Bone-RADS™ 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?

Bone-RADS Score: 0

Incompletely characterized, Risk cannot be adequately predicted
• Further workup is necessary
• Additional radiographic views or cross-sectionalimaging for further evaluation

Bone-RADS Score: 1

Very low risk of malignancy (Pathognomonic benign bone lesion)
• If asymptomatic, consider work up to be complete vs annual surveillance to ensure expected stability
• If symptomatic or change in clinical presentation, consider advanced imaging and orthopedic oncology referral for treatment of benign tumor

Bone-RADS Score: 2

Low risk of malignancy (probably benign)
• Short interval (3-6 month) surveillance to
ensure stability
• Consider advanced imaging to assess tumor composition and possibly biopsy to confirm benignity if needed
• Consider orthopedic oncology referral for surveillance or treatment of benign tumor

Bone-RADS Score: 3

Intermediate risk of malignancy (potentially malignant)
• Orthopedic oncology referral for probable 
biopsy and treatment planning
• Recommend advanced imaging such as CT, MRI, or bone scan for further characterization

Bone-RADS Score: 4

High risk of malignancy (malignant until proven otherwise)
• Orthopedic oncology referral for recommended biopsy and treatment planning
• Advanced imaging for tumor staging including additional sites of disease

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

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.

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