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Bone-RADS (Bone Lesion Scoring)

Bone-RADS (2023)

ACR Bone-RADS (2023) scores six radiographic features of a potentially neoplastic bone lesion — margination, periosteal reaction, endosteal scalloping, pathological fracture, extra-osseous soft-tissue mass, and known primary cancer — and maps the point total to risk categories 1–4 with management suggestions.

Also searched as: radiograph · bone tumor · lodwick · periosteal · msk · incidental · follow-up

Can the bony lesion be fully assessed?
Margination / zone of transition
Periosteal reaction
Endosteal scalloping
Pathological fracture present (+2 pts)
Extra-osseous soft-tissue mass (+4 pts)
Known primary malignancy (+2 pts)
Information
Incomplete input
  • Please provide: whether the lesion can be fully assessed.

How this tool works

Bone-RADS applies to solitary bone lesions seen on diagnostic radiography. Margination uses the modified Lodwick–Madewell grades (IA = 1, IB = 3, II = 5, IIIA–C = 7 points); periosteal reaction scores 0 for none, 2 for non-aggressive patterns, and 4 for aggressive patterns including Codman triangle; endosteal scalloping scores 0 for none or mild, 1 for moderate, and 2 for deep erosion; pathological fracture adds 2, an extra-osseous soft-tissue mass adds 4, and a known primary malignancy adds 2. Totals of 1–2, 3–4, 5–6, and 7 or more correspond to Bone-RADS 1 (very low risk), 2 (low), 3 (intermediate), and 4 (high, malignant until proven otherwise). Lesions that cannot be fully assessed are Bone-RADS 0 and need further imaging first.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

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