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O-RADS (Ovarian-Adnexal Reporting and Data System)

O-RADS is the ACR risk stratification system for ovarian and adnexal masses on ultrasound, classifying lesions from O-RADS 1 (normal) to O-RADS 5 (high risk of malignancy).

Purpose:
Classify ovarian/adnexal masses by malignancy risk to guide management
Population:
Women with ovarian or adnexal masses identified on ultrasound
Factors:
Lesion type (simple cyst, complex, solid), Size, Internal features, Colour score, Peritoneal features
Reference:
Andreotti et al., Radiology 2020
HomeO-RADS Calculator — Ovarian-Adnexal Reporting & Data System (Ultrasound)
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O-RADS Calculator — Ovarian-Adnexal Reporting & Data System (Ultrasound)

Clinical Context & Background

O-RADS™ US provides a standardized lexicon and risk stratification system for ovarian and adnexal masses. It assigns a risk category (O-RADS 1-5) based on morphology, the "3mm rule" for solid components, and vascularity (Color Score), which guides clinical management (observation, MRI, or specialist referral).
Primary Source EvidenceAndreotti RF, Timmerman D, Strachowski LM, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020;294(1):168-185.
Formula Logic
Algorithmic Decision Tree (Morphology → Size/Vascularity Modifiers)

Reference Data

CategoryRisk of MalignancyManagement
O-RADS 10%Physiologic (No follow-up)
O-RADS 2< 1%Almost Certainly Benign (Surveillance)
O-RADS 31 - 10%Low Risk (Gyn Specialist / MRI)
O-RADS 410 - 50%Intermediate Risk (Gyn Onc / MRI)
O-RADS 5≥ 50%High Risk (Referral to Gyn Oncologist)

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