Who reads the scan? quality, accountability, and appropriateness in the era of outsourced radiology: a perspective from Türkiye.

The rapid expansion of medical imaging, increasing demand for rapid reporting, workforce shortages, and advances in digital health infrastructure have facilitated the widespread adoption of teleradiology and outsourced radiology services. These models may improve access, turnaround time, and subspecialty coverage, particularly in regions with limited radiological resources. However, outsourcing also introduces challenges related to quality assurance, radiologist accountability, workload transparency, reporting standardization, appropriateness of imaging, duplicate examinations, and continuity of care. Türkiye has developed a national teleradiology infrastructure that enables remote access to imaging examinations, reporting, teleconsultation, and quality assessment. The Turkish Society of Radiology (TSR) has established guidelines stating that teleradiology should meet the same quality criteria as onsite radiology and should be supported by written quality-control, quality-improvement, and patient-safety plans [2]. This perspective proposes a national quality framework for outsourced and teleradiology services based on five principles: radiologist-level traceability, standardized quality assurance, appropriateness-based imaging, prevention of duplicate examinations, and transparent measurement of patient- and system-level outcomes. Outsourcing itself should not be regarded as inherently detrimental; rather, outsourcing without measurable quality assurance and accountability represents the greater risk. Importantly, this framework is a normative proposal rather than a validated quality-improvement intervention. Components already supported by professional-society guidance are distinguished from proposed national integration and measurement elements, and the framework requires prospective evaluation before any effectiveness claim can be made.