Evolving landscape of BIRADS

The Breast Imaging Reporting and Data System (BI-RADS), developed by the American College of Radiology (ACR) in the late 1980s, was created to address inconsistencies in breast imaging reports and to improve clarity, uniformity, and quality in communication.^[1] Prior to BI-RADS, reporting styles varied widely among radiologists, often resulting in diagnostic delays. To standardize practice, the ACR introduced BI-RADS as a structured system that categorizes imaging findings according to their level of suspicion for malignancy.

The first BI-RADS edition was published in 1992 and provided a detailed lexicon of descriptors along with assessment categories to guide radiologists in interpreting findings and recommending follow-up. Initially designed for mammography, BI-RADS was subsequently expanded to ultrasound and magnetic resonance imaging (MRI), supporting clear communication across the increasingly multimodal landscape of breast imaging.^[2]

Since its introduction, BI-RADS has undergone several updates to reflect technological progress and evolving clinical practices^[3]:

• 1st Edition (1992): Focused on mammography, establishing the initial lexicon and assessment categories.

• 2nd Edition (1995): Included early updates based on feedback from clinical users.

• 3rd Edition (1998): Expanded to incorporate ultrasound terminology.

• 4th Edition (2003): Added MRI lexicon and refined existing descriptors.

• 5th Edition (2013): The existing version further refined descriptors in line with emerging evidence.

• 6th Edition (2025): has been released at RSNA 2025 and shall be available soon.

Each revision has been shaped by advancements in imaging technology and shifts in breast cancer screening, diagnosis, and management paradigms. Although BI-RADS for ultrasound and MRI were introduced over a decade ago, both continue to evolve as new technologies and imaging features emerge. The ACR has also implemented initiatives such as the National Mammography Database and the National Radiology Data Registry to support quality improvement across imaging modalities.^[2]

The multidisciplinary purpose of BI-RADS is reflected in its assessment categories, which guide clinical decision-making and facilitate clear, actionable communication among radiologists, surgeons, oncologists, and primary care providers [Table 1]. Each category aims to balance early cancer detection with the avoidance of unnecessary procedures.^[3]

The ACR BI-RADS Committee oversees the system’s maintenance and updates. The latest edition has been chaired by Dr. Mary S. Newell of Emory University, who was responsible for the coordination and integration of updates across all imaging modalities as the committee worked toward the release of the BI-RADS^® v2025.^[4] Sub-chairs for each modality included recognized experts such as Dr. Stamatia Destounis, Dr. Jessica Leung, and Dr. Wendy DeMartini. The current version also features an Audit and Outcomes Monitoring section to align auditing practices with contemporary screening methods and technologies, including integration of Category 3 audit metrics. This continuous oversight ensures consistent, precise communication among radiologists worldwide, enhancing patient care, research, and outcomes monitoring.

Over time, BI-RADS has demonstrated its value as a comprehensive and standardized framework for breast imaging terminology and reporting. More than a classification system, it functions as a dynamic, evolving reference that enables even non-radiologists to accurately interpret and communicate imaging findings. Continued interdisciplinary collaboration and research-driven updates are essential to sustain BI-RADS as a cornerstone of excellence in breast imaging.