Introducing Rad-RADS 1.0

Radiology Reporting and Data Systems (RADS) have proliferated considerably in recent years. In mid-2022 the Rad-RADS steering committee met to develop an easy to use and practical system to classify reporting and data systems. The resultant Rad-RADS Reporting and Data System is now undergoing validation

Criteria (2 or more*)
  • Uses simple image features and whole number cutoffs 
  • Straightforward, single-step categorization 
  • Provides flexible and useful management recommendations 
  • Easy to remember annual follow-up intervals 

Recommendation: Development of RR-1 systems is acceptable  

Criteria (2 or more*)
  • Uses workable image features and intuitive decimal number cutoffs
  • Simple, two-step categorization process
  • Provides mildly prescriptive and practical management recommendations
  • Graspable follow-up intervals like 6, 12 and 24 months 

Recommendation: Development of RR-2 systems is questionable

Criteria (2 or more*)
  • Uses arbitrary decimal number cutoffs on things you normally wouldn’t measure
  • Moderately complex, multi-step categorization process likely to require a chart
  • Provides multifaceted, often obscure management recommendations
  • Uses seemingly random follow-up intervals that differ according to patient demographics 

Recommendation: Development of RR-3 systems is regrettable

Criteria (3 or more*)
  • Uses dubious imaging features, non-intuitive oblique measurements in non-standard planes, ratios, percentages and/or enhancement curves
  • Highly complex, multi-step categorization process resembling a Rube Goldberg machine
  • You’ll be needing a color-coded chart or three 
  • Provides costly and invasive management recommendations that keep everyone busy
  • Follow-up intervals that ignore the linearity of time and require knowledge of patient risk factors not found in the EMR

Recommendation: Development of RR-4 systems is unthinkable

Criteria (3 or more*)
  • Uses a series of measurements, calculations and qualitative judgements, each requiring its own separate reference article to be at hand 
  • Multi-step, multi-dimensional categorization process resembling an Escher drawing
  • Requires a wall of color charts to help you plot the conspiracy 
  • Provides boisterous management recommendations that can’t be ignored despite their futility 
  • Follow-up intervals determined by an online pay-walled black-box calculator 

Recommendation: Development of RR-5 systems is inexcusable

 * HIGHEST category to meet criteria is used

How do existing RAD Systems rate?
Updated 9 minutes ago (1374 ratings)

Help validate Rad-RADS 1.0

Radiologists and others who report medical imaging are invited to submit their ratings for existing RADS using the Rad-RADS criteria. Initial analysis from 864 ratings shows inter-rater agreement of 0.92 for categories RR-4 and RR-5. Very low or no data exists for RR-1, RR-2 and RR-3 categories at present due to the nature of existing RADS. 


Version 1.0 last revised 2023, April 1 by the Rad-RADS steering committee.

Citation data and disclosures

Citation: Dixon A, Jones J, Gaillard F, Rad-RADS Reporting and Data System - a system for classifying the systems collapsing the system,

Publication date: April 1, 2023

Disclosures: The steering committee reports the following relevant financial relationships: we got free snacks while we sat in a hotel lobby devising this; it wasn't great food but it was free and as we ate we dreamed about our plump CVs, our upcoming academic promotions and pay rises. 

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