Improved Quality of Thyroid Ultrasound Reports After Implementation of the ACR Thyroid Imaging Reporting and Data System Nodule Lexicon and Risk Stratification System

Purpose: The aim of this study was to compare the description and management recommendations for thyroid nodules before and after implementing a structured reporting template based on the ACR Thyroid Imaging Reporting and Data System (TI-RADS). Methods: Thyroid ultrasound reports for seven private practice radiologists were analyzed in three phases. In phase 1, radiologists dictated in a free-text format. In phase 2, they used a structured reporting template based on the ACR TI-RADS lexicon, but without the ACR TIRADS recommendations for nodule management. In phase 3, ACR TI-RADS management recommendations were added. The most suspicious thyroid nodule in each report was analyzed for size, features, and management recommendations in all three phases. Results: Seventy-one thyroid ultrasound reports were reviewed for each phase, for a total of 213 reports. In phase 1, reports did not describe the features of the majority of nodules. In particular, shape and margin were not reported for 100% and 92% of nodules, respectively. Ninety-six percent to 100% of nodules had descriptions of all five features in phases 2 and 3. The number of nodules without management recommendations was 34% in phase 1 and 31% in phase 2. It decreased to 6% in phase 3 (P <.0005). Conclusions: Implementing an ACR TI-RADS structured reporting template improved the quality of thyroid ultrasound reports in two key ways. A structured reporting template led to better description of features that are predictive of malignancy. The use of ACR TIRADS management guidelines substantially improved the number of reports with definitive management recommendations. J Am Coll Radiol 2018;15:743-748. Copyright (C) 2018 Published by Elsevier Inc. on behalf of American College of Radiology