A Closer Look at O-RADS: A Quality Assurance Tool for Standardized Description of Ovarian-Adnexal Lesions

The Ovarian-Adnexal Reporting and Data System (O-RADS) is a recent addition to the American College of Radiology (ACR) reporting and data systems and consists of both ultrasound (US) and MRI arms. As most ovarian or adnexal lesions are first detected with US, O-RADS US is considered the primary assessment tool. After many years of collaboration, the international multidisciplinary O-RADS committee published the O-RADS US lexicon in 2018, which was then applied to a risk stratification and management system in 2020. Read more about this system in Radiology.

The goal with this system design is to provide more consistent interpretations, minimize or eliminate ambiguity in US reporting, and provide a risk of malignancy and management recommendation for each type of lesion or risk category. Ultimately, use of the system will result in more accurate diagnoses and optimal patient management.

Lori Strachowski, MD, clinical professor in the Departments of Radiology and Biomedical Imaging and Obstetrics, Gynecology, and Reproductive Sciences at UC San Francisco, is one of the original members of the ACR O-RADS committee. She chairs the education committee for O-RADS US and recently released an ACR webinar titled O-RADS for Ultrasound: Why, What, When and How to Use and Report. Since the O-RADs system came out in 2018, she says there has been a lot of great feedback, as well as questions about how to use the system.

As a result, she and a team of US radiologists created an O-RADS Ultrasound User’s Guide (recently published in the American Journal of Roentgenology) that dives into some of the nuances to help simplify the system and answer user questions. See a video by the authors to promote the guide here.

The user’s guide emphasizes resources to expedite categorization and determination of a management recommendation which include easy online access to the ACR color-coded risk stratification scorecards and an O-RADS US calculator that is available as a smartphone app. Dr. Strachowski was instrumental in creating the app which was produced with the help of ACR IT staff. She says the app is a great tool for quickly getting to an O-RADS category and management recommendations.  

“I love the app! On average, it only takes me about seven seconds to get to a score, and that’s a big game changer in my daily practice,” says Tara Morgan, MD, associate professor of clinical radiology in the Abdominal Imaging and Ultrasound section. Dr. Morgan recently joined the ACR O-RADS committee and was also one of the authors of the user’s guide. “Both the app and the algorithm presented in the manuscript are identical and they really help to streamline the whole process.” 

Priyanka Jha, MBBS, associate professor of clinical radiology in the Abdominal Imaging and Ultrasound section at UCSF Radiology was also an author on the user’s guide for O-RADS US. This summer Dr. Jha joins ACR O-RADS, resulting in strong committee representation by UCSF faculty. Both Dr. Morgan and Dr. Jha bring with them their invaluable expertise not only in US but MRI as well.

Additional authors of the user’s guide include Katie Davis, DO, Christine K. Dove, MD and Rochelle Andreotti, MD – chair of the O-RADS Committee (Vanderbilt University) and Tanya Chawla, MBBS and Phyllis Glanc, MD (University of Toronto).


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