Vesical Imaging Reporting and Data System: Overcoming Barriers to Global Implementation—AJR Expert Panel Narrative Review

Since its introduction in 2018, the Vesical Imaging Reporting and Data System (VI-RADS) has emerged as a standardized and reproducible framework for multiparametric MRI assessment of bladder cancer, with validated diagnostic accuracy in distinguishing muscle-invasive from non–muscle-invasive disease. Despite growing international interest, expert consensus, and the system's inclusion in most major guidelines, real-world clinical adoption of VI-RADS remains limited. This AJR Expert Panel Narrative Review explores the key barriers that hinder the implementation of VI-RADS into everyday workflows across diverse healthcare settings, including skepticism among referring clinicians, an inability (unlike cystoscopy-based staging) to perform simultaneous tumor resection, suboptimal posttreatment performance, and variability in image quality and reader experience. Additional logistical and economic factors, including restricted access outside of specialized centers and limited cost-effectiveness data, further impair widespread uptake. The article outlines strategic recommendations to address these challenges, including standardizing bladder MRI quality, incorporating structured educational initiatives, refining VI-RADS protocols for posttreatment settings, and fostering multidisciplinary collaboration. VI-RADS has the potential to become a cornerstone of bladder cancer management, but the validation and implementation of a bladder-MRI pathway will depend on continued refinement, acceptance, and alignment across clinical, technical, and guideline domains.