Has anyone implemented system-wide O-RADS for adnexal mass triage in a multi-hospital OB/GYN network, and if so, what operational and clinical outcomes have you observed?
I am evaluating the feasibility of standardizing adnexal mass characterization and referral pathways across a large, mixed academic-community network that includes disparate radiology groups and varied ultrasound platforms. The goals are to reduce unnecessary gynecologic oncology referrals and surgeries for benign disease, decrease time-to-oncology for high-risk lesions, and align follow-up intervals with evidence-based risk. I am particularly interested in experiences from large integrated systems where community sites feed into a tertiary center, as the governance and workflow issues are complex.
Key points I’m seeking input on:
- Radiology adoption and training: How did you achieve uniform O-RADS v2022 adoption across radiology groups and sonographers? Did you mandate specific lexicon elements in reports (e.g., ascites, solid components, papillary projections), and how was interobserver variability handled? Any measurable improvement in report completeness or interrater agreement?
- EMR integration: What clinical decision support did you embed to translate O-RADS categories into next steps (e.g., O-RADS 2=OB/GYN follow-up ultrasound at 12 months, O-RADS 4-5=expedited Gyn Onc referral)? Did you use smart phrases, structured reporting, or order panels that auto-suggest follow-up intervals? How did you prevent alert fatigue?
- Access and scheduling: How did you operationalize fast-track pathways for O-RADS 4-5 (e.g., dedicated Gyn Onc slots within 7-14 days, direct nurse navigator outreach)? Any change in median time from index imaging to definitive surgery for malignant cases?
- Outcomes: Post-implementation, what were the effects on:
- Benign-to-malignant surgical case mix
- Negative laparotomy/robotic conversion rates
- Unnecessary MRI utilization
- ED bounce-backs for torsion or rupture in lesions assigned longer follow-up intervals
- Incidental findings: How are premenopausal functional cysts managed to avoid over-surveillance while safeguarding against missed malignancy? Any age-specific or menopausal status modifiers you applied beyond core O-RADS?
- Payer and coding considerations: Did insurers accept O-RADS-driven follow-up intervals, or did you encounter denials for short-interval imaging or MRI when O-RADS 3-4 suggested it?
- Patient communication: What standardized language or decision aids did you deploy to explain risk categories without causing undue anxiety? Any data on patient comprehension or satisfaction?
- Medico-legal and governance: Did you assign responsibility for follow-up (ordering provider vs. radiology “recommendation ownership” vs. centralized tracking)? Any closed-loop tracking dashboards to prevent loss to follow-up?
- Implementation science: What change-management tactics were most effective (pilot sites, audit-and-feedback, peer champions)? What metrics and review cadence sustained adherence over 12-24 months?
If you abandoned O-RADS or modified it, what were the deal-breakers, and what alternative pathways (IOTA Simple Rules, ADNEX model, internal risk stratification) have worked better in a multi-site environment?
Practical artifacts (report templates, CDS logic, referral criteria, navigator workflows, and dashboards) would be especially helpful.