AI Adoption, Adaptation, and Workforce Sustainability in Medical Imaging: Systematic Review and Conceptual Framework

Background Despite growing recognition that AI-driven systems offer transformative benefits for diagnostic imaging, insufficient evidence exists regarding how medical imaging workforces adapt to AI technology to support workforce sustainability. Objective The aim of this study is to systematically review the existing literature on perceptions and attitudes toward AI adoption in medical imaging, postadoption adaptation behaviors within the workforce, and the implications of these processes for workforce sustainability. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was carried out across 7 databases. Thematic analysis was used to systematically identify, analyze, and interpret patterns across the literature, providing a comprehensive understanding of workforce perceptions and adaptation behaviors. Results A total of 69 peer-reviewed articles were included for thematic synthesis. The findings produced 6 critical factors that were identified as themes associated with AI adoption: perceived benefits, trust, readiness to change, autonomy and control, perceived threat to professional identity, and attitudes and intentions toward AI adoption and use. Four key facets of effective cognitive and behavioral adaptation were identified: training and skills development, task performance during AI-assisted practice, reduction of mental health burden and work strain, and policy compliance. The influence of work engagement and job satisfaction on workforce sustainability was also conceptualized. The findings were integrated into a framework describing the radiology workforce perspectives on AI adoption, adaptation behaviors, and workforce sustainability. Conclusions The findings have potential implications for policy, particularly in strengthening AI-equipped medical imaging systems, fostering trust in AI-driven technologies, and supporting workforce training and upskilling, while considering professional autonomy and role identity. The review highlights a research gap, emphasizing the need for further investigation into postadoption adaptation processes and informing policy development that links AI integration with long-term workforce sustainability in medical imaging.