Despite the rapid growth in the literature [1], real-world translation of radiomics remains limited [2,3]. Key barriers include methodological complexity and inconsistent reproducibility across acquisition, segmentation, feature extraction, modeling, and validation steps [4,5]. To overcome these challenges, the Radiomics Quality Score (RQS) was proposed in 2017 [6], but ambiguity in item definitions and heterogeneity in applicability have constrained interrater agreement and score reproducibilit…