ACR lung-RADS: updates and future directions

Lung cancer remains the leading cause of cancer-related mortality worldwide, and low-dose CT (LDCT) screening has been shown to significantly reduce lung cancer deaths in high-risk populations. The American College of Radiology (ACR) introduced the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Since its inception, Lung-RADS has undergone iterative updates reflecting advances in evidence, clinical practice, and the expanding scope of lung cancer screening. This review summarizes the major updates to Lung-RADS, highlights areas of active discussion within the Lung-RADS Committee, and outlines future research directions. Key topics include the ongoing evaluation of volumetric versus diameter-based nodule measurement, the management of subsolid nodules and the balance between surveillance and intervention, the implementation of Category 0 for infectious or inflammatory findings, clarification of juxtapleural nodule classification, the approach to incidental findings, and the development of a Lung-RADS Atlas. Future directions address the integration of risk-based and category-based assessment approaches, the role of artificial intelligence and deep learning in nodule stratification, the potential incorporation of incidental nodules into Lung-RADS, and the prospect of international harmonization for lung cancer screening reporting and management. Lung-RADS has become an essential reporting and quality tool for lung cancer screening in the United States and increasingly worldwide. Continued refinement, guided by emerging evidence, multidisciplinary collaboration, and technological innovation, will be critical to advancing precision screening strategies and reducing the global burden of lung cancer.Clinical trial numberNot applicable.