How to Implement NI-RADS MRI v2025

No, it’s not yet another template. ACR’s Neck Imaging Reporting and Data System (NI-RADS) is really about a strategic sales pitch and local adaptation. Paul Bunch, MD, ACR NI-RADS Committee Chair, explained to AJR Neuroradiology Imaging Senior Editor Carlos Zamora, MD, PhD, in this Video Article how he successfully integrated NI-RADS MRI version 2025 recommendations at Wake Forest by focusing on clinical buy-in and implementation science.

How Concerned Are You? Standardized reporting like NI-RADS MRI v2025 eliminates ambiguity. Before implementation, tumor boards often struggled with reports where the rad’s level of concern was unclear. Post-implementation, 100% of surveyed referring physicians agreed that the numeric scoring system was valuable for patient management.

Steps for Success: Dr. Bunch followed a four-point roadmap to move NI-RADS from a white paper to daily clinical practice:

1. ID Your Champs—The push at Wake Forest actually began with a request from clinical colleagues at multidisciplinary tumor boards who saw the potential benefit.
2. Pitch Perfect—Dr. Bunch presented to his neuro group, framing NI-RADS not as a radical change to their interpretation skills, but as a tool for uniform communication.
3. 90 Days—The department ran an optional 3-month trial, using surveys and data mining to track usage and satisfaction alike among both rads and referring doctors.
4. Adaptation & Context—Following principles of implementation science, the team kept the core identity of NI-RADS (e.g., suspicion levels and linked recommendations), while modifying peripheral details to fit local needs. 

Local Mods: Dr. Bunch was quick to note that rigid adherence can hinder adoption. To gain full buy-in, his colleagues made two key adjustments:

1. Flexible Follow-Up: They removed that 3-month timeframe for short-interval follow-up to prevent insurance authorization issues and allow clinicians more flexibility.
2. Worst-First Lead: To ensure referring MDs didn’t stop reading after a NI-RADS 1 primary site score, Bunch et al. added an overall assessment score at the top of the report reflecting the most concerning finding in the entire study.

Bottom Line: By treating implementation as a collaborative effort rather than a top-down mandate, Dr. Bunch’s team turned NI-RADS into a templated tool that virtually eliminated “how worried are you?” questions during tumor boards.