0:01

Okay, so let's talk a

0:02

little bit now about ORADs.

0:05

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?

0:30

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

0:33

then what lesions are not in those categories

0:36

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,

0:49

follicles and corpus luteum cysts.

0:51

We've got our classic benign lesions

0:53

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,

1:09

and peritoneal inclusion cysts.

1:11

And we will spend a bit

1:12

more time on those as well.

1:14

And then we've got lesions that are not

1:16

classically benign, and those are broken

1:18

down into solid and cystic components.

1:21

So solid, as we talked about, you might

1:24

see some irregularity, some wall

1:27

thickness. We have to look at the inner

1:29

contour, the outer contour, whether

1:31

there's Doppler flow, and then cystic

1:33

lesions. Also have a variety of appearances,

1:36

that can be unilocular or multilocular.

1:39

They can be solid or have solid components.

1:42

And then again, we need to look

1:43

at the inner walls, whether there

1:45

are some projections, etc.

1:47

So there is quite an involved approach

1:51

in trying to characterize these lesions.

1:52

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

2:11

probably familiar with some of the

2:13

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

2:24

is here to stay and we're seeing more of

2:27

them pop up in different parts of the body.

2:30

So, ORADS is an ultrasound risk

2:32

stratification and management system.

2:35

And the goal is to really achieve some

2:38

sort of consistency in interpretation

2:41

and to decrease the ambiguity.

2:43

So radiologists traditionally like to

2:45

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

2:53

not helpful to the referring physician.

2:56

So if we just give a description and don't

2:58

really say what we think is going on with this

3:01

lesion, it really is challenging to determine

3:04

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

3:06

So that's the goal of ORADS.

3:08

And this is based on a lexicon

3:10

that was published by the ACR.

3:12

The ORADS system recommends six

3:15

categories, ORADS zero to five,

3:17

and we'll go through all of those.

3:20

And this algorithm is really to be applied

3:22

to average-risk patients who do not have any

3:25

acute symptoms and who do have adnexal lesions.

3:29

And the whole ORAD system is based on a

3:33

retrospective analysis from IOTA, which is the

3:35

International Ovarian Tumor Analysis Group.

3:38

They did, um, Phase one to three prospective

3:42

studies with almost 6,000 patients.

3:47

So it's a good chunk of

3:48

patients that this data is based on.

3:51

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.