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ACR Releases BI-RADS® v2025 Manual
Published Date: December 2, 2025
The American College of Radiology (ACR) has published the BI-RADS® v2025 Manual, an updated, illustrated reference designed to support clearer, more consistent breast imaging reports and performance evaluation in clinical practice.
What’s new at a high level
ACR frames BI-RADS v2025 as an extension of the 5th edition BI-RADS Atlas, with significant expansion in scope and content. The document shifts “edition” naming to a year-based versioning system, aligning BI-RADS with ACR’s broader RADS programs, and changes the name from BI-RADS Atlas to BI-RADS Manual to reflect expanded content.
The manual grows substantially in size and imagery, increasing from 696 pages in the prior edition to 896 pages in v2025 and expanding to 923 clinical images, including additional modality examples such as DBT, synthetic mammography, and ABUS.
Contrast-Enhanced Mammography becomes a core section
One of the most notable structural shifts is that contrast-enhanced mammography (CEM) is now an intrinsic section of the manual rather than a supplement—reflecting the modality’s increasing clinical use and the need for standardized reporting language.
Standardization across modalities and updated assessment language
ACR also harmonizes report organization across modalities and introduces standardized structured exam indication verbiage intended for consistent use across breast imaging. Lexicon terms are reordered “from least to most suspicious” where practical, supporting clarity and consistency in interpretation.
Assessment language is updated as well. For BI-RADS Category 0, the manual now separates incomplete assessments into two distinct statements—one for cases needing additional imaging evaluation and another for cases needing prior exams for comparison—reflecting updated MQSA-related requirements. Management language for Category 6 is revised to acknowledge definitive local therapies that may not always involve surgical excision.
Mammography updates: DBT, terminology refinements, and descriptor changes
Within mammography, BI-RADS v2025 incorporates examples beyond standard digital mammography, including DBT and synthetic mammography. It also updates definitions to reflect DBT capabilities—recognizing that features used to define a mass may be apparent on a single projection when imaged with DBT.
Their “What’s New” guide also details multiple terminology refinements aimed at reducing ambiguity (including adjustments to margin and shape terminology) and streamlining calcification descriptors by focusing on appearance rather than presumed histopathology.
MRI and broader workflow updates
Across sections, BI-RADS v2025 introduces dedicated FAQ sections and adds a general FAQ section addressing cross-modality questions. The guide also describes updated report organization for MRI, expanding structured elements such as acquisition parameters and background parenchymal enhancement (BPE).
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Here are some of the highlights:
Imaging examples have been updated to include digital views.
New search functions were developed to optimize provider queries on specific scenarios.
A guidance chapter for digital breast tomosynthesis was added. The goal of this chapter is to aid interpreting radiologists with the management of certain clinical scenarios and findings, and to improve consistency of DBT reporting.
The DBT section also includes an update to how lesions assessed on only one view can be described. Previously, masses seen on only one view could not be referred to as lesions. The update now allows these findings to be described as lesions; it is the committee’s hope this could eliminate the need for additional mammography views and radiation exposure.
Breast density assessments have been updated to reflect the likelihood overlying tissue may obscure cancer. Previously, such assessments were based on a percentage of dense tissue. Breast density classification is now based on the densest region, not the entire breast. The group also added a subsection on risk significance relative to breast density.
New mass descriptors have been added and removed for all modalities. They pertain to size, shape, associated features and margins.
Lymph nodes now have their own dedicated section for each modality (they were previously included in “associated features”).
New information and recommendations for implants and gynecomastia have been added, as has guidance on special cases, such as mastectomies and abscesses.
A new section on contrast-enhanced mammography has been added. This suggests that providers should describe low energy images separately from recombined one. The low energy portion will use the same lexicon as mammography, while the recombined images will use terms adopted from the MRI section but modified to cover situations unique to CEM.
Updates to tissue composition for breast ultrasound have been added.
Ultrasound revisions also include information on non-mass lesions for clarification.
Breast MRI updates describe different acquisition parameters (fast protocols, DWI, etc.) and subsequent findings for each.
The breast MRI lexicon has added a Mass T2 Hyperintensity Descriptor.
Additional guidance on the management of categories 3 and 6 (for MRI) has been added to provide clarification on how to manage specific patient scenarios.
The full updated manual went live today. It can
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분야별 서적
BI-RADS v2025 Manual - Print (Breast Imaging Reporting and Data System)
Breast Imaging: The Core Requisites
Comprehensive Atlas of Breast Imaging 
Diagnostic Imaging: Breast 3e
유방초음파진단학 제2판
Abbreviated MRI of the Breast: A Practical Guide
3D Automated Breast Volume Sonography: A Practical Guide
Breast Tomosynthesis
Breast Imaging: The Requisites, 3/e
Clinical Breast Imaging: The Essentials
Rosen's Breast Pathology, 4e 
