ARRS Annual Meeting: BI-RADS 3 “Report Card” Decreases the Rate of Usage

San Diego, CA | April 30, 2025—According to the Magna Cum Laude Award-Winning Online Poster presented during the 2025 ARRS Annual Meeting, anonymous, peer comparison BI-RADS 3 “report cards” proved to be an effective method of rate reduction, particularly at community hospitals where preintervention rates were higher than at academic sites.

Reserved for “probably benign” breast imaging abnormalities that have a low (< 2%) risk of being malignant, in practice, the actual use of ACR’s BI-RADS category 3 assessment varies among radiologists—often overutilized to equivocate a finding.

Giving radiologists a recommended target rate of less than 12% as a benchmark, head presenter Bonmyong “Bora” Lee, MD, and her team of researchers from UPenn’s Perelman School of Medicine sent quarterly BI-RADS 3 report cards to each breast imaging radiologist via automated emails. This report card included personal BI-RADS category 3 rates for each modality, as well as cumulative rates for the radiologist’s covering site and hospital. Each radiologist was blinded to others’ individual rates, participation was voluntary, and Lee et al. offered neither rewards nor punitive measures for performance.

Noting that radiologists were not monitored for review compliance either, “after 4 cycles, we reviewed the data to determine if there were changes in the rate of BI-RADS 3 assessment among radiologists and across the institution using paired t-tests,” Lee said.

Over Lee et al.’s 17-month assessment period, 38 radiologists issued BI-RADS 3 in 4,289 total patients: 1,171 diagnostic mammograms, 1,281 screening mammograms, 658 MRI, and 1,179 ultrasound examinations. After Lee and colleagues’ intervention, the average BI-RADS 3 rate decreased (all sites: p < 0.01; community sites: p < 0.01; academic sites: p = 0.07). Radiologists with preintervention BI-RADS 3 rates that were greater than the group median had larger reductions in BI-RADS 3 rates post-intervention (p < 0.05).

North America’s first radiological society, the American Roentgen Ray Society (ARRS) remains dedicated to the advancement of medicine through the profession of medical imaging and its allied sciences. An international forum for progress in radiology since the discovery of the x-ray, ARRS maintains its mission of improving health through a community committed to advancing knowledge and skills with the ARRS Annual Meeting, two radiology journals—American Journal of Roentgenology (AJR) and Roentgen Ray Review (R3)—InPractice magazine, ARRS Symposia, free-access multimedia from our Global Partner Societies, as well as awarding scholarships via The Roentgen Fund®.

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