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Published on: January 8, 2018
Why Radiomics Rarely Reaches the Clinic: Reproducibility, Validation, and Evidence Gap-A Critical Narrative Review
Jacopo Pozzi1, Jacopo D'Argenzio1, Serena Carriero2
1Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy.
Diagnostics (Basel, Switzerland)
|July 28, 2026
Summary
Radiomics research generates many publications but few clinical applications due to reproducibility issues. Improving clinical translation requires stricter evidence standards, not just better algorithms.
Area of Science:
- Medical Imaging Analysis
- Radiology
- Computational Pathology
Background:
- Radiomics has yielded numerous publications but few clinically adopted signatures.
- The gap between published findings and clinical practice is widening.
Purpose of the Study:
- To critically review the factors hindering radiomics reproducibility and clinical translation.
- To identify systemic issues within radiomics research that impede evidence-grade translation.
Main Methods:
- Meta-scientific analysis of publication bias, analytical flexibility, underpowering, HARKing, citation distortion, cognitive bias, and misaligned incentives.
- Review of empirical evidence on radiomics literature quality, validation, and reporting.
Main Results:
- Radiomics research is prone to seven fragility mechanisms, exacerbated by high-dimensional data, unstable measurements, and small sample sizes.
- The literature shows suboptimal methodology, limited external validation, and poor data sharing, indicating a self-reinforcing problematic system.
Conclusions:
- Better algorithms alone cannot solve radiomics' translation gap.
- Achieving decision-grade evidence requires stringent adherence to existing standards and evidence calibration.