📄

Bone-RADS

ACR Bone Reporting and Data System risk score for a potentially neoplastic bone lesion at diagnostic radiography (Caracciolo et al., JACR 2023). Radiographic features are scored and summed; the total maps to Bone-RADS 0–4.

For a newly identified, potentially neoplastic bone lesion on orthogonal radiographs, viewed in the proper clinical context. Assign the highest/most concerning margin grade present. Point values are consensus-based and await formal validation. Recommendations, not standard of care.

—

Bone-RADS

Point values (Table 1), scoring (Table 2) & management (Table 3)

Margin (modified Lodwick-Madewell)

IA (geographic, well-defined, marginal sclerosis) = 1; IB (geographic, well-defined, no marginal sclerosis) = 3; II (geographic, ill-defined margins) = 5; IIIA-C (changing margins / nongeographic moth-eaten or permeative / radiographically occult invisible margins) = 7.

Other features

Periosteal reaction: none = 0, nonaggressive = 2, aggressive = 4. Endosteal erosion: none or mild (<1/3 cortex) = 0, moderate (1/3–2/3) = 1, deep (>2/3 or cortical disruption) = 2. Pathological fracture: no = 0, yes = 2. Extra-osseous soft-tissue mass: no = 0, yes = 4. History of primary cancer: no = 0, yes = 2.

Score (point total → Bone-RADS)

N/A → 0 (incompletely characterized); 1–2 → 1 (very low / very likely benign); 3–4 → 2 (low / probably benign); 5–6 → 3 (intermediate / potentially malignant); ≥ 7 → 4 (high / highly suspicious).

Caracciolo JT, et al. Bone Tumor Risk Stratification and Management System: A Consensus Guideline from the ACR Bone-RADS Committee. J Am Coll Radiol 2023;20:1044–1058. Tables 1–3.

Cross-sectional imaging (MRI/CT) and orthopedic oncology input remain central to bone lesion management.