ACR lung-RADS: updates and future directions.
8 affiliations
- 1Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. [email protected].
- 2Harvard Medical School, Boston, MA, USA. [email protected].
- 3Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- 4Harvard Medical School, Boston, MA, USA.
- 5Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- 6BC Cancer Research Institute, Vancouver, BC, Canada.
- 7Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
- 8Department of Radiology, Duke University Medical Center, Durham, NC, USA.
Abstract
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.
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BibTeX
@article{petranovic2026lungrads,
title = {{ACR lung-RADS: updates and future directions.}},
author = {Milena Petranović and Ashley E Prosper and Andetta R Hunsaker and Stephen Lam and Jared D Christensen},
journal = {Cancer imaging : the official publication of the International Cancer Imaging Society},
year = {2026},
month = oct,
doi = {10.1186/s40644-026-01140-7},
url = {https://europepmc.org/article/MED/42907936},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - ACR lung-RADS: updates and future directions.
AU - Milena Petranović
AU - Ashley E Prosper
AU - Andetta R Hunsaker
AU - Stephen Lam
AU - Jared D Christensen
PY - 2026
DA - 2026/10/21
JO - Cancer imaging : the official publication of the International Cancer Imaging Society
DO - 10.1186/s40644-026-01140-7
UR - https://europepmc.org/article/MED/42907936
AB - 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.
SN - 1740-5025
SN - 1470-7330
ER -