At ECR 2026, the session on genitourinary reporting and data systems examined how structured frameworks are evolving across prostate, bladder and renal imaging. Focusing on PI-RADS, VI-RADS and KI-RADS, the discussion revolved around how these systems support diagnosis, where the current evidence stands and what still needs to be refined. Across the three talks, the emphasis remained on practical standardisation, clearer lesion characterisation and a better understanding of what comes next for RADS-based reporting.
Prostate Cancer Pathways and the Next Phase for PI-RADS
Francesco Giganti opened the session with a focus on prostate imaging and the future direction of PI-RADS. He situated the system within the broader context of prostate cancer by addressing the “natural history and management of prostate cancer” before turning to the framework itself. From there, he reviewed “the current status of PI-RADS for diagnosis of clinically significant prostate cancer” and used that as the basis for discussing what still needs attention.
His presentation moved between what PI-RADS already offers and the areas where further work is needed. That balance gave the talk a forward-looking tone. Rather than treating the system as complete, Giganti framed it as an evolving structure that still contains important open questions. In that sense, the key issue was not only how PI-RADS currently performs, but how it can continue to improve its role in the diagnosis of clinically significant disease.
The speaker’s objectives made that direction explicit. He aimed “to describe the natural history and management of prostate cancer”, “to describe the current status of PI-RADS” and “to highlight knowledge gaps and next steps for PI-RADS.” Taken together, these points suggested a progression from clinical context to present-day application and then to future development.
That sequence also reflected one of the session’s wider concerns: structured reporting systems are only useful if they remain closely tied to clinical decision-making while still being open to revision. Giganti’s contribution placed PI-RADS in exactly that space. It was presented as an important diagnostic tool, but also as a framework that must continue to respond to knowledge gaps if it is to move forward in a meaningful way.
VI-RADS and the Challenge of Advancing Bladder Cancer Assessment
Martina Pecoraro then turned to bladder imaging and the development of VI-RADS. Her talk followed a similar arc, beginning with “the natural history and management of bladder cancer” and then moving to “the current status of VI-RADS for diagnosis of muscle-invasive bladder cancer.” From there, she addressed “knowledge gaps and next steps for VI-RADS”, keeping the emphasis on development rather than closure.
The structure of her presentation made clear that VI-RADS is being considered not only as a reporting tool, but as part of a broader effort to sharpen the diagnosis of muscle-invasive disease. By anchoring the discussion in bladder cancer management, Pecoraro kept the clinical relevance of the system in view throughout. The session plan pointed specifically to diagnosis of muscle-invasive bladder cancer, giving the talk a focused scope and a defined clinical target.
Her approach also reinforced a recurring theme of the session: the maturation of RADS frameworks depends on understanding both what has already been established and what remains uncertain. Pecoraro did not treat VI-RADS as static. Instead, the presentation was framed around “new developments”, which immediately suggested an active process of refinement. The aim was not merely to restate the system’s present form, but to consider how it is changing and what those changes may mean.
The wording of the objectives highlighted that tension between consolidation and advancement. Pecoraro sought “to describe the natural history and management of bladder cancer”, “to describe the current status of VI-RADS” and “to highlight knowledge gaps and next steps for VI-RADS.” Those goals positioned VI-RADS as a framework with real diagnostic purpose, but also one still being shaped by ongoing questions.
In the context of the wider session, her talk helped show that standardisation is not a fixed endpoint. Even where a system is already in use, there is still work to do in defining its limits, testing its value and clarifying how best to move it ahead.
Building the Case for KI-RADS in Renal Lesion Characterisation
Ivan Pedrosa concluded the session with a presentation on KI-RADS and the standardisation of renal lesion characterisation. His talk differed slightly in emphasis from the previous two because it began with first principles. Rather than introducing a current framework through cancer management, he started with “the rationale for developing KI-RADS”, then moved to “the current evidence base for KI-RADS” and finally to “the potential for KI-RADS for characterising renal lesions.”
That structure was significant. It showed that KI-RADS is being advanced through a process that begins with justification, then looks to evidence and finally to clinical potential. The talk therefore appeared to be concerned not just with describing a system, but with making the case for why such a system is needed and how it might be used.
Pedrosa’s focus on standardising renal lesion characterisation placed KI-RADS firmly within the same family of structured approaches discussed earlier in the session, but with its own developmental pathway. The explicit attention to evidence suggested a framework that is still being established and assessed. At the same time, the reference to its potential pointed to a wider ambition: to provide a standard method for describing renal lesions in a more consistent way.
The three objectives captured that progression clearly. Pedrosa aimed “to understand the rationale for developing KI-RADS”, “to appreciate the current evidence base for KI-RADS” and “to appreciate the potential for KI-RADS for characterising renal lesions.” Together, these points gave the talk a foundational character, centred on why the system matters and how it may contribute to future reporting practice.
By closing on KI-RADS, the session widened the conversation beyond systems that are already more established and towards one still defining its role. That gave the overall discussion a useful breadth, spanning revision, development and early standardisation.
Conclusion
ECR 2026’s session on PI-RADS, VI-RADS and KI-RADS presented genitourinary RADS not as finished products, but as structured systems still moving forward. Across prostate, bladder and kidney imaging, the speakers returned to the same core concerns: clinical relevance, diagnostic purpose, remaining knowledge gaps and the need for clearer standardisation. The result was a coherent view of a field in evolution, where reporting frameworks are becoming more defined, but where the next steps remain just as important as the current status.
Source & Image Credit: ECR 2026
