Standardized terminology, benchmarking and tracking technology enable breast imagers to perform at the top of their game as the specialty evolves.
Interview by Chad Hudnall, senior writer, ACR Press
The illustrated BI-RADS® v2025 Manual — an extension of the fifth edition of ACR’s BI-RADS Atlas — provides standardized breast imaging terminology, report organization, assessment structure and a classification system for mammography, ultrasound, contrast-enhanced mammography (CEM) and breast MRI. BI-RADS reporting enables radiologists to communicate results to referring physicians clearly and consistently and includes specific management recommendations and a final assessment.
The Bulletin spoke with Mary S. Newell, MD, FACR, FSBI, chair of the ACR BI-RADS Committee, which oversees the development of and updates to the BI-RADS framework. She explains the improvements and importance of the updated BI-RADS® v2025 Manual and how new considerations contributed to the finished product.
BI-RADS represents the language of breast imaging. Anyone who is going to become involved in breast imaging — someone picking that up within their radiology practice, members in training, residents — will all learn to talk the same language. It’s important that we all speak the same language so our referring physicians, and hopefully patients, understand it. Just think of the science that can happen when everyone is on the same page with terminology. Research will benefit from this.
The BI-RADS manual includes more than 900 clinical images, auditing and outcomes monitoring (including mammography, ultrasound, CEM and MRI), an FAQ for each section and new descriptors for ultrasound and breast implants for MRI. The updated manual includes additional clinical images to enhance the learning experience — as well as updates on the latest imaging equipment. The material also gives imagers information on how to collect and assess their breast cancer screening and diagnostic outcomes data and compare it to national benchmarks.
BI-RADS represents the language of breast imaging. Anyone who is going to become involved in breast imaging — someone picking that up within their radiology practice, members in training, residents — will all learn to talk the same language.
Yes, feedback from ACR members and other stakeholders was considered and incorporated into the updated manual. BI-RADS v2025 used member recommendations even more than in past updates. We started committee meetings a few years ago in preparation for the revision. During those meetings we discussed potential changes. As we discussed the issues, and even when we presented possible changes at national meetings, stakeholders asked great questions and suggested areas that needed to be clarified or included.
People had very good points that we took to heart. We sent the draft manual out to many stakeholders — intentionally including people of all ages and practice types, international users of the manual — an extremely broad group. We reviewed comments thoroughly and many of them were used in the manual. This was key, as this manual is meant to be used by actual people with boots on the ground. It has to provide real-world guidance and not be viewed as some pie in the sky offering. The feedback that we solicited and got was extremely helpful.
There are plenty of breast imaging resources out there, but ours is pretty unique. It provides lots of imaging examples so that we know what specific findings look like and how to best describe them, but it also provides guidance on common scenarios. For instance, if you see a mass with these features, this is how you describe and manage it based on evidence and expert consensus. That said, there are many wonderful textbooks and other types of resources out there that provide information that supplements what we’re doing with BI-RADS. Our manual isn’t meant to be a standalone thing. We still need to read journal articles and keep up on the latest research, but this manual is a significant part of someone’s education in breast imaging.
A lot has changed in breast imaging and there’s recent technology that needs to be discussed, signaling the need for an update. Within mammography, for example, we have newly included synthetic mammograms and digital breast tomosynthesis. There is new information on ultrasound, with whole breast ultrasound examples included. New MRI techniques and examples are included, and the CEM section is now embedded in the manual, proper.
All the sections provide interest and value. The section on auditing and outcomes monitoring is an important section because it allows individual practices, individual practitioners and healthcare systems to assess how they’re doing against national benchmarks and to improve. These are valuable mechanisms for peer review and quality assurance data to provide the best possible patient care. The section provides guidance on how to gather the data to perform an audit. It tells you what data points you need, how to calculate the findings and outcomes and allows you to benchmark yourself, your group and the community of breast imagers as a whole. The audit goes hand in hand with ACR accreditation and MSQA requirements as well.
That’s a great question. While we don’t have a specific timeframe to follow, the good thing about an eBook is that it allows for rapid revisions. We don’t have to wait ten years to keep up with the times. ACR leaders support the committee, and we’ll be doing a little more thinking and talking regularly to keep up with anything important coming down the pike that our members need to know about. Plus, there are things happening clinically (such as response to neoadjuvant treatment) that will benefit from a standardized lexicon. I think within the next year or two, we’re going to want to add more information about those types of things. More updates will give all users a more robust experience.
The updated manual is available to anyone, with ACR members receiving a discounted price. You can get the BI-RADS v2025 Manual in a couple of different ways. There is a hard copy you can purchase, as well as an eBook version which is easier for most people to access. Visit the ACR website to gain access to it. Another helpful resource for breast imagers is the College’s Talking to Patients About Breast Cancer Screening ACR CME Toolkit, which is free to ACR members.
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