Article Type

Original Research

Publication Date





Purpose: This research aims to understand key problems and identify possible solutions in the market for radiology equipment in low- and middle-income countries.

Methods and Materials: This paper uses simple descriptive statistics to summarize the results of responses from 574 radiologists from 52 countries surveyed in April-May 2017, and 15 hardware and software vendors from six countries surveyed in September-October 2017.

Results: Radiologists surveyed came from both public and private sectors and were drawn from Radiological Society of North America (RSNA) members who, according to the survey results, appear to represent sites with more advanced technology. Virtually all the radiologists worked at sites where both X-ray and ultrasound were available, and the overwhelming majority (93%) had access to CT. Digital technology has gone worldwide: radiologists in all countries reported that digital radiography was either equally or more available than analog technologies. Sixty percent of radiologists said that they were “always” or “often” involved in the purchasing decisions in their institutions, but only 35% reported that they had the final say. According to the radiologists surveyed, the era of donated equipment is ending. Ninety-five percent felt that the disadvantages of donated equipment outweighed the cost savings. Training was a key concern both for radiologists and vendors. Radiologists felt that training was insufficient, materials left behind too complicated, online materials too limited, and follow-up from vendors insufficient. Vendors pointed out that the bidding process often excluded the cost of training and support and that many purchases are made through local distributors and they lack direct contact with vendors.

Conclusion: While digital radiology is spreading throughout the surveyed countries, access to advanced imaging remains limited. Donated equipment is no longer a major solution to limited equipment availability. There is an opportunity for vendors and radiologists to work together to ensure that training, service and support are always included in purchases.


Radiology, training, equipment donations, vendors, low- and middle-income countries, diagnostic imaging

Rights and Permissions

© 2019 DeStigter, Horton, Atalabi, Garcia-Monaco, Gharbi, Hlabangana, Nisenbaum, Nolsøe, Mendel.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.


The authors thank the RSNA Committee on International Radiology Education, the RSNA Information Management Team and the RSNA Survey Research Team for assistance in finalizing and distributing the survey, de-identifying the responses and assisting with analysis. The authors would also like to thank Kate Emshoff for administrative support and Devanshi Shah for assistance with a literature search.

Article Correction History

Dr. Mendel's name should be listed as Jeffrey Brian Mendel.

Corresponding Author(s)

Kristen DeStigter, MD, University of Vermont Health Center, 111 Colchester Ave, Burlington, VT, 05401; Kristen.destigter@uvmhealth.org