Rationale: This paper aims to identify factors that support or impede the introduction and expansion of teleradiology across borders in the European Union (EU), focusing on both those factors acting within countries and those that are specifically cross-border as well as discussing how the current EU legislation impacts on the provision of this type of services. Methods: A qualitative study was developed to explore the issues that arise when implementing teleradiology services across European borders. A total of 12 semi-structured interviews with key actors were conducted, recorded and fully transcribed. These were analysed using thematic analysis. Results: The factors supporting provision of new services in teleradiology were increasing demand for reading images in countries with few radiologists; long waiting lists for MRI reading; and new demand for second and sub-specialized reading of images. The obstacles to the introduction and expansion of teleradiology services included uncertainty about liability in case of malpractice, registration of health care professionals, data security, non-standard contracts and quality reporting systems; and health care system and cultural differences. Radiologists identified as positive experiences the chance to learn and improve their skills in a shorter period of time, having flexibility, and sharing knowledge in a network environment. The most frequently reported negative aspect was the inability to interact with referring clinicians. Language barriers were not identified as a constraint. When asked about policy implications and potential recommendations, participants proposed the introduction of EU wide policies on radiologists' credentials; greater clarity within the EU on data access and sharing; and minimum quality requirements for teleradiology providers. Conclusion: Teleradiology services face several challenges; most can be overcome if those engaging in this type of collaborations are eager to make it a success. However, it would be beneficial to have a transparent European legal framework that clarifies issues related to the registration and licensing of healthcare professionals; clarifies arrangements for data sharing and protection; and specifies liability and means of access to redress. Once this legal framework is in place it should be communicated to regulators, health care professionals and patients in a clear way so that it cannot be undermined or ignored and it truly promotes services of good quality which are beneficial to European citizens. © 2014 Fellowship of Postgraduate Medicine.