95 Proposal of a Reporting and Data System for Colorectal Anastomotic Leakage: CAL-RADS RESULTS AND DISCUSSION Patient inclusion and data extraction were finalized in April 2024. The test cases, which yielded good results, have been completed. Currently, the radiologists are assessing the CT scans. Results are expected in early 2025. As the use for CT scanning has gained validation in numerous clinical trials for evaluating patients with suspected AL after colorectal surgery, standardizing reporting is a key element to foster broader adoption in clinical practice, reduce errors, and ultimately enhance patient outcomes. The primary objective of the current study is to develop a CAL-RADS classification system that offers uniform categories for final assessment, accompanied by recommendations for subsequent management. It is crucial to emphasize that the CAL-RADS classification is intended to complement the final impression of the report, especially since the report will furnish detailed information regarding the timing, type of surgery and other relevant findings. We advise to use the CAL-RADS classification on a per-patient basis for clinically suspected AL cases after colorectal surgery. The CAL-RADS score will be developed by the CoReAL collaborative group and supportive radiological societies, providing a framework that builds on other reporting schemes for surgical complications but expands the concept in a way similar to systems like BI-RADS. Categories 1–4 provide increasing suspicion for AL after colorectal surgery at unenhanced abdominal CT, thus allowing for task-specific cutoff points for clinical decision making. Before clinical use, this score must show substantial interobserver agreement. If it does, the system may fulfill the need for a structured and fast reporting system that decreases ambiguity in communications with referring physicians and facilitates collection of CT performance data for further research of this worldwide colorectal surgery problem. Additionally, the effectiveness in clinical practice and flexibility in selecting optimal cutoff points for diverse clinical decisions should be investigated to make this type of system even more valuable. 4
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