Shared decision-making in radiology: leadership levers for patient-centred imaging.

BACKGROUND: Shared decision-making (SDM) is a cornerstone of patient-centred care, yet it has been underused in radiology. OBJECTIVE: To translate research into innovative strategies to empower radiology leaders to apply SDM and outline the cultural and structural changes required for meaningful integration into clinical practice. METHODS: This article synthesises case examples and evidence across imaging scenarios, evaluates emerging innovations and highlights leadership levers that can embed SDM as a core practice in radiology. RESULTS: Leadership interventions can transform radiology's contribution to SDM. Cases such as incidental pulmonary nodules, breast MRI in familial risk and Li-Fraumeni syndrome illustrate how radiologists can engage directly in preference-sensitive decisions. Key strategies include improving access to imaging data, using patient-friendly summaries, expanding opportunities for direct communication and incorporating patient-reported outcome measures, patient-reported experience measures and artificial intelligence (AI)-driven tools to support patient understanding. Barriers such as workflow demands, medicolegal uncertainty and lack of incentives can be addressed through leadership-driven reforms. CONCLUSIONS: Radiology plays a central role in care pathways, offers clinical and technical expertise and increasing patient-facing innovation. Leaders who embed SDM into training, workflows and systems can enhance radiology as a model of cutting-edge, patient-centred care. Clear actions include training, protected time, incentives, strategic application of AI and transformational leadership.