The BI-RADS v2025 Manual, like its predecessor, includes sections on mammography, ultrasound and magnetic resonance imaging (MRI) of the breast as well as the auditing and outcomes monitoring section (AOM), formerly referred to as follow-up and outcome monitoring. The contrast enhanced mammography (CEM) section, previously an atlas supplement, is now included in the manual proper.

The authors have placed an emphasis on ensuring consistency in terms and definitions among the four lexicons. Other updates include breast density descriptors to match the MQSA definitions, new finding type for “non-mass lesion” in ultrasound, descriptions of focal asymmetries in MRI and Mammography, and the introduction of method of detection in AOM.

The Manual outlines structured clinical indications to encourage radiologists to organize the report for all breast imaging modalities into major categories and optional subcategories using structured terminology. These structured categories are expected to aid in report clarity, outcomes monitoring, and determination of method of cancer detection.