The ACR BI-RADS experience: learning from history

Abstract

The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future.

Fig 1

Publication rate calculated on the basis of the percentage of papers published in a given 2-year period as a percentage of the total in that category over the entire 22-year interval. The slopes of the lines represent the publication rates within the respective categories. Papers catalogued in PubMed demonstrate that observer and performance studies outpaced generic mammographic or mammography standards studies after the mid-1990s, when BI-RADS was increasingly adopted. The search was performed on May 14, 2009. Searches used Medical Subject Heading (MeSH) terms as follows: mammography = “Mammography[MeSH Terms]”; standards = “Mammography/standards[MAJR]”; observer studies = “Mammography[MeSH Terms] AND Observer Variation[MeSH Terms]”; and performance = “Mammography[MeSH Terms] AND Sensitivity and Specificity[MeSH Term].”