Medical imaging is an integral part of clinical practice, with diagnostic test accuracy (DTA) representing a key consideration guiding test selection. DTA research can inform the utilization of diagnostic tests, however methodologic shortcomings and incomplete reporting may introduce bias and limit assessment of clinical applicability. This thesis aims to illustrate best practices for DTA systematic reviews and highlight on issues specific to imaging reviews. Regarding methodology of imaging DTA systematic reviews, we found that a minority of DTA systematic reviews published in imaging journals had used recommended statistical methods and less than a tenth of reviews reported how they handled multiple index test readers; both of which are important considerations for imaging systematic reviews to avoid overestimating test accuracy and ensure clinical applicability. Regarding overinterpretation practices in imaging DTA systematic reviews, we found a majority of reviews contained overinterpretation practices or ‘spin’ in both the abstract and full text. Reviews published in high impact factor journals were less likely to contain overinterpretation practices, however, this difference did not persist when a sensitivity analysis excluding Cochrane systematic reviews was performed. To assist in optimal reporting of DTA systematic reviews, we compiled a list of items potentially applicable to a reporting guideline for DTA systematic reviews, PRISMA-DTA. These items formed the basis of the Delphi survey which led to the PRISMA-DTA checklist. Lastly we provide a narrative review providing guidance and illustrative examples of current best practices for methodology and reporting of DTA systematic reviews.