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O-RADS Introduction

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Okay, so let's talk a

0:02

little bit now about ORADs.

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As we talked about very briefly in the

0:07

introduction, it can be quite overwhelming

0:09

when we're trying to determine the

0:11

risk of certain ovarian lesions.

0:13

As we now know, there's a lot of overlap in

0:17

ultrasound appearance, and there's quite a

0:19

spectrum of appearances depending on patient

0:22

age and phase of the menstrual cycle as well.

0:25

So we really need some kind of a framework to

0:27

help us figure out what can we just let go?

0:29

What's normal?

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Um, what's benign and doesn't need follow-up, and

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then what lesions are not in those categories

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and actually might be something that we need

0:38

to revisit or might need further workup.

0:41

So this is a really useful chart just

0:44

going through the risk stratification.

0:46

So we've got physiologic on the left,

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follicles and corpus luteum cysts.

0:51

We've got our classic benign lesions

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here, which we talked about briefly:

0:55

hemorrhagic cysts, dermoid

0:57

cysts, and we'll talk about those in a

0:59

little bit more detail, endometriomas.

1:00

And then there are extra-ovarian lesions,

1:04

which are quite commonly encountered:

1:06

parovarian cysts, hydrosalpinx,

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and peritoneal inclusion cysts.

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And we will spend a bit

1:12

more time on those as well.

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And then we've got lesions that are not

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classically benign, and those are broken

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down into solid and cystic components.

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So solid, as we talked about, you might

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see some irregularity, some wall

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thickness. We have to look at the inner

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contour, the outer contour, whether

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there's Doppler flow, and then cystic

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lesions. Also have a variety of appearances,

1:36

that can be unilocular or multilocular.

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They can be solid or have solid components.

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And then again, we need to look

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at the inner walls, whether there

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are some projections, etc.

1:47

So there is quite an involved approach

1:51

in trying to characterize these lesions.

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So it's helpful for radiologists and even for

1:55

the referring physicians, if we can put a lesion

1:58

into a specific box that has some follow-up.

2:02

So that really helps everybody out.

2:04

And that is the idea behind ORADS.

2:07

So if you do other sorts of body

2:09

imaging or breast imaging, you're

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probably familiar with some of the

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other RADS reporting systems out there:

2:15

LYRADS, PIRADS, BIRADS, etc.

2:18

And I think that the approach to characterizing

2:22

different lesions with these reporting systems

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is here to stay and we're seeing more of

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them pop up in different parts of the body.

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So, ORADS is an ultrasound risk

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stratification and management system.

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And the goal is to really achieve some

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sort of consistency in interpretation

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and to decrease the ambiguity.

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So radiologists traditionally like to

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tell stories and like to give lots of

2:47

description, but sometimes if we don't

2:49

actually give a solid conclusion, it's really

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not helpful to the referring physician.

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So if we just give a description and don't

2:58

really say what we think is going on with this

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lesion, it really is challenging to determine

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what, if any, other sort of follow-up or action the patient needs.

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So that's the goal of ORADS.

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And this is based on a lexicon

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that was published by the ACR.

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The ORADS system recommends six

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categories, ORADS zero to five,

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and we'll go through all of those.

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And this algorithm is really to be applied

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to average-risk patients who do not have any

3:25

acute symptoms and who do have adnexal lesions.

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And the whole ORAD system is based on a

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retrospective analysis from IOTA, which is the

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International Ovarian Tumor Analysis Group.

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They did, um, Phase one to three prospective

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studies with almost 6,000 patients.

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So it's a good chunk of

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patients that this data is based on.

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And just keep in mind that even if you use

3:54

ORADS, but you have professional judgment

3:57

on an individual case that maybe doesn't

4:00

quite jive with ORADS, you do have the

4:03

option of modifying the ORADS recommendation

4:06

based on your own professional judgment.

Report

Faculty

Zahra Kassam, MD, FRCPC

Associate Professor of Medical Imaging, Division Head of Body Imaging

Western University

Tags

Ultrasound

Ovaries

Non-infectious Inflammatory

Neoplastic

Idiopathic

Gynecologic (GYN)

Body

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