Barriers in Integrating Medical Visual Question Answering into Radiology Workflows: A Scoping Review and Clinicians' Insights

Medical Visual Question Answering (MedVQA) is a promising tool to assist radiologists by automating medical image interpretation through question answering. Despite advances in models and datasets, MedVQA's integration into clinical workflows remains limited. This study systematically reviews 68 publications (2018-2024) and surveys 50 clinicians from India and Thailand to examine MedVQA's practical utility, challenges, and gaps. Following the Arksey and O'Malley scoping review framework, we used a two-pronged approach: (1) reviewing studies to identify key concepts, advancements, and research gaps in radiology workflows, and (2) surveying clinicians to capture their perspectives on MedVQA's clinical relevance. Our review reveals that nearly 60% of QA pairs are non-diagnostic and lack clinical relevance. Most datasets and models do not support multi-view, multi-resolution imaging, EHR integration, or domain knowledge, features essential for clinical diagnosis. Furthermore, there is a clear mismatch between current evaluation metrics and clinical needs. The clinician survey confirms this disconnect: only 29.8% consider MedVQA systems highly useful. Key concerns include the absence of patient history or domain knowledge (87.2%), preference for manually curated datasets (51.1%), and the need for multi-view image support (78.7%). Additionally, 66% favor models focused on specific anatomical regions, and 89.4% prefer dialogue-based interactive systems. While MedVQA shows strong potential, challenges such as limited multimodal analysis, lack of patient context, and misaligned evaluation approaches must be addressed for effective clinical integration.