Purpose: To investigate the clinical utility, reproducibility, and radiologists’ acceptance of the Interstitial Lung Disease Imaging-Reporting and Data System (ILD-RADS). Method: In this single-institutional retrospective study, three radiologists independently reviewed the chest high- resolution CT (HRCT) scans of 111 consecutive patients diagnosed with ILDs. They assessed the HRCT pulmonary features using the ILD-RADS template and assigned an ILD-RADS category (1–4) to each scan based on the identified imaging pattern. Patients were classified into idiopathic pulmonary fibrosis (IPF) (n = 14) and non-IPF ILD (n = 97) groups based on clinical diagnoses determined by multidisciplinary discussion. Association between ILD-RADS categories and clinical diagnoses was assessed using the Chi-square test for trend. Reproducibility was evaluated using kappa (k) scores, and radiologists’ acceptance of the ILD-RADS was evaluated with a questionnaire. Results: We found a significant association between the ILD-RADS categories and patients’ clinical diagnoses (P ≤ 0.0001) for the three readers, with a trend toward increased assignment of ILD-RADS-1 to IPF patients (50 %-57.1 %), and ILD-RADS-4 to non-IPF patients (46.4 %-49.5 %). The ILD-RADS categories showed excellent intra-reader agreement (k = 0.873) and moderate inter-reader agreement (k = 0.440). ILD-RADS-1 and 4 categories showed the highest inter-reader agreement (k = 0.681 and 0.481, respectively). Radiologists gave a positive response to using the ILD-RADS in daily practice. Conclusions: The clinical utility of the ILD-RADS was demonstrated by the significant association between the ILD-RADS categories and patients’ clinical diagnoses, particularly the ILD-RADS-1 and 4 categories. Excellent intra-reader and moderate inter-reader reproducibility was observed. ILD-RADS has the potential to be widely accepted for standardized HRCT reporting among radiologists.