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Abstract

Background and objective

Identifying the barriers and facilitators to teleradiology is paramount to increasing technology acceptance in healthcare environments. This study aims to analyze the barriers and facilitators to teleradiology use and to introduce solutions based on these factors to increase its adoption.

Materials and methods

This scoping review was conducted in accordance with the PRISMA-ScR statement and focused on studies that examined barriers and facilitators to the adoption of teleradiology. Web of Science (WoS), PubMed, Scopus, and Google Scholar were searched to identify relevant studies from their inception to 15 March 2025. The relevant data were extracted using a data extraction form and organized through qualitative content analysis.

Results

After database searches, 1126 studies were retrieved. Ten studies, comprising seven original research articles, one report, and two reviews, were included in this study for data extraction. One hundred and three obstacles and 140 facilitators were identified for the adoption of teleradiology, which were classified into five main themes: technology, management and organizational, legal and regulatory, individual, and data management. According to the current study, inadequate information and communication technology) infrastructure, as well as insufficient investment in infrastructure, equipment, and skilled IT personnel, are significant barriers to the adoption of teleradiology.

Conclusion

This review highlights the factors that impede and facilitate the adoption of teleradiology. Certain factors, such as the use of artificial intelligence algorithms in teleradiology, can act as influential facilitators in this field. Considering factors and integrating them into the work programs of various healthcare stakeholders is significant for enhancing informed decision making and increasing the acceptance of teleradiology in healthcare settings. Moreover, top-level managers and policymakers can consider these factors when developing a comprehensive community-level guideline to ensure standardized, effective implementation and use of teleradiology by various healthcare stakeholders, including healthcare providers, system designers, and healthcare managers.

Keywords

Teleradiology telemedicine barrier facilitator digital health

Highlights

This study identified barriers and facilitators influencing teleradiology acceptance.

Poor information and communication technology infrastructure, along with a lack of investment in equipment, skilled IT personnel, and infrastructure, were identified as the most significant barriers to teleradiology adoption.

The use of artificial intelligence algorithms in teleradiology tasks, better and more affordable access to higher-quality services, and opportunities for professionals to collaborate on radiology cases through digital connectivity are among the common factors driving teleradiology adoption.

Introduction

Digital communications technologies, as a part of recent advances in telecommunications, provide vital services to remote locations.^1,2 Telemedicine encompasses the delivery of remote health services via information and telecommunications technologies, taking into account the security of exchanged data regardless of geographical distance.^3,4 As a subfield of telemedicine, teleradiology refers to the electronic transmission of radiographic images from one geographic location to another.^1,5 Teleradiology is crucial in increasing access to high-quality radiology services and effective diagnostic reporting, and ultimately achieving universal health coverage.^6,7

This technology is crucial for the accessibility of specialized radiologists, enhancing the efficacy of radiology tasks and the diagnostic process, as well as for training radiologists to expand their knowledge of rare congenital and developmental diseases.⁸ The use of teleradiology has shown an increasing trend worldwide due to its significant contribution to improving the quality of patient care and increasing access to healthcare resources.^9,10

Identifying barriers to teleradiology use and identifying facilitators to mitigate their impact across various aspects, such as technological and organizational factors, is crucial to improving the adoption of this technology.¹¹ Despite the efficiency and cost-effectiveness of teleradiology, factors such as software and hardware costs create barriers to its application, requiring the attention of various healthcare stakeholders to develop effective solutions.¹²

This scoping review aims to identify barriers and facilitators to the adoption of teleradiology, drawing on existing literature. In this way, factors influencing teleradiology adoption across various countries are identified from the existing literature, and some of the more common factors will be synthesized. Understanding the hurdles and facilitators enables the development of targeted strategies to address issues and capitalize on motivator factors, ultimately enhancing access to radiology services, particularly in underserved regions, and improving patient care. The inclusive, adaptable, and iterative nature of scope reviews makes them different from other reviews. Despite other forms of knowledge synthesis, scoping reviews do not adhere to strict methodological rules and do not need to assess evidence quality. In this study, some evidence was in a narrative review without any methodological structure, and some obligatory aspects in systematic reviews, such as critical appraisal, could not be investigated in the scoping review.¹³

Methods

This scoping review adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement.¹⁴ This review article was not registered.

Data sources and search strategy

In this study, the scientific databases were searched from their inception to 15 March 2025, to identify studies on obstacles and facilitators to the use of teleradiology. To achieve comprehensive results, four databases were selected: Web of Science (WoS), PubMed, Scopus, and Google Scholar. PubMed focuses on life sciences and biomedical literature,¹⁵ while WoS retrieves highly impactful articles from a robust selection of journals and performs a citation analysis.¹⁶ Scopus encompasses a broad range of articles across various scientific fields.¹⁷ The issues regarding the reproducibility of the studies were resolved after entering the studies into EndNote Software and excluding duplicates. The gray literature in Google Scholar was not considered for this study. The author selected the search strategy by conducting several database searches using relevant keywords and analyzing the resulting articles. The search strategy is presented in Table 1.

Table 1.

Search strategy in databases.

Databases	Web of Science (WoS), PubMed, Scopus, and Google Scholar
#1	“teleradiology” OR “tele-radiology” OR “remote radiology” OR “tele-imaging” OR “teleimaging” OR “remote imaging”
#2	“barrier” OR “challenge” OR “impediment” OR “obstacle” OR “hindrance” OR “facilitator” OR “enabler” OR “adoption factor”
#3	#1 AND #2

Databases	Web of Science (WoS), PubMed, Scopus, and Google Scholar
#1	“telemedicine” [MeSH Terms] OR “digital health” [MeSH Terms] OR “telemedicine adoption” OR “eHealth” OR “virtual healthcare” OR “mHealth” OR “digital healthcare” OR “telehealth”
#2	“radiology” OR “imaging” OR “medical imaging”
#3	“barrier” OR “challenge” OR “impediment” OR “obstacle” OR “hindrance” OR “facilitator” OR “enabler” OR “adoption factor”
#4	#1 AND #2 AND #3

Eligibility criteria

The inclusion criteria were English-language studies published up to 15 March 2025, including original articles, conference papers, reviews, and reports, with a primary focus on obstacles and facilitators to teleradiology adoption. On the contrary, studies mainly focusing on the technological aspects of teleradiology rather than the barriers and facilitators, as well as short reports, books, e-books, theses, letters to the editor, preprints, articles without full-text access, and conference abstracts, were excluded from the current review.

Study selection

After searching the databases, we imported the studies into EndNote to find and eliminate duplicates. The study selection process consisted of three steps based on the eligibility criteria. Firstly, the author and a medical informatics (MI) expert independently reviewed studies retrieved from databases based on title and abstract relevance. Secondly, the remaining studies were reviewed against inclusion and exclusion criteria, and those that did not meet them were excluded. Thirdly, the author and an MI specialist independently reviewed the full text of the remaining studies. Articles without full-text access and those deemed irrelevant thematically were excluded, and the studies were finalized for inclusion in the scoping review.

Data extraction, charting, and synthesis

The author and an MI specialist independently extracted data from the literature. The data extraction process was conducted using a standardized data extraction form. This form included several fields, such as author, publication year, publication location, the study's aim, the type of participants, the settings that used teleradiology, and the barriers and facilitators to its use. Three MI specialists confirmed the content validity of the data extraction form. To measure inter-rater reliability for charting content, we calculated the agreement percentage between three MIs on data fields, defined as the number of agreement scores divided by the total number of scores (agreement rate > 90%). This process was performed independently by the author and an MI specialist. If any discrepancies arose between the two individuals in the data extraction results, they were referred to and discussed with another MI specialist during a joint meeting among three individuals to resolve the issue. Next, the author entered the data on barriers and facilitators separately into an Excel spreadsheet for cell formatting and spell checking, and categorized them across multiple attempts using qualitative content analysis. In this way, barriers and facilitating factors were examined and categorized thematically by searching for and finding similar keywords, and similar factors were merged. Finally, all the obstacles and facilitators to the use of teleradiology were classified based on similar themes. Data on study characteristics were presented using descriptive statistics (frequencies) and narrative analysis.

Results

Study selection

In total, 1126 studies were identified from WoS (n = 84), PubMed (n = 216), Scopus (n = 311), and Google Scholar (n = 515) in accordance with the research objectives. After excluding duplicates, 812 studies were obtained for the screening process. By screening studies by title (n = 351) and abstract (n = 211), 250 studies were selected for review based on the eligibility criteria. After screening studies based on inclusion and exclusion criteria, we excluded 226 studies. Twenty-four studies remained for full-text screening. Finally, 10 studies, including 2 reviews, 7 research articles, and 1 report, were included in this review after excluding studies related to full-text availability (n = 4) and relevance (n = 10). The PRISMA flow chart diagram regarding the study selection process is shown in Figure 1.

Figure 1.

The PRISMA flowchart of the study selection process.

Study characteristics

The characteristics of the included studies are presented in Table Supplemental-B. The key characteristics of the included studies are provided in Table 2.

Table 2.

The key characteristics of the included studies.

Author	Country	Objective	Type of study	Participants	Setting
Nigatu et al.¹⁸	Ethiopia	Aiming at exploring the factors facilitating and hindering the web-based teleradiology	Research (qualitative)	17 participants, including hospital managers, physicians, emergency surgeons, and radiologists	10 public hospitals, 93 health centers, and 405 health posts
Alanazi et al.¹⁹	Saudi Arabia	To synthesize evidence on the opportunities and challenges to technicians in integrating digital health technologies	Review	N/A	N/A
Goelz et al.²⁰	Germany	To identify obstacles, illustrate solutions, and drive development of a national teleradiology network	Report (qualitative)	Senior staff members	Berlin Trauma Hospital
Kalyanpur et al.²¹	India	To identify usage patterns, benefits, and challenges of teleradiology in Indian milieu	Research (retrospective)	Radiologists	Hospitals and diagnostic centers in India
Legido-Quigley et al.²²	UK	To identify factors supporting or impeding the expansion of teleradiology	Research (qualitative)	Managerial roles and health professionals	Telemedicine Clinic in Barcelona
Yemeshev et al.²³	Turkey	To assess how teleradiology has improved quality of diagnosis, facilitated timely consultations, and increased access to specialized imaging and knowledge, particularly in underserved regions	Review	N/A	N/A
Johnston et al.²⁴	Australia	To identify critical factors for the challenges and enablers of the successful implementation and operation of a high quality teleradiology model	Research (qualitative)	Medical officers, breast nurses, remote radiologists, radiographers, sonographers, data managers, data administrators, health promotion officers and managers	Four BreastScreen services delivering remote radiology assessment services, including two outer regional Australia, one inner regional Australia, and one metropolitan Australia
Mahaer et al.²⁵	Iran	To identify and prioritize factors influencing the establishment of teleradiology	Research (cross-sectional and descriptive)	30 experts in radiology, information technology (IT), health insurance, health services management, and health information technology (HIT)	One public hospital in Tehran
Schoeman et al.²⁶	South Africa	To report radiologists’ experiences and perceptions regarding the benefits, opportunities, and barriers of implementing teleradiology	Research (qualitative)	82 radiologists	Public and private sectors
Hanna et al.²⁷	USA	Reviewing licensing and regulations, and discussing teleradiology in providing services to rural areas and assisting in disaster response	Review	N/A	N/A

Time and location of publications

Most studies were carried out in 2020 (n = 2) and 2024 (n = 2). Six publications were performed in 2014 (n = 1), 2016 (n = 1), 2018 (n = 1), 2021 (n = 1), 2023 (n = 1), and 2025 (n = 1). According to Table 2, these studies were conducted in various countries, including Ethiopia (n = 1), Saudi Arabia (n = 1), Germany (n = 1), India (n = 1), the United Kingdom (n = 1), Turkey (n = 1), Australia (n = 1), Iran (n = 1), South Africa (n = 1), and the United States (n = 1).

Participant feedback and settings that used teleradiology

According to Table 2, the participants were individuals who were directly or indirectly affected by teleradiology services or utilized this technology and were considered stakeholders. Their feedback reflects these stakeholders’ assessment of the barriers and facilitators of teleradiology. The majority of participants were radiologists (n = 6), followed by hospital managers (n = 4), health professionals (n = 2), and health information technology experts (n = 2). The frequency with which clinical centers leveraged teleradiology services is shown in Figure 2. More services were carried out in public hospitals (n = 4). Other clinical centers that provided teleradiology services were health centers (n = 1), trauma hospitals (n = 1), health posts (n = 1), diagnostic centers (n = 1), telemedicine clinics (n = 1), breast screening centers (n = 1), and private hospitals (n = 1).

Figure 2.

The clinical centers that utilized teleradiology services.

Obstacles to teleradiology adoption

Obstacles to the adoption of teleradiology are presented in Table Supplemental-C-1. In total, 103 barriers to the adoption of teleradiology were identified. As shown in this table, the barriers were categorized into technological, managerial and organizational, legal and regulatory, data management, and personal factors. Generally, managerial and organizational factors, including poor information and communication technology (ICT) infrastructure^18–20^,23,24,26 and a lack of investment in infrastructure, equipment, and skilled IT personnel,^18–20^,22,26 were more common barriers to the use of teleradiology. Low internet bandwidth,^18,27 poor ICT infrastructure,^18–20^,23,24,26 lack of access to reliable network and stable and fast internet connection,^18,20,23,27 technical issues regarding system accretion and interoperability,^18–20^,27 and heterogeneity of technical systems at sites (RIS/HIS/PACS)^20,23 were the more frequent technological barriers to the adoption of teleradiology. Lack of investment in infrastructure, equipment, and skilled IT personnel,^18–20^,22,26 insufficient incentives,^18,19 lack of awareness,^18,21,23 high startup costs,^21,23,26 lack of quality assurance measures,^21–24 expensive equipment and software,^25,26 lack of effective communication and collaboration between healthcare professionals,^18,26 absence of technical specialists in the field,^18,23 lack of on-site IT support,^18,21,24,26 and lack of culture in relation to technological progress^18,19 were most common managerial and organizational hindrances. Insufficient legal and regulatory guidelines,^18,21,22 a lack of robust governance, policy, and safeguards to protect data privacy, abuse, and data breaches,^19,22 and lack of legal, ethical, and technical considerations in data protection^19,22,23 were the most common legal and regulatory barriers to teleradiology. Lack of knowledge, competence, and confidence in using and adapting digital health technologies,^18,19 insufficient technical skills,^18,19 and language barriers^19,22 were identified as more critical personal barriers. Risks and vulnerabilities in the collection, storage, exchange, and use of sensitive data and images were a more common data management obstacle to the adoption of teleradiology.

Facilitators of teleradiology adoption

Factors facilitating the adoption of teleradiology are presented in Table Supplemental-C-2. In total, 140 facilitators of teleradiology adoption were obtained and categorized into technological, managerial and organizational, legal and regulatory, personal, and data management themes. As shown in this table, the use of artificial intelligence (AI) approaches in radiology tasks,^19,20,23,27 standardization and use of established protocols in teleradiology,^23,25 as well as quality of communication equipment and imaging devices,^24,25 were identified as more frequent technological factors. Regulatory requirements and data protection considerations^20,25 were identified as the most common regulatory factors affecting teleradiology adoption. Investment in national infrastructure,^20,25 saving time and reducing unnecessary costs.^18,19,26 Providing decision support and quality assurance,^19,22 increasing access, affordability, and quality of screening services and specialists,^19,22,26 self-training and ongoing training of employees,^20,25 significant advances in routine tasks,^23,26 high-quality and efficient radiology reports,^18,21,26 increased engagement of international radiologists,^18,22 ability for specialists to collaborate with radiologists from anywhere and via the internet at any time,^18,22,23,26 involvement of experts in initial discussions and during implementation,^24,25 strong leadership in exemplary work within organizations,^18,22 specific talents/skills/education of employees in relation to technical aspects,^20,24 open organizational culture for new ideas and hazards,^24,26 time required for participants to adapt to different workflows and team dynamics,^24,25 and individual radiologist productivity for more optimal utilization^21,22 were more common managerial and organizational facilitators. More flexibility for radiologists to better balance their personal and professional lives^22,26 was obtained as one critical enabler of teleradiology adoption.

Sensitivity analysis of factors

The results of a study-identifying factors influencing teleradiology adoption in a low-income country¹⁸ show that more barriers are related to technological aspects. Excluding this study's results would mitigate the technological hurdle for the current study, as most primary studies were conducted in high-income countries. All reviews conducted in the United States,²⁷ Turkey,²³ and Saudi Arabia¹⁹ underscore various legal and regulatory hindrances affecting teleradiology. By ignoring these studies, many legal and regulatory aspects would be excluded from this study. Additionally, the study in Iran²⁵ examines the costs associated with various aspects of technology, including improvements to communication infrastructure, equipment, and software, as well as employee training, while considering the economic implications of different technological and organizational dimensions of healthcare settings. Studies on this topic in South Africa,²⁶ Australia,²⁴ and India²¹ primarily focused on administrative factors affecting teleradiology, and excluding these studies would decrease the importance of administrative and organizational factors in the scoping review.

Discussion

Primary findings

This scoping review examined the barriers and facilitators to teleradiology adoption, drawing on feedback from various healthcare stakeholders. Our review comprised 10 studies conducted between 2014 and 2024 across different countries, including Ethiopia, Saudi Arabia, Germany, India, the United Kingdom, Turkey, Australia, Iran, South Africa, and the United States. Hospital managers and radiologists were more frequent participants, and their feedback was extracted regarding the adoption of teleradiology. Furthermore, public hospitals used teleradiology more frequently than other clinical settings. One hundred and three obstacles and 140 facilitators to teleradiology were identified after extracting data from the primary studies and conducting qualitative analysis. They were categorized into technological, management and organizational, legal and regulatory, personal, and data management factors.

To date, several reviews have examined the obstacles and facilitators influencing the adoption of teleradiology in healthcare. Alanazi et al.¹⁹ conducted a systematic review to synthesize evidence on the opportunities and challenges faced by technicians in integrating digital health technologies. They primarily focused on the legal and organizational hurdles, as well as the technological facilitators, affecting this technology. In a review by Yemeshev et al.,²³ the authors focused on various aspects of teleradiology adoption in healthcare, including technological, legal, and data management hurdles, as well as technological and organizational themes. Hanna et al.²⁷ conducted a narrative review aimed at investigating licensing and regulations, as well as discussing teleradiology in providing services to rural areas and assisting in disaster response. Additionally, they examined some technological and organizational hurdles and enablers to the adoption of teleradiology in healthcare. In this scoping review, we synthesized the obstacles and facilitators affecting teleradiology adoption in healthcare across various countries, ranging from low- to high-income countries and from developing to developed nations, to provide a more comprehensive insight into the factors influencing the global use of teleradiology.

The following sections outline additional critical barriers to the use of teleradiology and present, as facilitators, solutions to mitigate their negative impact, based on insights from the existing literature.

Technological factors

Poor ICT infrastructure,^18–20^,23,24,26 low internet bandwidth,^18,27 and lack of access to a reliable network and stable, fast internet connection^18,20,23,27 are the most common technological factors hindering the adoption of teleradiology. Some factors such as increasing investment in national infrastructure,^20,25 reducing costs by prevailing market-based ideology among providers in countries, reducing unnecessary expenses,^18,19,26 integrating digital health and informatics as training content to increase staff familiarity with teleradiology,¹⁹ and leveraging self-training and ongoing training of staff^20,25 are important for managers and policymakers to enhance the adoption of teleradiology in healthcare. The cost-effectiveness of technology²⁶ is significantly effective in reducing the adverse impact of inappropriate initial funding that hinders technology adoption. Technical issues regarding system integration and interoperability^18–20^,27 and the heterogeneity of technical systems, such as RIS, HIS, and PACS^20,23 are two highlighted technological barriers that require further investigation. The use of capabilities, such as utilizing interoperability standards and protocols such as DICOM for image format and HL7 for communication, along with IHE profiles for special workflows in teleradiology,^23,25 evidence-based technical standards,²⁷ and the multiclient capability of RIS/PACS²⁰ for adaptability of information systems, are efficient in optimizing the flexibility of teleradiology adoption. Teleradiology and AI exhibit significant synergies in improving healthcare delivery mechanisms, addressing the same fundamental issue of radiologist shortages.²⁸ The employment of AI in teleradiology is a significant aspect in enhancing various tasks in this field and is a more common enabler that should be considered.^19,20,23,27 Key benefits of AI systems used in medical imaging sciences include improved workflow, shortened examination times, reduced intravenous contrast and radiation dose, earlier disease detection, enhanced diagnostic accuracy, and more individualized diagnoses.²⁹

Managerial and organizational factors

Key barriers include the lack of investment in infrastructure, equipment, and skilled IT personnel,^18–20^,22,26 as well as the costs of equipment and software,^25,26 which are significant organizational factors hindering the acceptance of teleradiology. Investments in national infrastructure,^20,25 reducing unnecessary expenses of other organizational aspects, suspending teleradiology acceptance,^18,19,26 and cost-effective and sustainable opportunities covering the lack of experts, human resources, technology, and infrastructure²⁶ are financial and more tangible determinants enhancing the teleradiology adoption. Furthermore, considering human factors and indirect influencing factors, including the unification of digital health and informatics as training content,¹⁹ reducing operational and hidden costs (delayed diagnosis, mortality, increased hospital stays, and unnecessary transfers between facilities),²⁶ enthusiastic and capable staff and functional equipment,²⁶ employment of a medical physics expert,²⁰ self-studies, ongoing education of employees,^20,25 providing facilities such as training and conferences via video-conferencing,²⁰ reducing costs by prevailing market-based ideology among providers in countries,²² establishing an open organizational culture to new ideas and hazards,^24,26 specific talents/skills/education of staff concerning technical aspects,^20,24 continuous personal contacts/dialogue,²⁰ close cooperation between radiology and IT departments²⁰ are among facilitators that can be considered to minimize the impact of this challenge. Insufficient organizational incentives^18,19 and lack of awareness^18,21,23 are critical managerial and organizational obstacles in the studies investigating the leverage of teleradiology. To address these challenges, introducing some opportunities to staff, such as providing emergency services,²¹ reducing backlog,²¹ providing subspecialist reporting,²¹ providing services to remote locations,²¹ expediting and standardizing reporting,²¹ reducing costs by prevailing market-based ideology among providers in countries,²² significant advances in routine tasks^23,26 reductions in reporting time,²³ greater flexibility in working hours and ability of sharing knowledge with larger groups,²² high-quality radiology reports,^18,21,26 increased engagement of international radiologists,^18,22 holding briefing sessions to improve employee adaptability,²⁵ expanding learning opportunities by using global radiologists,²⁶ organizational change management,²⁶ and engaging specialists in initial discussions and throughout the implementation and decision-making process,^24–26 are key facilitators to enhance the acceptance of teleradiology.

The high startup cost^21,23,26 is another challenge affecting the acceptance of teleradiology. Some assistive solutions to mitigate this issue are cost-benefit of unlimited access to resources from other facilities and reduced infrastructure,²⁶ reducing operational and hidden costs (delayed diagnosis, mortality, increased hospital stays, and unnecessary transfers between facilities),²⁶ offset of the initial investment by long-term cost savings,²⁶ cost-effective and sustainable opportunity covering the lack of experts, human resources, technology, and infrastructure,²⁶ and lowering data costs²⁶ are considered to decrease the effects of this barrier to the adoption of teleradiology.

The critical managerial and organizational barriers include a lack of effective communication and collaboration among healthcare professionals and the absence of a culture that assists technological progress. Continuous personal contacts/dialogue in organizations,²⁰ open organizational culture to exchange new ideas and hazards,^24,26 strong and solid working relationships built on the importance of trust and good communication between team members,²⁴ and involving key people in organizations in a participatory manner²⁴ are among the managerial and organizational facilitators to enhance the efficacy of communications and professional performance. The lack of quality assurance measures^21–24 is a significant hindrance that affects the quality of images, such as X-rays. This factor compromises patient and staff safety, leading to errors in radiology tasks. The provision of decision support and quality assurance,^19,22 high-quality and efficient radiology reports,^18,21,26 accurate report reviewed by the appropriate professionals,¹⁸ reduction in the turnaround time,¹⁸ and enhancing the availability, affordability, and quality of radiological screening services^19,22,26 are influential facilitators to improve the quality of images and organizational procedures. Also, the absence of technical specialists in the field and the lack of on-site IT support would be minimized by employing IT support,²⁶ close cooperation between radiology and IT departments,²⁰ and leveraging on-site and off-site IT experts.²⁰

Legal and regulatory factors

Legal and regulatory factors significantly influence the acceptance of teleradiology. New legal issues arise in the adoption of teleradiology, which distinguishes it from other technologies. Despite teleradiology, there is a more apparent distinction between the physician's and the patient's roles in telemedicine. In teleradiology, physicians act as consultants, and the relationships between patients and physicians are more sophisticated. Therefore, identifying and clarifying the legal and regulatory aspects and responsibilities is crucial throughout the complex teleradiology tasks.³⁰ However, one additional centralized factor in this respect is establishing a legal and regulatory framework regarding data protection,^20,25 which should be given close attention during the adoption and implementation of teleradiology.

Inadequate legal and regulatory guidelines,^18,21,22 lack of robust governance, policies, and safeguards to protect data privacy, abuse, and breaches,^19,22 and lack of legal, ethical, and technical aspects of data protection^19,22,23 are among the frequent challenges that negatively impact the adoption of teleradiology. Using regulative requirements and data protection aspects,^20,25 establishing guidelines for the use of teleradiology,²⁴ establishing and applying national and jurisdictional regulations,²⁴ enforcing computer crime laws,²⁵ establishing and applying laws on performing activities in cyberspace,²⁵ establishing and applying laws on maintaining the safety of patient information,²⁵ and establishing and applying laws on patient rights²⁵ are essential legal and regulatory enablers in decreasing the adverse impact of barriers to the adoption of this technology.

Individual factors

Individual factors play a crucial role in determining the acceptance of teleradiology. For example, other studies have demonstrated that the perceived usefulness and convenience of the technology significantly influence its use.³¹ The lack of knowledge, competence, and confidence in using and adapting to digital health technologies^18,19 is one crucial personal hindrance to adopting teleradiology. Understanding the diverse needs of teleradiology users is vital to its widespread acceptance. Education is a critical factor for both cultural development and technological advancement. It should be considered for users at various levels, such as technologists and radiologists. Moreover, educational content must be prepared, updated, and made available in multiple formats depending on different level requirements.²⁵ Mitigating human errors and variability¹⁹ and having the knowledge, skills, and competencies necessary to effectively utilize and integrate digital health technologies into their profession are crucial enablers. Moreover, increasing the patients’ participation in radiology screening,¹⁹ promoting patients’ adherence to screening recommendations and followup,¹⁹ enhancing patients’ communication and satisfaction with radiology services,¹⁹ increasing patients’ knowledge, motivation, and compliance with screening guidelines,¹⁹ aligning the competency frameworks with the digital skills and knowledge,¹⁹ and employing skilled and trustworthy physicians²⁶ are paramount in increasing the involvement of patients and physicians and obtaining occupational skills, knowledge, and confidence for the use of teleradiology services.

Insufficient technical skill^18,19 is another personal barrier significantly influencing the acceptance of teleradiology. Using jurisdictional level managerial and technological experts,²⁴ supporting clinics with training and technical advice,²⁴ employing IT support,²⁶ using governmental support and policies,²⁶ providing close cooperation between radiology and IT departments²⁰ and using IT experts on-site and off-site²⁰ are influential enablers to enhance the chance of teleradiology acceptance.

Data management factors

Data management is an essential factor that has received less attention in previous studies. However, given the more complex processes and data types used in teleradiology, we should examine the data flow in greater detail. Sensitivity in data and images belonging to patients^19,27 is highlighted as a data management hindrance that should be considered when establishing effective preventive strategies to facilitate the adoption of teleradiology. Enhancing data integrity and data encryption,²⁵ monitoring the data privacy processes,²⁴ providing regulative requirements for data protection,^20,25 establishing guidelines for the use of teleradiology,²⁴ enforcing computer crime laws,²⁵ establishing laws on performing activities in cyberspace,²⁵ establishing laws on maintaining the safety of patient information,²⁵ establishing laws on liability and tracking errors,²⁵ and establishing laws on patient rights²⁵ would significantly improve the data protection to increase the acceptance of teleradiology.

Establishing robust policies and standards to ensure the quality of data analysis and data exchange in teleradiology is critical, as it addresses the risks and vulnerabilities associated with the collection, storage, sharing, and use of sensitive patient data and images.^19,27 It will enhance the data accessibility and quality of diagnostic results in teleradiology for various stakeholders, ultimately leading to better clinical decision making and improved quality of care. So, it should be considered in future studies investigating the adoption factors of teleradiology.

Comparison of influential factors across countries

This scoping review identifies significant differences in the types and frequencies of influential factors affecting teleradiology adoption in healthcare. Some hurdles to teleradiology adoption in healthcare in developing or less developed countries, such as Iran and Ethiopia,^18,25 are more related to technological issues and the cost of technologies. In contrast, in developed countries, such as the United Kingdom,²² South Africa,²⁶ and Australia,²⁴ the themes primarily focus on managerial or legal factors. However, this evidence is not generalizable to all developed countries. For example, in the United States, some technological factors, such as a lack of technology and systems integration, variety in imaging quality and protocols, the use of different imaging hardware, advanced communication protocols, and technology-related issues, such as an unreliable internet connection, are still considered frequent obstacles that should be considered. In Germany,²⁰ technological factors such as the heterogeneity of technical systems at sites (RIS/HIS/PACS), a sophisticated teleradiology network, an initially underdeveloped architecture of RIS/PACS, and a lack of HL7 for integration are core hindrances to the use of teleradiology. In high-income countries, such as the United States,²⁷ Saudi Arabia,¹⁹ and Turkey,²³ using an AI approach is regarded as a facilitating factor of teleradiology, while in low-income and middle-income countries, such as Ethiopia and Iran,^18,25 utilizing AI, such as ML or DL, is not considered. Although using AI for teleradiology tasks is costly for healthcare organizations, this technology is being implemented in high-income countries due to its potential to enhance the quality and speed of teleradiology services. In high-income countries, such as India²¹ and the United Kingdom,²² the focus is more on the lack of training of various teleradiology stakeholders. In contrast, in middle-income countries, such as Iran, the issues were more related to the cost of education. However, in both groups, it indicates the importance of education in enhancing the knowledge of various stakehodels of teleradiology for better acceptance, and reducing their resistance in utilizing technology in healthcare environments.

Limitations and future implications

Although this review was conducted within a broader scope, incorporating feedback from various healthcare stakeholders on teleradiology across different countries, it had limitations that should be considered. We investigated English papers in 4 databases: WoS, PubMed, Scopus, and Google Scholar, and obtained 10 studies for data extraction. For future studies, we recommend considering non-English articles and other scientific databases to identify additional studies and provide more comprehensive results on this topic, thereby strengthening the evidence. Also, the full texts of four articles were unavailable, which may affect the frequency of hurdles and facilitators and the generalizability of the synthesis to some extent. This scoping review failed to assess the frequency analysis of factors across conditions, such as study quality, sample size, or context, as the variations in the primary studies’ designs and methodologies were high in the included studies, given the various study types (e.g. qualitative or quantitative research, or narratives), and limited contextual information. The factors were assessed qualitatively based on their frequency of occurrence in various studies. Moreover, using specific primary studies with particular characteristics, for example, narrative reviews without specific methodologies, hindered the ability to conduct a critical appraisal and quality assessment of the studies.

Conclusion

The current scoping review aimed to identify obstacles and facilitators to teleradiology adoption and analyze these factors to enhance acceptance. One hundred three barriers and 140 facilitators were extracted from the existing literature and categorized into five themes: technological, managerial and organizational, legal and regulatory, individual, and data management. Technological, managerial, and organizational barriers and facilitators, such as inadequate ICT infrastructure and a lack of investment in infrastructure, equipment, and skilled IT personnel, as well as the utilization of AI algorithms, were identified as the most common factors influencing the adoption of teleradiology. Future studies should consider these hurdles and facilitators to gain a deeper understanding of these critical factors and enhance the acceptability of this essential technology in healthcare.

Overcoming obstacles and leveraging facilitators is essential to optimizing teleradiology and enhancing service delivery and patient outcomes. Additionally, the findings of this review, and specifically more common factors, such as utilizing AI approach and enhancing IT infrastructures and skills are beneficial for managers and policymakers in implementing guidelines or roadmaps at national and jurisdictional levels, thereby standardizing and improving the use, implementation, and adaptability of this technology among various healthcare stakeholders, including technology designers, healthcare managers, and healthcare providers.

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Supplemental material, sj-docx-3-dhj-10.1177_20552076261419231 for Obstacles and facilitators of teleradiology adoption in healthcare: A scoping review by Raoof Nopour in DIGITAL HEALTH

Footnotes

Acknowledgments

We thank all the specialists who assisted us in all steps of this study.

ORCID iD

Raoof Nopour

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Contributorship

RN conducted the writing, review, and editing of this manuscript.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Guarantor

RN.

Availability of data and materials

All data generated and analyzed are included in this article.

Supplemental material

Supplemental material for this article is available online.

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