On the Same Page

What's new in the latest BI-RADS®?on the same page

The much anticipated fifth edition of the BI-RADS® Atlas is here at last. Wil Creech, leader of the BI-RADS team, explains how to make the best use of BI-RADS and why the atlas is so important.

Q: What is new in the latest edition of BI-RADS?

A: The fifth edition of the atlas contains a significant amount of new material, updates, and over 700 clinical images. We’ve also made several changes to the previous lexicons and expanded many of the definitions. Plus there has been a substantive change involving assessment category 3 (a probably benign assessment), which has a significant impact on the audit metrics for breast imaging. BI-RADS now strongly encourages imagers to issue a category 3 assessment only after an appropriate workup. (A category 3 assessment rendered from a screening exam without workup is considered a positive screening exam.)

The ultrasound section includes and expands on anatomy, image quality, labeling, and tissue composition. Additionally, the MRI section has a discussion on breast implants. It also clearly defines potentially troublesome issues that breast imagers may encounter, such as background enhancement and foci. Finally, the fifth edition contains a new section dedicated to follow-up and outcome monitoring that defines how to determine the sensitivity, specificity, and accuracy for all three modalities: ultrasound, MRI, and CT.

Q: What was the process for creating BI-RADS?

A: This edition of BI-RADS is the fifth in a line that began in 1993. The premises for the work have remained constant. With each edition we’ve set out a standard lexicon, standard reporting practices, and a standard auditing system. However, the depth and breadth of the content have grown, and the presentation has become more sophisticated with each new edition. BI-RADS was meticulously crafted by experts from each subspecialty and underwent several rounds of review to resolve any inconsistencies, clear up discrepancies, and harmonize content where possible. Carl J. D’Orsi, MD, FACR, Edward A. Sickles, MD, FACR, Elizabeth A. Morris, MD, FACR, and Ellen B. Mendelson, MD, FACR, the section editors, reviewed hundreds of clinical images that serve as visual examples of the terminology recommended by the atlas. As of press time, the development team is preparing the electronic version of the publication to be released in spring 2014.

Q: Why was there a need for a new edition?

A: The material in the latest edition, just like the science and practice of breast imaging, is always evolving. Mammography images are now predominantly digital, so the atlas now reflects that by using only digital images in the lexicon. The quality of ultrasound has also significantly improved over time, which is reflected in the new edition by more definitive descriptors and better clinical illustrations.

MRI, which was relatively new when the fourth edition was released, is now a critical tool in diagnostic workups. The authors have worked to reconcile the terminology among mammography, breast ultrasound, and breast MRI for breast cancer findings as much as possible. More recent benchmarks are available for both screening and diagnostic mammography, and for ultrasound screening and MRI screening.

Finally, we are in a world that demands multiple formats for publication, particularly digital ones. This is the first time that BI-RADS will be available in an electronic format compatible with computers, tablets, and even smart phones.

Q: Why is it important that imaging specialists use BI-RADS?

A: First, the BI-RADS lexicons allow breast imagers to speak the same language. This minimizes the chance of miscommunicating the results of a breast imaging examination when speaking with other radiologists, referring physicians, surgeons, or patients. Essentially, it helps breast imagers to relay findings more consistently time after time.

Second, the auditing procedures recommended in BI-RADS enable specialists to accurately track and compare results. BI-RADS is a quality-assurance practice-improvement tool for breast imagers and breast imaging practices.

Q: Where can I get BI-RADS?

A: As of press time, the new atlas is available in hardcopy. A digital version will be launched in the spring. Order online at bit.ly/BIRADS2013 or call 1-800-227-7762.


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