O-RADS Ultrasound Version 1: A Scenario-Based Review of Implementation Challenges.

The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) risk stratification and management system was first published by the American College of Radiology in 2020, providing standardized terminology for evaluation of ovarian and adnexal masses, aiding risk stratification, and providing management guidelines for different categories of lesions. This system has been validated by subsequent research and demonstrated to be a useful diagnostic and management tool. However, as noted in the system's governing concepts, in some clinical scenarios, such as in patients with acute symptoms or with history of ovarian malignancy, O-RADS US does not apply, or the system's standard management may be adjusted. Additional scenarios, such as an adnexal mass in pregnancy, provide challenges in the application of O-RADS US to assist diagnosis and management. This article highlights ten clinical scenarios where O-RADS US version 1 may not apply, may be difficult to apply, or may require modified management. Additional scenarios where O-RADS US can be appropriately applied are also described.