Bone-RADS™ v. 2023

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

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


  1. Marek says:

    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.

  2. Marek says:

    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?

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