Key Takeaways

  • The O-RADS Ultrasound classification system is receiving another update in 2026, with the most significant additions being formalized MRI management recommendations and improved lexicon alignment across imaging modalities.
  • The 2022 version already reduced false-positive malignancy rates and introduced new morphologic descriptors – but it left open questions around MRI integration that the 2026 update directly addresses.
  • Dr. Priyanka Jha, a co-author of the O-RADS US v2022 update, will be presenting a dedicated session on what’s new in 2026 at the Contemporary OB-GYN Ultrasound 2026 conference.
  • Better lexicon alignment between ultrasound and MRI is expected to lead to fewer ambiguous reports, cleaner handoffs between imaging teams, and more consistent patient management across institutions.

For clinicians who work with adnexal lesions regularly, keeping pace with O-RADS is the standard. The 2026 update closes gaps that the 2022 version left open, particularly around how MRI fits into the workflow when ultrasound findings are indeterminate.

O-RADS Is Getting Another Update – Here’s Why It Matters

The Ovarian-Adnexal Reporting and Data System for Ultrasound (O-RADS US), developed by the American College of Radiology (ACR), has become the benchmark for standardizing how adnexal lesions are described and risk-stratified. First published in 2019, the system assigns a numeric score based on morphologic features, giving clinicians a structured, reproducible way to communicate malignancy risk.

Standardization is an ongoing process, not a one-time publication. Clinical practice evolves, multicenter validation studies generate new data, and gaps in the original framework become apparent over time. That’s exactly what happened after 2019 – leading to a 2022 revision, and now another update arriving in 2026. Each iteration sharpens the system’s ability to guide real clinical decisions.

What the 2022 Version Changed (And Why It Wasn’t the Last Word)

The O-RADS US v2022 update, released by the ACR, was a meaningful step forward. Rather than overhauling the scoring framework, it targeted specific areas where the original system was producing too many false positives or leaving clinicians without enough descriptive vocabulary for lower-risk lesions.

New Descriptors That Improved Specificity

One of the more practical additions in 2022 was the expansion of the lexicon for classic benign lesions. New descriptors – including bilocular cysts and acoustic shadowing – gave sonographers and radiologists more precise language for lesions that previously might have landed in an ambiguous category. The 2022 update also clarified the O-RADS US 1 category (normal ovary) by adding “no ovarian lesion” to capture normal ovaries without any focal findings, a small but clinically useful refinement.

Revised Management for O-RADS 3 Lesions

Perhaps the most impactful change in 2022 was the updated management pathway for O-RADS 3 cystic lesions. Revised guidelines introduced short-term ultrasound follow-up as an acceptable option for this category, rather than defaulting to more invasive workup. This shift reflected growing evidence that a meaningful proportion of O-RADS 3 lesions are benign and can be safely monitored. Still, the 2022 update left one important gap largely unresolved: how MRI should be formally integrated into the management algorithm, particularly for indeterminate solid or complex lesions.

What’s New in 2026: Key Updates to the System

The 2026 update builds on the 2022 foundation with two headline changes – one that formalizes MRI’s role in the workflow, and one that cleans up cross-modality communication.

MRI Management Recommendations

The 2022 version acknowledged that MRI was a valuable supplemental tool for characterizing solid adnexal lesions and cystic lesions with solid components, where ultrasound specificity has limits. It stopped short, however, of embedding MRI recommendations directly into the O-RADS management framework. The 2026 update changes that. Formalized MRI management recommendations are intended to provide clinicians with clearer decision points, defining which lesions warrant MRI and what that escalation should look like when ultrasound findings reach a specific threshold of uncertainty. The practical implications extend beyond workflow convenience – clearer MRI criteria may help avoid unnecessary surgery in patients whose lesions could be more definitively characterized non-invasively.

Improved Lexicon Alignment Across Modalities

Lexicon mismatches between ultrasound and MRI reports are a persistent source of clinical friction. When two modalities describe the same lesion using different terminology, interpretive ambiguity follows, and multidisciplinary communication becomes harder. The 2026 update addresses this directly by improving alignment between O-RADS US descriptors and their MRI equivalents. The goal is a shared language across imaging teams, so that a referring physician or gynecologic oncologist sees consistent, comparable descriptors regardless of which modality generated the report.

The Clinical Stakes: Better Risk Stratification, Fewer Unnecessary Surgeries

The practical argument for staying current on O-RADS is straightforward. The system exists to reduce the rate at which low-risk patients end up in the operating room. Clinical data on O-RADS US v2022 has shown that improved specificity directly lowers false-positive rates for malignancy, meaning fewer patients are flagged for surgical evaluation when watchful waiting or further imaging would have been sufficient.

Research has demonstrated that an O-RADS US cutoff score of 4 or higher is optimal for identifying malignancy, with one cohort study reporting 90.6% sensitivity and 81.9% specificity in a U.S. patient population. Adding formalized MRI recommendations to the 2026 framework extends that precision further, particularly for the indeterminate lesions that currently produce the most clinical uncertainty. The Centers for Medicare and Medicaid Services have also recognized O-RADS US management recommendations as a quality assurance tool, signaling the system’s growing role as an institutional standard rather than just a reporting convention.

Who’s Leading the 2026 Session – and Why That Credential Matters

Clinical guideline updates are most useful when explained by someone who helped write them. That’s the case here.

Dr. Jha’s Direct Role in Shaping O-RADS Guidelines

Priyanka Jha, MBBS, FSRU, Associate Professor of Radiology in the Body Imaging Division at Stanford University and a member of the Stanford Cancer Institute, is a co-author of the O-RADS US v2022 update and an active contributor to national consensus guidelines through the ACR and the Society of Radiologists in Ultrasound. Her clinical focus centers on pelvic imaging, adnexal lesion characterization, endometriosis, and the complementary use of ultrasound and MRI in gynecologic oncology – precisely the intersection that the 2026 update targets.

Dr. Jha will lead the dedicated “O-RADS Ultrasound: What’s New in 2026?” session on Sunday, September 20, at the Contemporary OB-GYN Ultrasound 2026 conference. Her session pairs with a complementary talk she’ll deliver the same morning: “Complementary Role of Ultrasound and MRI in Gynecologic Imaging” – a natural companion piece that contextualizes why the 2026 lexicon alignment work matters in daily practice.

A Key Forum for the 2026 O-RADS Updates

The Contemporary OB-GYN Ultrasound 2026 conference runs September 18-20, 2026, at the Gaylord Rockies Resort and Convention Center in Aurora, Colorado. The three-day, multidisciplinary program covers both prenatal and gynecologic ultrasound, led by faculty from Stanford, UC San Diego, and other leading academic institutions.

The O-RADS session on Sunday morning is one of several gynecologic imaging sessions rounding out the final day, alongside sessions on pelvic floor ultrasound, endometriosis imaging, and acute pelvic pain – making the third day particularly relevant for clinicians focused on GYN imaging.

Hybrid Format: In-Person and Live-Streamed

The event is offered as a hybrid program – attendees can participate in person at the Gaylord Rockies or join via live stream. Both formats provide access to the same sessions, including the O-RADS update. For clinicians who can’t travel, the live-stream option keeps the content accessible without sacrificing the interactive Q&A structure that runs after each session block.

CME Credit and Accreditation Details

World Class CME is accredited by the ACCME to provide continuing medical education for physicians. The conference offers:

  • 18.25 AMA PRA Category 1 Credits – applicable toward ABR Maintenance of Certification
  • 18.25 Cognate Credits – assigned by the American College of Obstetricians and Gynecologists
  • 21 Category A CE Credits – approved by the American Society of Radiologic Technologists, and accepted by ARDMS toward continuing education requirements

Nurse practitioners, RNs, and physician assistants can also apply these credits through their respective certification bodies, which accept ACCME-accredited programming. Registration fees are as follows: Physicians: $1,495 | Sonographers: $1,075. Groups of two or more registering at the same time each receive $75 off. The hotel reservation deadline at the Gaylord Rockies Resort and Convention Center is August 27, 2026.

Register for Contemporary OB-GYN Ultrasound 2026 Before Spots Fill

The 2026 O-RADS updates – formalized MRI integration, cross-modality lexicon alignment, and refined risk stratification pathways – represent a meaningful evolution in how adnexal masses are assessed and managed. Having that content delivered by a co-author of the guidelines, within a broader gynecologic imaging curriculum, is a combination that doesn’t come around often.

Clinicians who work with adnexal lesions, whether through radiology, OB-GYN, or sonography, have good reason to be in the room – or on the stream – when Dr. Jha walks through what the 2026 system actually changes and why it was updated.

Visit World Class CME to see their full calendar of evidence-based CME programs designed for healthcare professionals in women’s imaging and beyond.

World Class CME

6201 Fairview Rd.
Suite 200
Charlotte
NC
28210
United States

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