Thyroid nodules are a commonly encountered clinical problem. Although 85 to 98% of thyroid nodules are benign1the small chance of malignancy leads to the workup of many benign nodules leading to additional imaging and biopsies. In an effort to address the problem of excessive workup of benign thyroid nodules the ACR developed the TIRADS (Thyroid Imaging Reporting and Data System) with the aim of reducing unnecessary biopsies, detect thyroid malignancies and promote standardisation of thyroid nodule description and management recommendations2,3. We undertook this study to...

200 thyroid ultrasound reports were retrospectively analysed from PACS. 100 pre and 100 post the implementation of a structured TIRADS reporting template used by sonographers and by the reporting radiologist or registrar. Radiologists and sonographers involved in imaging and reporting thyroid ultrasounds were given educational sessions on TIRADS and how to use the structured templates. Reports were excluded if prior biopsy or surgery for benign or malignant disease had been performed. Thyroid ultrasound studies were reported by both radiologists and radiology registrars. Thyroid ultrasound reports...

Study population: A total of 200 thyroid ultrasound reports were analysed (100 in each phase). Nodule size categories were based on the cut off ranges for biopsy as per TIRADS (25mm). The majority of nodules for both phases fell in the Effect on nodule description and risk categories: Table 1 shows the frequency of nodule characteristics in each phase of the study. In phase one the majority of reports did not include the five ACR TIRADS feature categories.Shape was not described for 96% and margins...

Implementing the ACR TIRADS structured reporting template improved the quality of thyroid ultrasound reports in two key ways. A structured reporting template, in itself, led to better description of features that are predictive of malignancy. Secondly there was a substantial improvement in the number of reports with definitive management recommendations. This has the potential of reducing unnecessary workup and health care costs.

1 Smith-Bindman R, Lebda P, Feldstein VA, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med 2013;173: 1788-96 2 Griffin AS, Mitsky J, Rawal U, et al. Improved Quality of Thyroid Ultrasound Reports After Implementation of the ACR Thyroid Imaging Reporting and Data System Nodule Lexicon and Risk Stratification System. J Am Coll Radiol 2018;15:743-748 3 Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper...