The impact of teleradiology: balancing clinical benefits and operational limitations.

PURPOSE: This review provides a global overview of the clinical benefits and operational limitations of teleradiology. It synthesizes evidence from diverse healthcare settings and considers how teleradiology may evolve alongside ongoing digital transformation. MATERIALS AND METHODS: Search and screening were informed by PRISMA principles and covered PubMed, Scopus, and Web of Science from 2018 to 2025. Eligible studies were peer-reviewed articles addressing the clinical use, operations, costs, and regulation of teleradiology, with an emphasis on international perspectives. RESULTS: Teleradiology improves access to subspecialty expertise and enables round-the-clock coverage; reported turnaround-time reductions reached up to 89% in individual studies, though the magnitude varied substantially by setting and should not be generalized as a single effect. It may also help reduce diagnostic disparities in resource-limited settings, though this benefit depends on local staffing and infrastructure. Reported cost savings vary by model; associated environmental benefits are plausible, but the evidence does not support a single generalized estimate of emissions reduction across service models. However, important limitations persist: unreliable internet connectivity remains a substantial and unevenly distributed barrier, particularly in rural and low-resource settings; missing prior imaging and incompatible PACS systems can reduce interpretation quality and completeness; and data security breaches remain a concern. Cross-border practice also raises legal challenges, with 82% of respondents in one national survey ranking liability concerns among the top barriers to adoption. CONCLUSION: Teleradiology has become central to contemporary radiology practice, advancing efficiency and equity in imaging access worldwide. Addressing its remaining challenges will require structured quality-assurance systems, interoperable and resilient digital infrastructure, practical regulatory evolution supporting cross-border licensing, and evidence-based integration of artificial intelligence with continued radiologist oversight.