Modified TI-RADS standardizes thyroid cancer reporting among radiologists

A modified TI-RADS was successful in helping one Canadian hospital achieve standardized reporting in their thyroid imaging department, the physicians reported in Academic Radiology this month, suggesting a globally uniform reporting system for thyroid cancers might not be far from reality.

Though their rate of malignancy hovers just around 5 to 15 percent, thyroid nodules affect nearly three-quarters of the U.S. population, corresponding author Ania Z. Kielar, MD, FRCPC, and colleagues at Ottawa Hospital and the University of Ottawa in Ontario, Canada, wrote. And despite a decades-long increase in diagnoses of the nodules, the five-year mortality rate for thyroid cancers has remained steady—around 6 percent—since 2005.

“With more thyroid nodules being detected, emphasis should be placed on consistent imaging technique, template reporting use and standardized management recommendations by radiologists,” Kielar et al. said. “One of the main challenges in this sequence of events is determining which nodules require biopsy and which ones are better left alone.”

Standardization would improve communication between healthcare providers and promote the adoption of a consistent reporting structure for documenting thyroid cancers, the authors wrote. Similar to the breast imaging reporting system, a uniform lexicon and set of guidelines for thyroid nodules would help harmonize the oncologic environment.

Kielar and her team adopted a modified version of TI-RADS (Thyroid Imaging Reporting and Data System), a model for standardization first released in 2011, for their study. They tracked all thyroid biopsies performed over two six-month periods at their tertiary care hospital—once ahead of the implementation of TI-RADS and one after.

“We sought to analyze radiologist adoption and adherence to these changes using a plan, do, study, act (PDSA) cycle,” Kielar and co-authors said. “We also sought to determine if implementation of TI-RADS affected the number of biopsies, biopsy wait times [and] positive thyroid malignancy rates.”

Before implementing the TI-RADS program, the researchers said, the hospital’s average number of thyroid biopsies and diagnostic ultrasounds per month were 74 and 271, respectively. After TI-RADS was introduced, biopsies dropped to 60 per month while ultrasounds climbed to 287, and wait times were reduced from five to three weeks.

“This quality assurance project demonstrated that implementation of a Community of Practice-modified TI-RADS system had a positive effect on lowering the net number of thyroid biopsies in our institution and also on reducing patient wait times for thyroid nodules,” the authors wrote. “It did not significantly reduce the percent of malignant biopsies per month; however, this could be due to the more remote introduction of ATA guidelines in our institution.”

Radiologists at the hospital also responded well to learning about the modified TI-RADS system through meetings and positive reinforcement, Kielar and colleagues said, reaching 86 percent adherence to guidelines by the end of the study. 

“The PDSA technique was found to be a good framework of implementing this standardized reporting and management recommendation system in our institution and could be applied to all healthcare providers who diagnose patients with thyroid nodules,” they said.