O-RADS 3 Low risk of Malignancy (1-10%) US Specialist or MRI management by gynecologist.
For Non-classic Ovarian lesions
How is the outer margin?
O-RADS 5 High risk of Malignancy (≥50%) Management by GYN-oncologist.
Color Score
O-RADS 3 Low risk of Malignancy (1-10%) US Specialist or MRI management by gynecologist.
O-RADS 4 Intermediate risk of Malignancy (10-<50%) US Specialist or MRI Management by gynecologist with GYN-oncologist consultation or solely by GYN-oncologist.
O-RADS 5 High risk of Malignancy (≥50%) Management by GYN-oncologist.
For Cystic lesions
For Simple Cystic lesions
Maximum diameter of lesion in any plane
Menopausal Status?
O-RADS 2 No further imaging or follow up.
O-RADS 1 Normal Ovary
Menopausal Status?
O-RADS 2 Follow-up ultrasound in 1 year.
O-RADS 2 No further imaging or follow-up is necessary.
Menopausal Status?
O-RADS 2 Follow-up in 1 year in post-menopausal women
O-RADS 2 Follow-up ultrasound in 8-12 weeks
O-RADS 3 Low risk of Malignancy (1-10%) US Specialist or MRI management by gynecologist.
For Non-simple Cystic lesions
For Unilocular Non-simple Cystic lesions
For Unilocular Smooth Inner Walls
Maximum diameter of lesion in any plane
Menopausal Status?
O-RADS 2 Follow up in 1 year. If concerning, US specialist or MRI.
O-RADS 2 No further imaging or follow up necessary.
Menopausal Status?
O-RADS 2 US specialist or MRI
O-RADS 2 Follow-up in 8-12 weeks. If concerning US specialist or MRI
O-RADS 3 Low risk of Malignancy (1-10%) US Specialist or MRI management by gynecologist.
O-RADS 3 Low risk of Malignancy (1-10%) US Specialist or MRI management by gynecologist.
For Unilocular with solid components
How many papillary projections(PP) does the lesion have?
O-RADS 4 Intermediate risk of Malignancy (10-<50%) US Specialist or MRI Management by gynecologist with GYN-oncologist consultation or solely by GYN-oncologist.
O-RADS 5 High risk of Malignancy (≥50%) Management by GYN-oncologist.
For Multilocular Non-simple Cystic lesions
Color Score
For Color Score of 1-3
Maximum diameter of lesion in any plane
O-RADS 3 Low risk of Malignancy (1-10%) US Specialist or MRI management by gynecologist.
O-RADS 4 Intermediate risk of Malignancy (10-<50%) US Specialist or MRI Management by gynecologist with GYN-oncologist consultation or solely by GYN-oncologist.
O-RADS 4 Intermediate risk of Malignancy (10-<50%) US Specialist or MRI Management by gynecologist with GYN-oncologist consultation or solely by GYN-oncologist.
O-RADS 4 Intermediate risk of Malignancy (10-<50%) US Specialist or MRI Management by gynecologist with GYN-oncologist consultation or solely by GYN-oncologist.
For Multilocular with solid components, The Color Score is:
O-RADS 4 Intermediate risk of Malignancy (10-<50%) US Specialist or MRI Management by gynecologist with GYN-oncologist consultation or solely by GYN-oncologist.
O-RADS 5 High risk of Malignancy (≥50%) Management by GYN-oncologist.
The American College of Radiology (ACR) developed the Ovarian-Adnexal Reporting and Data System (ORADS) in response to the need for a standardized reporting system for ovarian and adnexal lesions detected by ultrasound.
The ACR ORADS criteria are divided into five categories, which are described below:
ORADS 1: Normal or Negative This category indicates that no abnormal findings were observed during the ultrasound examination of the ovaries and adnexa. In this case, no further imaging or follow-up is required.
ORADS 2: Benign Findings This category indicates the presence of benign findings, such as simple cysts or hemorrhagic cysts, which do not require further evaluation or management.
ORADS 3: Uncertain or Indeterminate Findings This category is used when the ultrasound examination reveals findings that are not clearly benign or malignant. The radiologist may recommend further imaging, such as MRI or CT, or close follow-up with repeat ultrasound examinations to monitor the lesion.
ORADS 4: Suspicious or Likely Malignant This category indicates that the ultrasound examination has revealed suspicious or likely malignant findings. These findings may include solid or complex masses with irregular borders, septations, or papillary projections. In this case, the patient should undergo further evaluation, such as a biopsy or surgical removal of the lesion, to confirm the diagnosis and determine the appropriate treatment.
ORADS 5: Malignant This category is used when the ultrasound examination reveals findings that are highly suspicious for malignancy, such as large solid masses with irregular borders and septations. In this case, immediate referral to a gynecologic oncologist is recommended for further evaluation and management.
It is important to note that the ACR ORADS criteria are not a definitive diagnosis, but rather a standardized reporting system for ovarian and adnexal lesions detected by ultrasound. The final diagnosis and management of these lesions should be made by a team of healthcare providers, including radiologists, gynecologists, and oncologists.
In conclusion, the ACR ORADS criteria provide a standardized reporting system for ovarian and adnexal lesions detected by ultrasound. By categorizing lesions into specific groups based on their characteristics, the ACR ORADS criteria help guide further evaluation and management of these lesions. It is important for healthcare providers to be familiar with these criteria to ensure timely and appropriate diagnosis and treatment of ovarian and adnexal lesions.
You can watch this detailed lecture on O-RADS Ultrasound by Dr. Avni Skandhan for reference:
More video tutorials for ORADS Ultrasound evaluation of Ovarian Cysts:
Basics of ORADS Classification for Ultrasound :
In this YouTube video titled “O-RADS for Ultrasound: Why, What, When and How to Use and Report,” Dr. Strachowski emphasizes the need for a standardized lexicon when diagnosing ovarian cancer via ultrasound due to the rare and hard-to-diagnose nature of the disease. The O-RADS system provides a solution to the problem and includes six categories with recommendations for each category’s respective management. The speaker discusses how to manage patients depending on their likelihood of malignancy, lesion size, and patient’s menopausal status, among other factors. Additionally, the speaker demonstrates the use of O-RADS through multiple ultrasound case examples and encourages the use of appropriate lexicon and charts when reporting ultrasound results using O-RADS.
O-RADS Ultrasound – Learn from Examples:
Frequently asked questions about ORADS Ultrasound:
The ACR ORADS ultrasound educational series covers frequently asked questions about the ORADS system in this video. Experts discuss topics such as the terminology used for Solid Smooth and Solid Irregular lesions in Risk Categories 3, 4, and 5, the role of spectral doppler, and the definition of ascites. The video also highlights differences between O-RADS and other systems like LI-RADS and emphasizes the importance of consulting an ultrasound specialist for a higher level of characterization. Two sample reports are presented to illustrate how non-specialist imagers and ultrasound specialists differ in reporting and management recommendations.
For some reason the preferred search term for O-RADS is o’rads. Probably an indexing error.
Disclaimer: The author makes no claims of the accuracy of the information contained herein; this information is for educational purposes only and is not a substitute for clinical judgment.
Dr. Amar Udare is a board-certified radiologist. He is a clinical assistant professor at the University of Calgary. He has a passion for teaching (#FOAMrad and #FOAMed) and has been a semi-finalist for the 2018 and 2020 Aunt-Minnie Most effective Radiology Educator Awards. He has authored multiple peer-reviewed publications which can be accessed on PubMed and Google Scholar.
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Dr. Amar Udare is a board-certified radiologist. He is a clinical assistant professor at the University of Calgary. He has a passion for teaching (#FOAMrad and #FOAMed) and has been a semi-finalist for the 2018 and 2020 Aunt-Minnie Most effective Radiology Educator Awards. He has authored multiple peer-reviewed publications which can be accessed on PubMed and Google Scholar.