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For each patient, both the untreated and irradiated breasts were scanned at five locations: 12:00, 3:00, 6:00, 9:00, and tumor bed to evaluate for heterogenous responses to radiation within the entire breast. In total, 314 images were analyzed. Based on ultrasound findings such as skin thickening, dermis boundary irregularity, and subcutaneous edema, a 4\u2010level, Likert\u2010like grading scheme is proposed: none (G0), mild (G1), moderate (G2), and severe (G3) toxicity. Two ultrasound experts graded the severity of breast toxicity independently and reported the inter\u2010 and intra\u2010observer reliability of the grading system. Imaging findings were compared with standard clinical toxicity assessments using Common Terminology Criteria for Adverse Events (CTCAE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The inter\u2010observer Pearson correlation coefficient (PCC) was 0.87 (95% CI: 0.83\u20130.90,<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). For intra\u2010observer repeatability, the PCC of the repeated scores was 0.83 (95% CI: 0.78\u20130.87,<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). Imaging findings were compared with standard clinical toxicity assessments using CTCAE scales. The PCC between BUS scores and CTCAE results was 0.62 (95% CI: 0.35\u20130.80,<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). Among all locations, 6:00 and tumor bed showed significantly greater toxicity compared with 12:00 (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>BUS can investigate the cutaneous and subcutaneous tissue changes after RT. 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