Abstract
OBJECTIVES: Artificial intelligence (AI) promises to accelerate and democratize medical imaging, yet low- and middle-income countries (LMICs) face distinct barriers to adoption. This perspective identifies those barriers and proposes an action-oriented roadmap. MATERIALS AND METHODS: Insights were synthesized from a Johns Hopkins Science Diplomacy Hub workshop (18 experts in radiology, AI, and health policy) and a scoping review of peer-reviewed and grey literature. Workshop discussions were transcribed, thematically coded, and iteratively validated to reach consensus. RESULTS: Five interlocking barriers were prioritized: (1) infrastructure gaps-scarce imaging devices, unstable power, and limited bandwidth; (2) data deficiencies-small, non-representative, or ethically constrained datasets; (3) workforce shortages and brain drain; (4) uncertain ethical, regulatory, and medicolegal frameworks; and (5) financing and sustainability constraints. Case studies from Nigeria, Uganda, and Colombia showed that low-field MRI, cloud-based PACS, community-engaged data collection, and public-private partnerships can successfully mitigate several of these challenges. CONCLUSIONS: Targeted policy levers-including shared procurement of low-cost hardware, regional AI and data hubs, train-the-trainer workforce programs, and harmonized regulation-can enable LMIC health systems to deploy AI imaging responsibly, shorten diagnostic delays, and improve patient outcomes. Lessons are transferable to resource-constrained settings worldwide. KEY POINTS: Question How can LMICs overcome infrastructure, data, workforce, regulatory, and financing barriers to implement artificial-intelligence tools in clinical medical imaging? Findings Our multinational consensus identifies five obstacles and maps each to actionable levers: low-cost hardware, regional data hubs, train-the-trainer schemes, harmonized regulation, blended financing. Clinical relevance Implementing these targeted measures enables LMIC health systems to deploy AI imaging reliably, shorten diagnostic delays, and improve patient outcomes while reducing dependence on external expertise.