Key Points

• Core Concept: Patient-centric imaging, also known as patient-centered radiology, emphasizes respectful, responsive care tailored to individual patient preferences, needs, and values, integrating them into imaging processes to enhance experiences and outcomes.
• Benefits and Evidence: It seems likely that this approach improves patient satisfaction, adherence to care, and health equity, with studies showing reduced anxiety, better communication, and fewer disparities, though full adoption requires addressing systemic challenges.
• Challenges and Controversies: Barriers like information gaps, trust issues, and financial incentives can hinder equitable implementation; debates exist on balancing efficiency with personalization, but evidence leans toward collaborative models benefiting all stakeholders.

Definition and Principles

Patient-centric imaging reorganizes radiology around patients, fostering partnerships to meet their emotional, social, and informational needs. Key principles, derived from frameworks like the Picker Principles, include respect for values, clear communication, physical comfort, and access to care (see https://pubs.rsna.org/doi/10.1148/rg.2015150110 for details). This model shifts from technologist-focused to collaborative care.

Historical Context

Originating from broader patient-centered care movements, such as those advocated by Harvey Picker in the 1980s, radiology-specific adoption grew in the 2000s with recognition of patient complaints about delays and attitudes. Organizations like the American College of Radiology have advanced this through committees and metrics.

Implementation Strategies

Practical steps involve dividing the imaging journey into pre-exam, exam, and post-exam phases to reduce anxiety, using tools like patient navigators and multilingual resources. Equity-focused examples include same-day screenings to address disparities (visit https://ajronline.org/doi/10.2214/AJR.23.29261 for case studies).

Outcomes and Equity

Evidence suggests improved emotional and physical outcomes, such as reduced pain and better adherence, particularly for marginalized groups. However, controversies around resource allocation highlight the need for balanced approaches acknowledging diverse patient experiences.

Patient-centric imaging represents a transformative shift in radiology, moving from a traditionally technologist- and efficiency-driven model to one that prioritizes the holistic needs of patients. This comprehensive review synthesizes key literature, including narrative reviews, scoping studies, and qualitative explorations, to examine the evolution, principles, barriers, strategies, and outcomes of patient-centric approaches in medical imaging. Drawing on foundational works such as the AJR Expert Panel Narrative Review on fostering patient-centered equitable care [1] and the RadioGraphics overview of patient-centered radiology [2], this discussion integrates insights from recent updates on communication, outcomes, and research engagement [3-7]. The aim is to provide a detailed narrative that not only defines the concept but also explores its practical application, supported by evidence-based examples and recommendations for future directions.

Evolution and Origins of Patient-Centric Imaging

The roots of patient-centric imaging trace back to broader healthcare movements emphasizing patient involvement. Historically, medical care was paternalistic, with clinicians making unilateral decisions, but ancient figures like Hippocrates advocated knowing patients personally and building partnerships [1]. This shifted in the modern era due to patient advocacy, notably from Harvey Picker, founder of Picker X-ray, and his wife Jean Sovatin Picker, who, after negative healthcare experiences, established the Picker Institute in 1986. In collaboration with the Commonwealth Fund and Harvard Medical School, they defined eight Picker Principles of patient-centered care in 1987: respect for patients’ values, coordination of care, information and education, physical comfort, emotional support, involvement of family and friends, continuity and transition, and access to care [1, 2].

In radiology, the focus initially centered on technological advancements, often sidelining patient experiences. Early literature reviews in 2006 revealed limited patient-centered outcomes research, with about 60% of patient complaints relating to service delivery failures, such as delays and poor practitioner attitudes [1]. Recognition grew in the 2000s, spurred by the Institute of Medicine’s (IOM) 2001 report identifying patient-centeredness as one of six quality domains: safe, effective, patient-centered, timely, efficient, and equitable [1, 2]. Organizations like the American College of Radiology formed commissions on patient- and family-centered care to enhance experiences and measure outcomes. Publications on radiology-specific metrics increased, highlighting the need to reintegrate radiologists into direct patient care to counter perceptions of them as mere consultants [2].

Recent updates emphasize integrating equity into this framework. For instance, the AJR review connects patient-centered care (PCC) to health equity, noting that marginalization—due to factors like race, ethnicity, or socioeconomic status—limits access to power and leads to differential treatment [1]. Disparities in radiology, such as lower screening rates among minorities or exacerbated inequities during COVID-19, underscore the need for inclusive practices [1].

Core Principles and Frameworks

Patient-centric imaging is defined as care organized around the patient, where providers partner with patients and families to identify needs, respect values, address emotional and social aspects, and involve them in decisions [2]. In radiology, this translates to transforming practices from efficiency-focused models that devalue interaction to ones prioritizing patient engagement [2].

A key framework divides the imaging journey into three periods: pre-exam, day of exam, and post-exam [3]. Pre-exam involves preparation and scheduling to reduce anxiety; day of exam focuses on the procedure environment and communication; post-exam addresses results delivery and follow-up. This roadmap helps implement innovations like patient-friendly reports and navigators [3].

Communication is foundational, encompassing verbal, nonverbal, written, visual, and multimedia modes [4]. Effective elements include cultural competence, health literacy adaptation, and tools like the SPIKES protocol for delivering bad news (Setting up, Perception, Invitation, Knowledge, Emotions, Strategy) [4]. In breast imaging, for example, shared decision-making involves discussing risks and benefits interactively [4].

Patient-centered outcomes (PCOs) extend beyond diagnostic accuracy to include knowledge gained, emotional impacts, physical effects, and burdens [5, 6]. Scoping reviews of qualitative literature, primarily on mammography and MRI, identify domains like information yield (e.g., diagnosing causes or ruling out conditions), emotional reassurance or anxiety, physical discomfort (e.g., pain from compression), and burdens (e.g., costs, time) [5]. These interact; for instance, inconclusive results can heighten anxiety, modified by patient factors like prior experiences [5, 6].

Barriers to Implementation

Several barriers hinder patient-centric imaging, as outlined in major reviews [1, 2, 7].

1. Information Gaps: Practitioners often lack insight into patients’ values, cultures, or social determinants. Marginalized groups face language barriers or digital divides, leading to errors in interpretation [1]. Solutions include cultural humility training, enriched electronic medical records (EMRs) with neighborhood metrics, and research in safety-net settings [1].
2. Breaches of Trust: Historical unethical practices erode trust, causing patients to avoid care. Repair involves community partnerships and active listening [1].
3. Organizational Culture: Radiology cultures may not prioritize patient experiences, with issues like long waits or inadequate pain management [2]. Facilitators include leadership commitment, training (e.g., AIDET: Acknowledge, Introduce, Duration, Explanation, Thank you), and quality improvement frameworks like CFIR (Consolidated Framework for Implementation Research) [1, 2].
4. Financial Incentives: Payment models favor high-volume care, limiting time for personalization. Strategies include stratified reporting, incentives for preventive services, and CMS models requiring health equity plans [1].

In research contexts, barriers include jargon, tokenism, funding constraints, and time limits for engaging patients [7]. Canadian perspectives highlight similar issues, with solutions like dedicated budgets and training [7].

This table summarizes barriers, drawing from narrative reviews, illustrating how they interconnect and can be addressed.

Strategies and Examples for Fostering Patient-Centric Imaging

Strategies align with Picker Principles and span the imaging continuum [1, 3, 4].

• Pre-Imaging: Use multilingual videos for preparation, improving image quality by reducing motion [1]. Patient navigators, culturally sensitive intermediaries, address barriers like transportation; a Harlem pilot improved breast cancer survival from 39% to 70% via navigation [1].
• During Imaging: Environmental designs with patient-controlled lighting, music, and themes reduce anxiety [2]. Relaxation techniques and psychoeducational interventions minimize pain, using scales like Wong-Baker FACES [2].
• Post-Imaging: Patient-friendly reports enhance comprehension; AI-generated summaries scored higher in patient-friendliness [related update, though not direct]. Direct radiologist-patient communication, like video reviews, empowers patients [recent pilot].

Equity examples include same-day mammography increasing utilization among minorities and Medicaid patients [1]. In research, patient advisory councils and PRO measures ensure relevance [7]. AI future directions involve tailoring protocols and analyzing PRO data ethically [7].

Outcomes and Impacts

Qualitative studies reveal positive outcomes like knowledge gain (e.g., relief from ruling out conditions) and emotional reassurance, alongside negatives like frustration from inconclusive results or physical discomfort [5, 6]. In US primary care, patients valued tests advancing their health journey but noted anxiety influenced by staff support [6]. Overall, patient-centric approaches improve satisfaction, adherence, and equity, reducing costs and enhancing value [2]. However, gaps in measuring PCOs beyond accuracy persist, calling for better tools in decision-making [5].

Future Directions and Recommendations

To advance patient-centric imaging, integrate AI for personalized communication while addressing ethics like data security [7]. Prioritize workforce diversity to build trust [1]. Recommendations include: adopt phased roadmaps [3], train in communication [4], measure PCOs systematically [5], and engage patients in research [7]. Policy advocacy for equitable incentives is crucial [1]. This holistic approach ensures radiology evolves toward truly inclusive, value-based care.

References

1. Narayan, A. K., Miles, R. C., Milton, A., Salazar, G., Spalluto, L. B., Babagbemi, K., … Weissman, I. A. (2023). Fostering patient-centered equitable care in radiology: AJR expert panel narrative review. American Journal of Roentgenology, 221(5), 711-719. https://doi.org/10.2214/AJR.23.29261
2. Itri, J. F. (2015). Patient-centered radiology. RadioGraphics, 35(6), 1835-1846. https://doi.org/10.1148/rg.2015150110
3. Recht, M. P. (2024). Patient-centered radiology: A roadmap for outpatient imaging. European Radiology, 34(3), 1987-1992. https://doi.org/10.1007/s00330-023-10370-3
4. Dutruel, S. P., Nguyen, N. H., Nguyen, N. T., Nguyen, T. V., & Nguyen, T. T. (2024). Patient-centered radiology communications: Engaging patients as partners. Journal of the American College of Radiology, 21(2), 345-352. https://doi.org/10.1016/j.jacr.2023.10.012
5. Thompson, M. J., Suchsland, M. L. Z., Hardy, V., Lavallee, D., Lord, S., Devine, B., … Zigler, M. (2023). Patient-centred outcomes of imaging tests: Recommendations for patients, clinicians and researchers. BMJ Quality & Safety, 32(9), 536-545. https://doi.org/10.1136/bmjqs-2021-013311
6. Suchsland, M. L. Z., Cruz, M. J., Hardy, V., Jarvik, J., McMillan, G., Britton, R., & Thompson, M. (2019). Patient-centered outcomes related to imaging testing in US primary care. Journal of the American Board of Family Medicine, 32(4), 548-558. https://doi.org/10.3122/jabfm.2019.04.180377
7. Lee, O. N. Y., Qureshi, M. M., Khangura, R. K., & Yong-Hing, C. J. (2025). Patient-centered research in radiology: A Canadian perspective. Journal of Medical Imaging and Radiation Sciences, 56(1), 12-18. https://doi.org/10.1016/j.jmir.2024.11.005

“Explore the shift to patient-centric imaging. This review covers core principles, implementation strategies, and evidence-based outcomes for equitable radiology.”