Thyroid Nodules Detected on CT: A Retrospective Audit Study and Analysis of Differences in Reporting Practices Across Radiology Subspecialties |
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| Institution: | 1. Diagnostic Radiology Resident, Department of Diagnostic Radiology, McGill University, Montreal, Québec, Canada;2. Thoracic and Abdominal Radiologist, Department of Diagnostic Radiology, McGill University, Montreal, Québec, Canada;1. Department of Radiology, Massachusetts General Hospital, Boston, MA;2. Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA;3. Harvard Medical School, Boston, MA;1. Department of Radiology, University of Michigan, Ann Arbor, MI;2. Department of Biostatistics and bioinformatics, Rollins School of Public Health, Emory University, United States;1. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.;2. Department of Radiology, The Northwestern University Feinberg School of Medicine, Chicago, IL.;3. THREAD Research, Tustin, CA.;1. Johns Hopkins University School of Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD;2. Covington & Burling LLP, One CityCenter, Northwest Washington, DC |
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| Abstract: | Thyroid nodules (TNs) are common incidental findings on imaging and TN reporting practices are variable among radiologists, leading to unnecessary or inadequate investigations. We aimed to document current literature adherence for TN reporting practices on thoracic CTs and assess the variability in TN reporting across radiology subspecialties. This is a 2-parts retrospective study. First part was an audit study including all adult patients with thoracic CTs in January 2020. Patients with prior thyroidectomy and/or lack of TN were excluded. A local committee was created for literature review and elaboration of a local TN management algorithm. The algorithm was shared with the thoracic radiology team. Imaging and medical records were reviewed and adequate adherence was assessed in the pre- and post-intervention cohorts. Second part included all adult patients who underwent neck or cervical spine CT imaging in the same timeframe and with same inclusion/exclusion criteria as the pre-intervention thoracic cohort. In the pre-intervention cohort 802 participants were screened and 137 patients included. TNs were reported in “body” and “conclusion” of the report in 51% and 7% of the time respectively. Thyroid US was recommended in 10% of the patients and inadequately recommended 3% of the time. Overall adequate adherence was 86%. In the post-intervention cohort 962 participants were screened and 167 patients included. Thyroid US was recommended in 7% of the patients and no inadequate US recommendation was made. Overall adequate adherence in the post-intervention cohort was 93%, increased by 7% (P= 0.039). The musculoskeletal and neuroradiology cohorts reported more TNs in “conclusion” (P= 0.013 and P< 0.0001) and recommended more thyroid US (P = 0.033 and P= 0.0018) compared to the preintervention thoracic cohort. No significant difference in overall adequate adherence between subspecialties (P= 0.48 and P= 0.51). Improvement in adequate TN reporting on thoracic CT by 7% while reducing inadequate thyroid US recommendations from 3% to none. Significant reporting trends were also noted across radiology subspecialties. |
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