ACR BI-RADS^Ⓡ v2025: A summary of changes

The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS^Ⓡ) provides a standardized framework for breast imaging interpretation, reporting, assessment, and outcomes monitoring. The BI-RADS^Ⓡ v2025 Manual represents the first transition to year-based versioning and incorporates updates reflecting the role of advanced imaging technologies in contemporary breast imaging practice. Key updates in BI-RADS^Ⓡ v2025 include expanded integration of digital breast tomosynthesis (DBT), synthetic mammography, contrast-enhanced mammography (CEM), and refinements aligned with multiparametric breast MRI and high-resolution ultrasound. Important modifications include the introduction of new descriptors like "non-mass" in ultrasound, the omission of ambiguous terms like "focus" and "developing asymmetry," as well as the harmonization of the lexicon across modalities (e.g., standardized Category 4 subdivisions). Definitions of mammographic density have been improved to place more emphasis on masking risk than volume. The revisions aim to enhance consistency in terminology, reporting structure, and clinical communication across imaging modalities. This review compares BI-RADS^Ⓡ v2025 with the 5th edition, summarizing the principal lexicon, reporting, and structural changes, and discussing their implications for clinical practice and outcomes monitoring. The article is intended to serve as a practical reference for radiologists seeking to understand and implement the latest BI-RADS updates.