International Perspectives on Remote Radiology
Teleradiology's rapid growth is transforming care delivery globally, with benefits that come bundled with challenges
In the early 1990s, data digitization and fast internet speeds ushered in the first possibilities for remote imaging as Nighthawk Radiology, a 24/7 teleradiology and telemedicine company, began offering overnight reading services.
In the decades that followed, radiology groups have continued to use external teleradiology to fill in staffing gaps, especially for studies conducted in the emergency department and for subspecialty expertise.
Yet it was the COVID pandemic and its fortuitous alignment with robust technological advancements that accelerated the use of teleradiology, with the help of integrated PACS and electronic medical record systems that enabled staff radiologists to work from home.
Current realities in the specialty—including high levels of burnout, workforce shortages, increasing work volumes and a growing trend toward subspecialization—are further expanding the use of teleradiology. Its impact, including the pros and cons, was the subject of an RSNA 2025 session highlighting teleradiology practice in Australasia, the U.S., Canada and Singapore.
“The global teleradiology market was about $15.5 billion in 2024 and is estimated to grow to nearly $60 billion by 2030,” said session presenter John P. Slavotinek, MBBS, president of the Royal Australian and New Zealand College of Radiologists. “That’s a compound annual growth rate of 25%—faster than the growth of imaging itself.”
Telework Gains Momentum in the U.S.
Radiology practices around the globe are now using three teleradiology models—external, internal and hybrid—to experiment with ways to improve efficiency, turnaround times and both radiologist and patient satisfaction.
In a 2021 American College of Radiology (ACR) and Radiology Business Management Association workforce survey, the majority of radiologists who responded stated that remote work was allowed at their workplace, and nearly 40% reported working remotely; another 44% wanted to telework in the future.
“It’s become almost mainstream now for practices to allow some sort of telework, whether external, internal or hybrid,” said Jay R. Parikh, MD, professor, from the Division of Diagnostic Imaging at the University of Texas MD Anderson Cancer Center in Houston, who moderated the session. “In a survey of 424 breast radiologists published in 2025, a third of respondents said they had home workstations and were reading breast exams remotely about a quarter of their clinical time.”
Ongoing pressures on recruitment and retention are the main drivers for practices to incorporate telework opportunities. “We have a real workforce shortage across this country that we’re all feeling,” Dr. Parikh said. “If you look at the ACR Career Center job postings, there’s been an exponential rise over the last decade, and those are only the jobs that are actually posted.”
Dr. Parikh said the newest generation of radiologists, and even several middle- and older-generation radiologists, value work-life balance and relief from the day-to-day grind. “Having work-life balance and empowering physicians with autonomy over their schedule helps mitigate burnout,” he said.
“Having work-life balance and empowering physicians with autonomy over their schedule helps mitigate burnout.”
— JAY R. PARIKH, MD
Remote Supervision Improves Canadian Mammography
Jean M. Seely, MD, who manages 12 radiologists in her breast imaging section at The Ottawa Hospital in Canada, said she is always looking for ways to enhance her team’s work experience.
She recently adopted a hybrid model that combines on-site procedures with remotely supervised diagnostic imaging at the system’s outlying community hospitals that span a 155-mile radius around the capital city.
“Driving to these hospitals several times a week was becoming tiring for our radiologists, and it can be dangerous on these roads,” said Dr. Seely, professor of radiology at the University of Ottawa. “We have to try to reach everybody, and yet we have a workforce shortage.”
In this hybrid model, technologists perform screening mammography and breast US without direct radiologist supervision at community sites. Diagnostic mammography and US are also performed by technologists at the sites, but a breast radiologist from a tertiary center reviews images in real time online before the patient leaves.
“The radiologist can request additional mammographic views, targeted ultrasound of specific areas, or more focused imaging, which reduces unnecessary return visits,” Dr. Seely said.
Benign or routine outcomes are communicated directly to the patient by the technologist, while the radiologist uses video conferencing to explain findings that require a biopsy.
Dr. Seely said the approach has cut travel time by at least 50%. “It's probably helping delay the retirement of some of my older staff because they're happy to reduce their travel, and at the same time, they find the work they do in the community hospitals very rewarding,” she said. “It's also definitely helping us appeal to younger radiologists who aren’t interested in a commute.”
The program has also improved patient satisfaction. “Patients appreciate not having to travel to a big academic center, and they're grateful to be able to talk to the radiologist,” she said. “Every woman leaves the diagnostic exam knowing what the next step is."
“Teleradiology connects patients to radiology expertise beyond the walls of a single hospital/imaging facility. For patients, this shift brings clear advantages: faster reporting times, access to subspecialists regardless of geography, and reduced need for travel.”
— NIKETA CHOTAI, MD
Expanding Access Amid Challenges
Ensuring underserved populations have access to diagnostic imaging is also a concern in Singapore. A network of polyclinics and four major hospitals serve the entire island’s population and is also a medical tourism hub for surrounding countries.
“The global shortage of radiologists means our services are not evenly distributed nor available to one and all,” said Niketa Chotai, MD, lead consultant radiologist at Radlink Women Imaging & Research Centre in Singapore. “Teleradiology connects patients to radiology expertise beyond the walls of a single hospital/imaging facility. For patients, this shift brings clear advantages: faster reporting times, access to subspecialists regardless of geography, and reduced need for travel.”
In emergency settings, cancer care and trauma imaging, Dr. Chotai noted that this timely access can significantly influence diagnosis and treatment options. “In many parts of the world, particularly rural or underserved regions, remote radiology is helping bridge long-standing gaps in access to imaging expertise,” she said.
Yet Dr. Chotai emphasized that this transformation also raises important questions from the patient’s perspective. “Concerns about data privacy, cross-border reporting and the potential loss of direct interaction with radiologists highlight the need for thoughtful implementation,” she said. “At the same time, emerging technologies such as artificial intelligence are beginning to enhance remote radiology by prioritizing urgent cases, supporting diagnostic accuracy and improving workflow efficiency.”
However, expanded access and speed alone are not enough, according to Dr. Chotai. “As health care systems continue to evolve, the future of imaging will likely lie in hybrid, patient-centered models that combine local clinical presence with global expertise—ensuring that the benefits of technology translate into more equitable, timely and trusted care for patients everywhere."
Balancing Access with Clinical Realities
Dr. Seely said her biggest challenge is not being able to physically examine a patient during a remote visit. “Sometimes there’s a benefit to actually laying eyes on the patient and examining what they're feeling,” she explained. “We have to recognize that some women we see remotely will have to come back on another day when there is an on-site radiologist."
When introducing the remote reading model to community sites, it’s also important to communicate the benefits to both staff and patients, invest in training technologists and establish standardized protocols. “We must help the community realize they aren’t losing anything, and that in fact they’re actually benefiting from remote reporting," Dr. Seely said.
Other teleradiology hurdles for practice leaders include licensing, credentialing, data security, privacy and patient trust issues. When looking to contract with an external firm, Dr. Slavotinek advises practices to begin with a clarity of purpose, objectives, KPIs and a budget before selecting a cost model. “Regular progress meetings should be held on an ongoing basis to measure financial impact, quality issues, and provide feedback,” he said.
Dr. Slavotinek said that of the teleradiology models, the hybrid option seems to offer the best of both worlds and the strongest strategic advantages. However, ongoing research will be important to specifically measure outcomes delivered by teleradiology.
“Obviously, the outcomes are of paramount importance, and we need to make sure the quality of care is at the highest levels,” Dr. Parikh said. “But I don’t think this train is stopping. It has left the station now. I can only envision that teleradiology is going to be increasingly prevalent in the future.”
For More Information
Read previous RSNA News stories on expanding access to radiology care:
- Bridging the Gap in Screening Access: Radiologists Lead the Way
- Building Radiology Excellence in Indonesia
Read previous RSNA News stories on teleradiology: