This commentary introduces agentic artificial intelligence (AI) as an emerging paradigm in radiology, marking a shift from passive, user-triggered tools to systems capable of autonomous workflow management, task planning, and clinical decision support. Agentic AI models may dynamically prioritize imaging studies, tailor recommendations based on patient history and scan context, and automate administrative follow-up tasks, offering potential gains in efficiency, triage accuracy, and cognitive support. While not yet widely implemented, early pilot studies and proof-of-concept applications highlight promising utility across high-volume and high-acuity settings. Key barriers, including limited clinical validation, evolving regulatory frameworks, and integration challenges, must be addressed to ensure safe, scalable deployment. Agentic AI represents a forward-looking evolution in radiology that warrants careful development and clinician-guided implementation.

BackgroundAdvancements in imaging technology, alongside increasing longevity and co-morbidities, have led to heightened demand for diagnostic radiology services. However, there is a shortfall in radiology and radiography staff to acquire, read and report on such imaging examinations. Artificial intelligence (AI) has been identified, notably by AI developers, as a potential solution to impact positively the workload of radiology services for diagnostics to address this staffing shortfall. MethodsA rapid review complemented with data from interviews with UK radiology service stakeholders was undertaken. ArXiv, Cochrane Library, Embase, Medline and Scopus databases were searched for publications in English published between 2007 and 2022. Following screening 110 full texts were included. Interviews with 15 radiology service managers, clinicians and academics were carried out between May and September 2022. ResultsMost literature was published in 2021 and 2022 with a distinct focus on AI for diagnostics of lung and chest disease (n = 25) notably COVID-19 and respiratory system cancers, closely followed by AI for breast screening (n = 23). AI contribution to streamline the workload of radiology services was categorised as autonomous, augmentative and assistive contributions. However, percentage estimates, of workload reduction, varied considerably with the most significant reduction identified in national screening programmes. AI was also recognised as aiding radiology services through providing second opinion, assisting in prioritisation of images for reading and improved quantification in diagnostics. Stakeholders saw AI as having the potential to remove some of the laborious work and contribute service resilience. ConclusionsThis review has shown there is limited data on real-world experiences from radiology services for the implementation of AI in clinical production. Autonomous, augmentative and assistive AI can, as noted in the article, decrease workload and aid reading and reporting, however the governance surrounding these advancements lags.

To assess changes in peer-reviewed evidence on commercially available radiological artificial intelligence (AI) products from 2020 to 2023, as a follow-up to a 2020 review of 100 products. A literature review was conducted, covering January 2015 to March 2023, focusing on CE-certified radiological AI products listed on www.healthairegister.com . Papers were categorised using the hierarchical model of efficacy: technical/diagnostic accuracy (levels 1-2), clinical decision-making and patient outcomes (levels 3-5), or socio-economic impact (level 6). Study features such as design, vendor independence, and multicentre/multinational data usage were also examined. By 2023, 173 CE-certified AI products from 90 vendors were identified, compared to 100 products in 2020. Products with peer-reviewed evidence increased from 36% to 66%, supported by 639 papers (up from 237). Diagnostic accuracy studies (level 2) remained predominant, though their share decreased from 65% to 57%. Studies addressing higher-efficacy levels (3-6) remained constant at 22% and 24%, with the number of products supported by such evidence increasing from 18% to 31%. Multicentre studies rose from 30% to 41% (p < 0.01). However, vendor-independent studies decreased (49% to 45%), as did multinational studies (15% to 11%) and prospective designs (19% to 16%), all with p > 0.05. The increase in peer-reviewed evidence and higher levels of evidence per product indicate maturation in the radiological AI market. However, the continued focus on lower-efficacy studies and reductions in vendor independence, multinational data, and prospective designs highlight persistent challenges in establishing unbiased, real-world evidence. Question Evaluating advancements in peer-reviewed evidence for CE-certified radiological AI products is crucial to understand their clinical adoption and impact. Findings CE-certified AI products with peer-reviewed evidence increased from 36% in 2020 to 66% in 2023, but the proportion of higher-level evidence papers (~24%) remained unchanged. Clinical relevance The study highlights increased validation of radiological AI products but underscores a continued lack of evidence on their clinical and socio-economic impact, which may limit these tools' safe and effective implementation into clinical workflows.

The integration of artificial intelligence (AI) in radiology may necessitate refinement of the competencies expected of radiologists. There is currently a lack of understanding on what competencies radiology residency programs should ensure their graduates attain related to AI. This study aimed to identify what knowledge, skills, and attitudes are important for radiologists to use AI safely and effectively in clinical practice. Following Arksey and O'Malley's methodology, a scoping review was conducted by searching electronic databases (PubMed, Embase, Scopus, and ERIC) for articles published between 2010 and 2024. Two reviewers independently screened articles based on the title and abstract and subsequently by full-text review. Data were extracted using a standardized form to identify the knowledge, skills, and attitudes surrounding AI that may be important for its safe and effective use. Of 5920 articles screened, 49 articles met inclusion criteria. Core competencies were related to AI model development, evaluation, clinical implementation, algorithm bias and handling discrepancies, regulation, ethics, medicolegal issues, and economics of AI. While some papers proposed competencies for radiologists focused on technical development of AI algorithms, other papers centered competencies around clinical implementation and use of AI. Current AI educational programming in radiology demonstrates substantial heterogeneity with a lack of consensus on the knowledge, skills, and attitudes for the safe and effective use of AI in radiology. Further research is needed to develop consensus on the core competencies for radiologists to safely and effectively use AI to support the integration of AI training and assessment into residency programs.

Artificial intelligence (AI) is rapidly advancing in health care, particularly in medical imaging, offering potential for improved efficiency and reduced workload. However, there is little systematic evidence on process factors for successful AI technology implementation into clinical workflows. This study aimed to systematically assess and synthesize the facilitators and barriers to AI implementation reported in studies evaluating AI solutions in routine medical imaging. We conducted a systematic review of 6 medical databases. Using a qualitative content analysis, we extracted the reported facilitators and barriers, outcomes, and moderators in the implementation process of AI. Two reviewers analyzed and categorized the data separately. We then used epistemic network analysis to explore their relationships across different stages of AI implementation. Our search yielded 13,756 records. After screening, we included 38 original studies in our final review. We identified 12 key dimensions and 37 subthemes that influence the implementation of AI in health care workflows. Key dimensions included evaluation of AI use and fit into workflow, with frequency depending considerably on the stage of the implementation process. In total, 20 themes were mentioned as both facilitators and barriers to AI implementation. Studies often focused predominantly on performance metrics over the experiences or outcomes of clinicians. This systematic review provides a thorough synthesis of facilitators and barriers to successful AI implementation in medical imaging. Our study highlights the usefulness of AI technologies in clinical care and the fit of their integration into routine clinical workflows. Most studies did not directly report facilitators and barriers to AI implementation, underscoring the importance of comprehensive reporting to foster knowledge sharing. Our findings reveal a predominant focus on technological aspects of AI adoption in clinical work, highlighting the need for holistic, human-centric consideration to fully leverage the potential of AI in health care. PROSPERO CRD42022303439; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022303439. RR2-10.2196/40485.

To evaluate the cost-effectiveness of AI-assisted digital mammography (AI-DM) compared to conventional biennial breast cancer digital mammography screening (cDM) with double reading of screening mammograms, and to investigate the change in cost-effectiveness based on four different sub-strategies of AI-DM. A decision-analytic state-transition Markov model was used to analyse the decision of whether to use cDM or AI-DM in breast cancer screening. In this Markov model, one-year cycles were used, and the analysis was performed from a healthcare perspective with a lifetime horizon. In the model, we analysed 1000 hypothetical individuals attending mammography screenings assessed with AI-DM compared with 1000 hypothetical individuals assessed with cDM. The total costs, including both screening-related costs and breast cancer-related costs, were €3,468,967 and €3,528,288 for AI-DM and cDM, respectively. AI-DM resulted in a cost saving of €59,320 compared to cDM. Per 1000 individuals, AI-DM gained 10.8 quality-adjusted life years (QALYs) compared to cDM. Gained QALYs at a lower cost means that the AI-DM screening strategy was dominant compared to cDM. Break-even occurred at the second screening at age 42 years. This analysis showed that AI-assisted mammography for biennial breast cancer screening in a Swedish population of women aged 40-74 years is a cost-saving strategy compared to a conventional strategy using double human screen reading. Further clinical studies are needed, as scenario analyses showed that other strategies, more dependent on AI, are also cost-saving. Question To evaluate the cost-effectiveness of AI-DM in comparison to conventional biennial breast cDM screening. Findings AI-DM is cost-effective, and the break-even point occurred at the second screening at age 42 years. Clinical relevance The implementation of AI is clearly cost-effective as it reduces the total cost for the healthcare system and simultaneously results in a gain in QALYs.

Artificial intelligence (AI) is already having a significant impact on healthcare. For example, AI-guided imaging can improve the diagnosis/treatment of vascular diseases, which affect over 200 million people globally. Recently, Chiu and colleagues (2024) developed an AI algorithm that supports nurses with no ultrasound training in diagnosing abdominal aortic aneurysms (AAA) with similar accuracy as ultrasound-trained physicians. This technology can therefore improve AAA screening; however, achieving clinical impact with new AI technologies requires careful consideration of commercialization strategies, including funding, compliance with safety and regulatory frameworks, health technology assessment, regulatory approval, reimbursement, and clinical guideline integration.

This study aimed to systematically map the development methods, scope, and limitations of existing artificial intelligence (AI) reporting guidelines in medicine and to explore their applicability to generative AI (GAI) tools, such as large language models (LLMs). We reported a scoping review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Five information sources were searched, including MEDLINE (via PubMed), EQUATOR Network, CNKI, FAIRsharing, and Google Scholar, from inception to December 31, 2024. Two reviewers independently screened records and extracted data using a predefined Excel template. Data included guideline characteristics (e.g., development methods, target audience, AI domain), adherence to EQUATOR Network recommendations, and consensus methodologies. Discrepancies were resolved by a third reviewer. 68 AI reporting guidelines were included. 48.5% focused on general AI, while only 7.4% addressed GAI/LLMs. Methodological rigor was limited: 39.7% described development processes, 42.6% involved multidisciplinary experts, and 33.8% followed EQUATOR recommendations. Significant overlap existed, particularly in medical imaging (20.6% of guidelines). GAI-specific guidelines (14.7%) lacked comprehensive coverage and methodological transparency. Existing AI reporting guidelines in medicine have suboptimal methodological rigor, redundancy, and insufficient coverage of GAI applications. Future and updated guidelines should prioritize standardized development processes, multidisciplinary collaboration, and expanded focus on emerging AI technologies like LLMs.

This review paper comprehensively summarizes healthcare provider (HCP) evaluation of explanations produced by explainable artificial intelligence methods to support point-of-care, patient-specific, clinical decision-making (CDM) within medical settings. It highlights the critical need to incorporate human-centered (HCP) evaluation approaches based on their CDM needs, processes, and goals. The review was conducted in Ovid Medline and Scopus databases, following the Institute of Medicine's methodological standards and PRISMA guidelines. An individual study appraisal was conducted using design-specific appraisal tools. MaxQDA software was used for data extraction and evidence table procedures. Of the 2673 unique records retrieved, 25 records were included in the final sample. Studies were excluded if they did not meet this review's definitions of HCP evaluation (1156), healthcare use (995), explainable AI (211), and primary research (285), and if they were not available in English (1). The sample focused primarily on physicians and diagnostic imaging use cases and revealed wide-ranging evaluation measures. The synthesis of sampled studies suggests a potential common measure of clinical explainability with 3 indicators of interpretability, fidelity, and clinical value. There is an opportunity to extend the current model-centered evaluation approaches to incorporate human-centered metrics, supporting the transition into practice. Future research should aim to clarify and expand key concepts in HCP evaluation, propose a comprehensive evaluation model positioned in current theoretical knowledge, and develop a valid instrument to support comparisons.

Artificial intelligence has become an impressive force manifesting itself in the radiology field, improving workflows, and influencing clinical decision-making. With this increasing presence, a closer look at how residents can be properly exposed to this technology is needed. Within this paper, we aim to discuss the three pillars central to a trainee's experience including education on AI, AI-Education tools, and clinical implementation of AI. An already overcrowded clinical residency curricula makes little room for a thorough AI education; the challenge of which may be overcome through longitudinal distinct educational tracks during residency or external courses offered through a variety of societies. In addition to teaching the fundamentals of AI, programs which offer education tools utilizing AI will improve on antiquated clinical curricula. These education tools are a growing field in research and industry offering a variety of unique opportunities to promote active inquiry, improved comprehension and overall clinical competence. The near 700 FDA-approved AI clinical tools almost guarantees that residents will be exposed to this technology which may have mixed effects on education, although more research needs to be done to further elucidate this challenge. Ethical considerations, including algorithmic bias, liability, and post-deployment monitoring, highlight the need for structured instruction and mentorship. As AI continues to evolve, residency programs must prioritize evidence-based, adaptable curricula to prepare future radiologists to critically assess, utilize, and contribute to AI advancements, ensuring that these tools complement rather than undermine clinical expertise.