Bone-RADS Calculator v. 2023

ACR's Bone Reporting and Data System for Bone Tumor Risk Stratification and Management (BONE RADS ™), released October 2023

bone-RADS
Can the bony lesion be fully assessed?
Is there a pathological fracture?
Is there evidence of extra-osseous soft tissue mass?
Does the patient have a known primary cancer?
How is the lesion’s margination / zone of transition?
Is there periosteal reaction?
Is there endosteal scalloping?

Score & recommendations:

Bone-RADS 0. Recommend further evaluation with additional radiographic views or CT/MRI.

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Incompletely characterized, Risk cannot be adequately predicted

Score & recommendations:

Bone-RADS 1. If patient is asymptomatic, consider work up to be complete or alternatively, continue annual surveillance to ensure expected stability. If patient is symptomatic or clinical presentation changes, consider orthopedic oncology referral and further evaluation with CT/MRI.

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Very low risk of malignancy (Pathognomonic benign bone lesion)

Score & recommendations:

Bone-RADS 2. Recommend follow-up imaging in 3-6m vs. further evaluation with CT/MRI. Consider orthopedic oncology referral for surveillance or treatment of benign tumor.

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Low risk of malignancy (probably benign)

Score & recommendations:

Bone-RADS 3. Recommend orthopedic oncology referral and further evaluation with CT, MRI, or bone scan.

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Intermediate risk of malignancy (potentially malignant)

Score & recommendations:

Bone-RADS 4. Recommend orthopedic oncology referral and further evaluation with CT, MRI, or bone scan.

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High risk of malignancy (malignant until proven otherwise)

Reference:
  1. Caracciolo JT, Ali S, Chang CY, Degnan AJ, Flemming DJ, Henderson ER, Kransdorf MJ, Letson GD, Madewell JE, Murphey MD. Bone Tumor Risk Stratification and Management System: A Consensus Guideline from the ACR Bone Reporting and Data System Committee. J Am Coll Radiol. 2023 Oct;20(10):1044-1058. doi: 10.1016/j.jacr.2023.07.017. Epub 2023 Oct 17. PMID: 37855758.

Click here to visit ACR's page for Bone-RADS.

3 Comments

  1. Avatar of Marek Marek says:
    September 19, 2023 at 9:13 am

    It seems that this calculator incorrectly assigns 4 points for a soft tissue mass, while according to the ACR’s page for Bone-RADS it should assign 2 points only. May you please verify this and fix the bug? Thank you.

    Reply
    • Avatar of Pooyan Khalighinejad Pooyan Khalighinejad says:
      September 21, 2023 at 12:58 pm

      Hello Dr. Marek,
      Thank you so much for bringing this error to my attention. The bug has been fixed!
      I appreciate your feedback.

      Reply
  2. Avatar of Marek Marek says:
    September 22, 2023 at 3:02 pm

    Thank you for your reply! Now I realized that the cause of the confusion is on the ACR’s page for Bone-RADS, because the presence of a soft tissue mass is differently assessed in two documents:
    – 2 points in the “Bone-RADS TM v2023 Assessment Categories and Scoring System”
    – 4 points in the “Bone-RADS TM – Radiography Imaging Report Template for Potentially Neoplastic Bone Lesions”.
    Is there a way to check which document contains an error?

    Reply

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