How BI-RADS v2025 Helps Patients: New Audits and Method of Detection

Breast imaging audits are essential for measuring performance, ensuring regulatory compliance, and improving patient outcomes. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) v2025 Manual refines established auditing principles and introduces several important additions to the Auditing and Outcomes Monitoring chapter. This review details fundamental auditing principles and describes the methodology and rationale for three key updates. First, routine auditing of BI-RADS category 3 assessments is now recommended to promote appropriate use of this category and ensure that it is applied correctly to findings with a ≤2% likelihood of malignancy. Second, a new framework has been introduced for auditing preoperative breast magnetic resonance imaging performed for staging, which incorporates both examination-level and finding-level metrics. Third, prospective assignment of the initial method of detection is encouraged to link cancer outcomes directly to screening and clinical presentation. Together, these updates expand breast imaging audits beyond traditional metrics and lay the foundation for future benchmark developments and global standardization.