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Clinical calculator summary

ACR O-RADS Ultrasound v2022 per-lesion algorithm

A source-locked ultrasound decision tree that assigns one O-RADS US category to one ovarian or adnexal observation at a time.

Evidence-based context for fast calculator use

Purpose:
Standardize ultrasound risk categorization and display context-qualified management information without replacing clinical assessment.
Population:
Patients with an ovarian or adnexal observation evaluated using the ACR O-RADS US v2022 lexicon; standard management language assumes average risk without acute symptoms.
Factors:
Evaluation completeness, Observation and morphology, Menopausal phase when required, Lesion size, Solid components and vascularity, Extraovarian findings
Reference:
American College of Radiology. O-RADS Ultrasound v2022 assessment categories and algorithm.
HomeACR O-RADS US v2022 Per-Lesion Calculator
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ACR O-RADS US v2022 Per-Lesion Calculator

Clinical Context & Background

This English calculator implements the ACR O-RADS Ultrasound v2022 assessment categories released in November 2022. The 2020 publication is historical context only. It scores one ovarian or adnexal observation at a time; multiple lesions must be scored separately and overall management follows the highest category.
Lexicon: bilocular means 2 locules; multilocular means 3 or more locules. A solid lesion is at least 80% solid. A solid component protrudes at least 3 mm into a cyst lumen from a wall or septation; irregular wall thickening or projection is less than 3 mm. A papillary projection is a solid-component subtype surrounded by fluid on 3 sides. Color score is intralesional vascularity: 1 none, 2 minimal, 3 moderate, 4 very strong. Qualified shadowing is broad or diffuse and excludes refractive artifact.
Postmenopause means at least 1 year of amenorrhea: early is less than 5 years and late is at least 5 years. If status is uncertain or the uterus is absent, ACR guidance uses age over 50 years, with early over 50 but under 55 and late at least 55. Classic-lesion selection requires typical morphology. A typical hemorrhagic cyst is not accepted in late postmenopause and must be reclassified with other lexicon descriptors.
Risk categories can be applied in many clinical contexts, but the stock management recommendations are for average-risk patients without acute symptoms. Serial 10%-15% average-linear-dimension change is guidance requiring professional judgment, not a fabricated calculator cutoff.
Primary Source Evidences: https://cs.acr.org/Clinical-Resources/Reporting-and-Data-Systems/O-RADS/O-RADS-US; https://cs.acr.org/-/media/ACR/Files/RADS/O-RADS/US-v2022/O-RADS--US-v2022-Assessment-Categories.pdf; https://www.acr.org/-/media/ACR/Files/RADS/O-RADS/US-v2022/O-RADS-US-v2022-Assessment-Categories-Algorithm.pdf; https://doi.org/10.1148/radiol.230685; https://radssupport.acr.org/support/solutions/articles/11000124649-applicability-criteria-and-management.
Formula Logic
Strict ACR O-RADS US v2022 conditional decision tree; mixed features use the highest applicable category.

Reference Data

CategoryRisk of malignancyCore interpretation
O-RADS US 0Incomplete evaluationTechnically inadequate
O-RADS US 1No assignmentNormal ovary or qualifying physiologic finding
O-RADS US 2<1%Almost certainly benign
O-RADS US 31% to <10%Low risk
O-RADS US 410% to <50%Intermediate risk
O-RADS US 5>=50%High risk

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use for one ovarian or adnexal observation at a time after applying the ACR O-RADS US v2022 lexicon.
  • For multiple lesions, categorize each lesion separately and use the highest category for overall management context.

How To Interpret

  • O-RADS US 0 indicates an incomplete evaluation; categories 2-5 use the source-defined malignancy-risk intervals.
  • Risk categorization can be used across clinical contexts, but stock management guidance assumes average risk without acute symptoms.

What To Do Next

  • Integrate the category with symptoms, risk factors, prior imaging, lesion growth, patient preferences, and specialist judgment.
  • Use biomarker-based RMI or ROMA only for their separate intended questions rather than as replacements for O-RADS imaging categorization.

Limitations

  • This is the ultrasound v2022 system, not O-RADS MRI.
  • It does not replace urgent assessment for acute symptoms or individualized management for high-risk contexts.
  • It does not automate a final diagnosis, referral, surveillance, or treatment decision.

Validated Population

Patients with ovarian or adnexal observations assessed using the ACR O-RADS US lexicon and v2022 algorithm.

Gynecologic oncology calculator hubReview imaging, biomarker, and treatment-context tools by clinical question.O-RADS ultrasound clinical guideReview lexicon, risk categories, workflow, and limitations.Risk of Malignancy IndexUse the separate ultrasound, menopausal-status, and CA-125 index where appropriate.ROMAUse the separate biomarker-based ovarian malignancy-risk algorithm where appropriate.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed O-RADS US v2022 cases passed through visible production controls at Categories 0, 1, and 5.
    • The unsupported generic risk gauge was absent; no unexpected N/A, literal undefined value, stale control, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/orads-2026-08-03.json.

  2. : Local browser remediation

    • All valid and invalid O-RADS outcomes now explicitly suppress the shared generic risk gauge so categories US 0-5 and their exact source intervals remain the only displayed framework.
    • Ten source-backed cases passed through visible local browser controls across 11 submissions, covering categories 0-5, size equality, extraovarian upgrade, conditional validation, and reset/repeat behavior.
    • The existing calculator-specific audit passed 182/182. Production status remains open until this commit is deployed and the public route is revalidated.

    Local case-level remediation evidence is retained in validation/browser-production/orads.local-remediation.json.

  3. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-ui-console. high: Every rendered O-RADS US 0-5 result displayed a generic Low Risk / Intermediate / High Risk gauge that is not the six-category source system and is nonsensical beside O-RADS US 0 Incomplete evaluation and O-RADS US 1 No malignancy-risk assignment. | medium: Production emitted minified React error #418 during the route load.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/orads.json.

  4. : Full validation test

    • 182/182 source, schema, branch, boundary, management, applicability, output, provenance, registry, report, and evidence assertions passed.
    • This is implementation verification of the English route, not independent clinical validation; ES/PT/DE localized copies do not inherit this status.

  5. : Correction

    • Locked the route to the ACR November 2022 release and corrected the complete lexicon decision tree, strict validation, exact risk intervals, and conditional management.
    • Removed favorable defaults, coercion, unknown fallthrough, incorrect solid branches, unilocular color-score overcalling, overlapping intervals, and universal size escalation.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

Is this O-RADS Ultrasound or O-RADS MRI?

This calculator implements ACR O-RADS Ultrasound v2022. O-RADS MRI is a separate system and is not calculated on this page.

Which O-RADS US version is implemented?

The November 2022 ACR O-RADS US assessment categories and algorithm are implemented. The 2020 publication is retained only as historical context.

Can several adnexal lesions be entered together?

No. Categorize one lesion at a time. When several lesions are present, assess each separately and use the highest category for overall management context.

How is menopausal phase handled?

Postmenopause means at least one year of amenorrhea. When status is uncertain or the uterus is absent, the implementation follows the ACR age-based guidance described in the calculator.

What do O-RADS US categories mean?

O-RADS US 0 is incomplete, 1 is a normal or qualifying physiologic finding, 2 is almost certainly benign, and categories 3-5 represent increasing source-defined malignancy-risk intervals.

When should the standard management text not be followed directly?

The standard text assumes average risk without acute symptoms. Acute symptoms, substantial risk factors, pregnancy, prior malignancy, or other clinical considerations require individualized assessment.

Evidence-based oncology decision support. Verify with clinical guidelines.