(Background) Over the years, there has been increasing interest in adopting a quality approach in radiology, leading to the strategic pursuit of specific and key performance indicators (KPIs). These indicators in radiology can have significant impacts ranging from radiation protection to integration into digital healthcare. (Purpose) This study aimed to conduct a narrative review on the integration of key performance indicators (KPIs) in radiology with specific key questions. (Methods) This review utilized a standardized checklist for narrative reviews, including the ANDJ Narrative Checklist, to ensure thoroughness and consistency. Searches were performed on PubMed, Scopus, and Google Scholar using a combination of keywords related to radiology and KPIs, with Boolean logic to refine results. From an initial yield of 211 studies, 127 were excluded due to a lack of focus on KPIs. The remaining 84 studies were assessed for clarity, design, and methodology, with 26 ultimately selected for detailed review. The evaluation process involved multiple assessors to minimize bias and ensure a rigorous analysis. (Results and Discussion) This overview highlights the following: KPIs are crucial for advancing radiology by supporting the evolution of imaging technologies (e.g., CT, MRI) and integrating emerging technologies like AI and AR/VR. They ensure high standards in diagnostic accuracy, image quality, and operational efficiency, enhancing diagnostic capabilities and streamlining workflows. KPIs are vital for radiological safety, measuring adherence to protocols that minimize radiation exposure and protect patients. The effective integration of KPIs into healthcare systems requires systematic development, validation, and standardization, supported by national and international initiatives. Addressing challenges like CAD-CAM technology and home-based radiology is essential. Developing specialized KPIs for new technologies will be key to continuous improvement in patient care and radiological practices. (Conclusions) In conclusion, KPIs are essential for advancing radiology, while future research should focus on improving data access and developing specialized KPIs to address emerging challenges. Future research should focus on expanding documentation sources, improving web search methods, and establishing direct connections with scientific associations.