Building Sustainable Interventional Radiology in Low- and Middle-Income Countries: Lessons, Ethics, and a Global Roadmap for Training and Self-Reliance

Abstract Noncommunicable diseases and cancer account for an increasing share of global morbidity and mortality, with a disproportionate burden borne by low- and middle-income countries. Interventional radiology (IR) and interventional oncology provide minimally invasive and potentially cost-effective therapies, yet access to these services remains highly unequal because of limitations in imaging infrastructure, trained personnel, and sustainable supply chains. This review synthesizes evidence from global IR initiatives and outlines a framework for sustainable, locally driven program development in resource-constrained settings. Structural barriers to IR implementation are examined, including infrastructure fragility, workforce shortages, and challenges in consumable procurement. Existing models from sub-Saharan Africa and Asia demonstrate feasible pathways to capacity building through locally anchored training pipelines, train-the-trainer approaches, and national or regional accreditation mechanisms that support workforce retention and institutional legitimacy. Strategies for supply chain adaptation, cost-conscious technology use, and equipment optimization are discussed as system-level approaches that prioritize long-term functionality over episodic expansion. Ethical and cultural considerations are central to sustainable implementation. Programs aligned with local health system priorities, multidisciplinary team integration, and context-appropriate procedural scope show greater potential for durable impact and patient safety. Ethical frameworks emphasizing sustainability, reciprocity, and local leadership support a transition from short-term, externally driven interventions to institutionally anchored models of care. Overall, current evidence indicates that the central challenge is no longer whether IR can be established in low- and middle-income countries, but how it can be scaled responsibly and sustainably. With sustained investment, locally driven training pathways, and ethically grounded partnerships, IR can become a self-reliant and clinically impactful component of health systems across diverse resource settings.