ACR Neck Imaging Reporting and Data Systems (NI-RADS): A White Paper of the ACR NI-RADS Committee

J Am Coll Radiol. 2018 Aug;15(8):1097-1108. doi: 10.1016/j.jacr.2018.05.006. Epub 2018 Jul 6.


Imaging surveillance after treatment for head and neck cancer is challenging because of complicated resection and reconstruction surgery, in addition to posttreatment changes from radiation and chemotherapy. The posttreatment neck is often a source of anxiety for diagnostic radiologists, leading to suboptimal reporting and no standardized guidance for next management steps. Nevertheless, imaging is critical for detecting submucosal recurrences in a timely manner, so that patients remain candidates for salvage surgery. In 2016, the ACR convened the Neck Imaging Reporting and Data Systems (NI-RADS) Committee with the goals to (1) provide recommendations for surveillance imaging; (2) produce a lexicon to distinguish between benign posttreatment change and residual or recurrent tumor in the posttreatment neck; and (3) propose a NI-RADS template for reporting on the basis of this lexicon with defined levels of suspicion and management recommendations. In this article, the authors present the ACR NI-RADS Committee's recommendations, which provide guidance regarding the management of patients after treatment for head and neck cancer.

Keywords: NI-RADS; Neck Imaging Reporting and Data Systems; head and neck cancer; structured reporting; surveillance; templates.

Publication types

  • Practice Guideline

MeSH terms

  • Data Systems
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / therapy
  • Humans
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Population Surveillance
  • Radiology Information Systems
  • Research Design