The challenge of clinical adoption—the insurmountable obstacle that will stop machine learning?

Machine learning promises much in the field of radiology, both in terms of software that can directly analyse patient data and algorithms that can automatically perform other processes in the reporting pipeline. However, clinical practice remains largely untouched by such technology. This article highlights what we consider to be the major obstacles to widespread clinical adoption of machine learning software, namely: representative data and evidence, regulations, health economics, heterogeneity of the clinical environment and support and promotion. We argue that these issues are currently so substantial that machine learning will struggle to find acceptance beyond the narrow group of applications where the potential benefits are readily evident. In order that machine learning can fulfil its potential in radiology, a radical new approach is needed, where significant resources are directed at reducing impediments to translation rather than always being focused solely on development of the technology itself.