4 million exams a year. The rollout covered a viewer, reporting tools and the integration of DeepHealth and third-party algorithms into a single diagnostic workspace.
Berger told The Imaging Wire that this work gave RadNet a closer look at the rising volumes and staffing problems hospitals face. RadNet already relies heavily on teleradiology across its own centers; what changes is that it will now sell interpretation capacity at scale to external customers, mostly hospitals. The move extends an AI strategy that also includes the roughly $270 million purchase of French AI developer Gleamer announced in March.
ONRAD has been an acquirer too. In January 2025 it announced the purchase of Direct Radiology, a teleradiology group whose platform and operations Philips had owned since 2019. The Imaging Wire dates that deal to late 2024, but ONRAD’s own announcement is dated January 7, 2025.
Why the radiologist shortage drives consolidation
Teleradiology means a radiologist interprets images away from the site where they were acquired, with studies transmitted in DICOM. In the U.S., teleradiology firms cover nights and weekends, absorb volume spikes and increasingly provide routine final reads for hospitals that cannot recruit enough radiologists. Some, like ONRAD, also staff hospitals with on-site physicians.
RadNet’s release rests the deal’s logic on two points: hospitals and health systems account for more than half of U.S. diagnostic imaging volume, according to a Signify analysis, and demand for imaging is growing faster than the supply of trained radiologists. The imbalance shows up in stories we have covered, from the debate over whether the radiologist shortage is regional to the exodus of VA radiologists after a remote work ban. On the technology side, cloud teleradiology has made it easier to read for many hospitals from one worklist, which makes larger networks more practical to run.
RadNet’s bet is that AI stretches that workforce further, through case prioritization, worklist management and better matching of reading capacity to demand. Those are the buyer’s claims; the release provides no productivity or turnaround data to test them.
RadNet vs. Radiology Partners: providers that build their own AI
The deal moves RadNet onto Radiology Partners’ turf. RP, the largest radiology group in the country, grew by rolling up physician practices rather than running imaging centers, but it owns vRad, a direct ONRAD competitor, and in August announced its acquisition of international teleradiology provider Everlight. RP also has a dedicated AI subsidiary, Mosaic Clinical Technologies, whose algorithms compete with DeepHealth’s.
As The Imaging Wire sees it, the common thread is the business model. While many hospitals are still debating whether and how to adopt AI, large imaging services providers have decided to build their own, deploy it across their own networks and then sell it to third parties. The outlet sees the same approach, on a much smaller scale, in Harrison.ai’s backing of Frontier Radiology.
Our editorial reading: a hospital that outsources reads to one of these groups is, in effect, also adopting that provider’s software stack, from the viewer to the algorithms. That can bring AI to sites that lack the scale to evaluate it on their own, but it concentrates decisions about which tools are used, how they are validated and who controls the data in a handful of companies.
A view from Brazil and Latin America
The same pressures exist outside the U.S., but rules differ. Teleradiology is widely used in Brazil and is governed by Federal Council of Medicine (CFM) Resolution 2,107/2014. It requires that a radiology specialist registered with a regional medical council take responsibility for transmission and reporting, that teleradiology companies be based in Brazil and registered with the council, that the attending specialist and the remote reader share liability, and it bars teleradiology for interventional procedures and ultrasound.
Those rules make cross-border reading models harder to import, but they do not stop the underlying trend of reading groups bundling their own AI into the service. Hospitals that outsource reads should ask which algorithms touch the read and how they were validated, where images and derived data are stored under Brazil’s data protection law (LGPD), and which turnaround and quality metrics will be reported.
Caveats and what to watch before closing
The transaction still needs regulatory review. Revenue and EBITDA figures are RadNet’s own non-GAAP projections, and the earnout will not be settled until after 2027. ONRAD’s size figures are also hard to compare: in January 2025 it cited more than 160 radiologists and 550 facilities; the new release cites more than 130 contracted radiologists and 225 hospital facilities, counting bases the company does not reconcile. Exam volumes and turnaround times were not disclosed.
Worth watching: whether the deal closes on schedule, how DeepHealth tools are rolled into ONRAD’s operations, and whether independent data emerge on AI’s effect on teleradiology productivity.
Source: The Imaging Wire — RadNet to Buy ONRAD in Teleradiology Shift. Company release: RadNet — RadNet, Inc. Announces Agreement to Acquire ONRAD, Inc.
