ACR Thyroid Webinar: "This is How We Do It"

Introduction

• Moderator: Jenny Hong, Neuroradiologist at Jeek University.
• Speakers:
  • Dr. Franklin Tesla: Professor of Radiology at the University of Alabama, 30+ years in thyroid ultrasound, chairs ACR thyroid committee.
  • Dr. Bill Middleton: National leader in thyroid ultrasound, Malik Wright Institute of Radiology.
• Jenny's Role: Driving research, principal investigator on a multicenter registry project funded by ACR.
• Motivation for Webinar: Initiative by the speakers to share knowledge and improve thyroid ultrasound practices.

Agenda

• Session Parts:
  • Franklin Tesla: Discuss ACR TIRADS; rationale, tips for implementation.
  • Bill Middleton: Case studies, ACR TIRADS lexicon.
  • Jenny Hong: Structured reporting and resources.
• Interactive Elements: Live blogging, hashtag #ACRTIRADS.
• Audience Poll: Engaging the audience with questions about their profession and use of ACR TIRADS.

Franklin Tesla's Presentation

ACR TIRADS Rationale

• Thyroid Nodules: Very common, vast majority benign.
• History:
  • Named by Thomas Wharton in the 17th century.
  • Various professional guidelines over the years.

Key Points of ACR TIRADS

• Guideline, not Standard: Allows flexibility in practice.
• Point-Based System: Divides nodules into levels TR1 to TR5 based on specific criteria.
• Risk Stratification: Helps determine which nodules require FNA (Fine Needle Aspiration) or follow-up.

Implementation Suggestions

• Team Preparation: Distribute and review relevant papers as a team.
• Accessibility of Charts: Place up everywhere, including scanning rooms.
• Consistent Reporting Process: Use a structured reporting template.

Bill Middleton's Presentation

Image Analysis and Interpretation

• Nodule Measurement: Importance of consistent technique.
• Composition Categories: Solid, mixed, cystic, spongiform, with different point assignments.
• Echogenicity Assessment: Compare to thyroid/strep muscles, categorized from hyper to very hypoechoic.
• Margins and Shape: Understanding significance in point assignment, from well-defined to irregular.
• Calcifications: Differentiating types, importance in risk stratification.

Imaging Examples

• Examples Provided: To illustrate different compositions, echogenicity, margins, and calcifications.
• Clarifications on Ambiguous Cases: How to interpret shadowed or calcified nodules.

Jenny Hong's Presentation

Structured Reporting

• Template Use: Importance for consistency and accuracy.
• Study Findings: Structured reports improve completeness and accuracy of feature documentation.

Resources and Upcoming Webinars

• ACR TIRADS Website: Offers templates, educational materials.
• Future Webinars: Scheduled for case-based review and evidence behind ACR TIRADS.

Q&A Session

• Highlights: Addressed common questions on application of TIRADS, such as pediatric cases and ambiguous nodules.
• Encouragement: Attendees encouraged to ask questions and participate in future webinars.

Conclusion

• Call to Action: Participants encouraged to use structured reporting and attend future webinars.
• Acknowledgments: Thanks to all speakers and organizers.