Radiologic exposomics: imaging the environmental imprint on cancer for precision oncology

Environmental exposures-such as airborne pollutants, metals, and urban stressors-contribute to cancer development and progression, yet their downstream biological effects remain difficult to characterize in vivo. Quantitative medical imaging may help fill this gap. Radiomics, in particular, offers access to tissue-level patterns shaped by chronic injury and microenvironmental remodeling. In this review, we discuss the rationale for linking geospatial exposure assessment with CT- and MRI-derived imaging biomarkers and outline how radiologic features may reflect processes associated with long-term environmental stress, including oxidative damage, inflammation, and metabolic or immune dysregulation. We also summarize epidemiologic evidence across major cancer types to contextualize where imaging-exposure integration is most plausible. A methodological workflow is presented, covering exposure assignment, imaging standardization, feature extraction, and strategies for harmonizing and modeling high-dimensional exposomic and radiomic data. Considerations related to confounding, data governance, and equity are also addressed, as these factors are integral to responsible implementation. Viewed in this light, imaging can be interpreted as an intermediate phenotype of the exposome-capturing aspects of tumor and peritumoral biology influenced by external stressors. This perspective may expand the role of radiology in precision oncology and generate new hypotheses about how environmental conditions shape cancer biology.