Radiogenomics: Revolutionizing Clinical Trials and Precision Medicine

Radiogenomics—the convergence of medical imaging (radiology) and genetic data (genomics)—is transforming how we approach cancer diagnosis, prognosis, and treatment. This innovative field offers non-invasive insights into tumor biology by linking image features with genetic markers. While early applications have focused on specific cancers, radiogenomics has broad potential across oncology.

What is radiogenomics?

Radiogenomics combines imaging phenotypes with genomic information to provide a comprehensive view of a tumor.

• Imaging Phenotype

  This refers to the vast amount of quantifiable data extracted from standard medical images (CT, MRI, PET, etc.) using computer algorithms, a process known as radiomics. These features can describe a tumor's shape, size, texture and internal heterogeneity, which are often invisible to the naked eye.

• Genomic Genotype

  This includes information from the study of an organism's entire genetic material, including gene expression patterns, specific gene mutations (e.g., EGFR, KRAS, BRCA), and other molecular data. This information is typically obtained through invasive tissue biopsies or liquid biopsies.

• The Link

  The fundamental hypothesis of radiogenomics is that specific genetic alterations manifest as detectable changes in tissue appearance on medical images.ⁱ By identifying these correlations, imaging can serve as a non-invasive "virtual biopsy" to infer the underlying genetic profile of the entire tumor, overcoming the sampling limitations of a single tissue biopsy.

Key Benefits of Radiogenomics in Oncology

By associating imaging features with genetic markers, radiogenomics can:

• Offer Non-Invasive Precision

  Reduce reliance on invasive biopsies by using imaging biomarkers.

• Improve Early Detection and Prognosis

  Predict survival, progression, and relapse more accurately.

• Enable Personalized Care

  Match patients to therapies based on integrated imaging-genomic profiles.

• Streamline Clinical Workflows

  Facilitate faster, data-driven decision-making for clinicians.

Why it’s relevant to drug development

Radiogenomics is not just a diagnostic breakthrough—it offers strategic advantages for clinical trial sponsors. For a CRO and drug developers alike, radiogenomics holds promise in several strategic ways:

• Biomarker Discovery and Validation

  Radiogenomic signatures may act as non-invasive biomarkers of response or resistance, enhancing patient stratification in early and late-phase trials.

• Adaptive Trial Design Enhancement

  With richer phenotypic and genotypic data available earlier in development, sponsors and CROs can design more informative adaptive trials with improved dose selection, enrichment strategies, and interim decision rules.

• Reduced Reliance on Invasive Sampling

  Imaging based biomarkers can reduce dependency on repeated biopsies, lowering burden on patients and simplifying logistics without sacrificing depth of biological insight.

• Supporting Precision Medicine Decisions

  Radiogenomics can help identify subpopulations more likely to benefit from a therapeutic, and therefore can improve targeted enrollment strategies and endpoint selection.

Current challenges and opportunities

• Reproducibility and Standardization

  Variability in imaging hardware and analysis methods can impact the robustness of radiogenomic findings.

• Data Integration

  Translating complex imaging features into actionable genomic predictions requires advanced data pipelines and analytical expertise.

These challenges present significant opportunities for CROs like Fortrea—with strong data science, imaging analytics platforms, and global trial capabilities—to collaborate with sponsors and integrate radiogenomics into clinical development toolkits.

The road ahead

Most current radiogenomic studies are retrospective and institution-specific, but the future lies in multi-institutional, prospective research. Artificial intelligence and advanced data processing will further refine radiogenomic models and broaden their applicability across various cancers.

Radiogenomics is also helping connect what we observe through imaging with the underlying pathology, genetic alterations, and protein expression profiles that shape tumor behavior. This integrated view supports a more precise understanding of each cancer and can guide more informed treatment and trial decisions.

How Fortrea Advances Radiogenomics-Enabled Clinical Trials

At Fortrea, we help sponsors operationalize this type of imaging–molecular integration through the combined capabilities of our device and imaging teams, medical oncology expertise, and experience executing precision oncology trials. This cross functional foundation allows us to support radiogenomics enabled research in a scientifically grounded and operationally practical way—advancing the next generation of oncology studies.

Ready to lead the next wave of precision medicine?

Connect with Fortrea today and discover how we can help you design and execute radiogenomics-driven clinical trials that deliver results.

Based on “The Convergence of Radiology and Genomics: Advancing Breast Cancer Diagnosis with Radiogenomics: https://www.mdpi.com/2072-6694/16/5/1076 ” (Cancers 2024, 16, 1076), co-authored by a Fortrea medical oncologist.

ⁱ Demetriou D, Lockhat Z, Brzozowski L, Saini KS, Dlamini Z, Hull R. The Convergence of Radiology and Genomics: Advancing Breast Cancer Diagnosis with Radiogenomics. Cancers (Basel). 2024 Mar 6;16(5):1076. doi: 10.3390/cancers16051076. PMID: 38473432; PMCID: PMC10930980.