Image Quality Standardization in Radiomics: A Systematic Review of Artifacts, Variability, and Feature Stability.

This paper explores the role of metrology in the assessment of image quality in the field of radiomics. Image Quality Assessment (IQA) is central to ensuring the reliability and reproducibility of radiomic analyses, as it directly affects the accuracy of feature extraction and segmentation, ultimately impacting diagnostic outcomes. From the analysis of approximately 20,000 papers sourced from three databases (PubMed, Scopus, IEEE Xplore), last searched in December 2025, the need for standardized imaging protocols and quality control measures emerges as a critical theme. Studies were included if they involved radiomic feature extraction and evaluated the impact of image quality variations on feature robustness and no formal risk-of-bias assessment was performed. A total of 105 studies were included, covering different medical imaging modalities. Across the included studies, noise, motion, acquisition and reconstruction parameters, and other artifacts consistently emerged as major sources of radiomic feature instability. Indeed, in most papers, IQA is neglected, while the effect of poor-quality images is reported. This research identifies and discusses the relevant issues reported in clinical practice, as well as the main metrics adopted for image quality evaluation. Through a comprehensive review of current literature and an analysis of emerging trends, this paper highlights the urgent need for innovative solutions in image quality metrics tailored to radiomics applications.