Taking the mobile to the patient's home: A systematic review of domiciliary x-ray imaging

Ageing populations and associated co-morbidities are increasing demand for diagnostic imaging, while parallel political shifts in healthcare systems aim to move care closer to home. Domiciliary X-ray imaging (DXI) has emerged as a solution, supported by advances in portable digital radiography and remote reporting. This systematic review evaluates international evidence on DXI services, including patient populations, operational considerations, patient and clinical experiences, and economic outcomes.

A pre-registered systematic review was conducted in accordance with PRISMA. Searches of MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, and Web of Science ranged from inception to March 2026. Studies evaluating DXI services in home or care home settings were included. Data extraction and quality assessment (QuADS) were performed independently by two reviewers. Due to heterogeneity, findings were synthesised narratively.

Thirty-three geographically diverse studies were included, predominantly local service evaluations and pilot programmes. DXI services primarily targeted frail older adults with complex needs. Evidence predominately demonstrated improved patient experience, with reduced distress. Several studies reported avoided ambulance conveyance in at least half of cases with reductions in hospital admissions. Service delivery varied, with challenges including workforce training, radiation safety in non-clinical environments, and logistical constraints. Image quality was generally reported as clinically acceptable, with limitations noted in some scenarios. Economic analyses suggested potential cost-effectiveness, but long-term evaluations remain limited.

DXI is a promising approach for delivering patient-centred imaging in community settings. Evidence is dominated by small-scale observational studies, and further robust evaluation of diagnostic accuracy, long-term outcomes, and economic impact is needed.

DXI services require clear referral pathways, workforce training, and strong governance frameworks. Establishing best practice is essential as healthcare systems prioritise community-based care and admission avoidance models.