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.
Kamran et al. (2025) studied this question.