Radiology plays a bigger role in large-scale combat operations than many realize, and it’s important to understand how to make sure it’s accessible in combat.
The future of radiology will be shaped not only by technological innovation, but also by the geopolitical realities of great‑power competition. These post-Cold War multipolar rivalries bring the threat of large‑scale combat operations (LSCO) and targeting of global supply chains. As technology and geopolitics change rapidly, both traditional and evolving battlespaces — land, sea, air, space and cyberspace — will fundamentally alter how imaging is performed, delivered and interpreted.
The U.S. currently hosts the world’s largest healthcare and medical device market ($191.2 billion in 2025), but this is quickly evolving. China now controls more than 10 percent of the global imaging-device market and continues to grow its domestic manufacturing capacity. This shift reflects the broader ambitions of the “Made in China 2025” initiative, which seeks to reduce foreign dependence and establish China as the U.S.’s peer competitor in the global high‑technology sectors. Its trajectory suggests that U.S. access to critical imaging equipment and components may become increasingly constrained.
This vulnerability is amplified by China’s dominance in rare earth elements (REEs), such as the gadolinium used in contrast agents, that underpin modern imaging systems and are essential components of advanced electronics. In a geopolitical crisis, disruptions to REE supply chains, due to adversaries’ naval blockade of international maritime shipping routes and choking points, could significantly degrade U.S. radiologic capability across both military and civilian sectors.
As witnessed in recent global conflicts, denied passage through maritime corridors is also detrimental to the global supply chains necessary to replenish prepositioned medical equipment in forward locations. Additionally, sophisticated adversaries can have robust anti-access/area denial capabilities. These barriers can restrict opposing forces’ access to operational areas and delay rapid movement of casualties to rear‑area facilities with full imaging capability. An LSCO would force medics and forward-deployed surgical teams to manage casualties with limited imaging and constrained resources for extended periods of time, causing delays in care and risking otherwise preventable deaths.
The Russia-Ukraine war, Syrian civil war and Israel-Gaza conflicts provide contemporary small-scale models of a future LSCO’s medical realities in which medical facilities are considered legitimate targets in violation of international law. This possibility underscores the need for improved operational security, enhanced defensive posture, protective equipment for medical personnel, protection of assets and logistic supply chains and clarification of the rules of international humanitarian law. Furthermore, high casualty volumes can rapidly overwhelm forward treatment facilities and often demand swift imaging capability on the battlefield as far forward as possible. Ukraine has relied heavily on point‑of‑care ultrasound, mobile radiography, prolonged underground casualty holding and international teleradiology support. These experiences highlight the need for imaging modalities that are portable, resilient and work in underground facilities under harsh conditions for extended periods of time.
Additional anticipated challenges will require focused attention on securing essential infrastructure against non-kinetic high-tech warfare. Electromagnetic pulse effects, cyberattacks and space warfare are expected to degrade or disable communications, satellite links and cloud‑based systems. Teleradiology — central to modern military imaging — depends on satellite communications pathways and secure networks that are vulnerable to jamming and intrusion. Portable CT scanners introduce risks such as generators, and cooling units produce thermal signatures detectable by heat-seeking drones and loitering munitions. Protecting imaging assets will require thermal camouflage, insulated shelters and decoy heat sources.
To prepare for future conflicts, the U.S. and its allies must strengthen radiologic resilience. Priorities include reshoring and near-shoring the manufacture of imaging equipment and REEs as well as hardening digital infrastructure against cyber, sabotage and electromagnetic attacks. Radiology must evolve from a rear‑area specialty to a frontline force multiplier — mobile, secure and adaptable to the demands of LSCOs.
In the next great power conflict, imaging will not be optional. It will be decisive.
Disclaimer: The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of the U.S. government, Department of War or the U.S. Army.
A New Appreciation for CPT Codes
The James M. Moorefield, MD, Economics Fellowship offers a behind-the-scenes look at the advocacy and policymaking work that shapes the practice of radiology.
Read more
The Root Act: Why Radiology Advocacy in Action Matters
Featured speakers at the ACR Washington, DC Metro Chapter’s inaugural advocacy session highlighted the College’s work as the voice of radiology on Capitol Hill.
Read more
Access on the Go
The emergence of mobile lung cancer screening has given patients better access to the care they need, while reducing screening disparities.
Read more
