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

Since its introduction in 2018, 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 disease 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 implementation of VI-RADS into everyday workflows across diverse health care settings, including skepticism among referring clinicians, an inability (unlike with cystoscopy-based staging) to perform simultaneous tumor resection, suboptimal posttreatment performance, and variability in image quality and reader experience. Additional logistic and economic factors, including restricted access outside of specialized centers and limited cost-effectiveness data, further impair widespread uptake. This 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.