Audit on reporting of incidental thyroid nodules detected on computer tomography - Implementation of The White Paper of the ACR Incidental Thyroid Findings Committee

Purpose: Incidental thyroid nodule (ITN) is very common on computer tomography (CT). The workup of ITNs is costly and causes patients’ anxiety. Majority of the ITNs are small and benign. Incidental thyroid cancers are typically indolent. The ACR formed the Incidental Thyroid Findings Committee, describing a practical approach for radiologists to distinguish between ITNs that do verse do not require dedicated thyroid ultrasound (US).
The purpose of the audit is to achieve greater consistency in reporting and managing ITNs detected on CT, to reduce unnecessary US workup and downstream risks for clinically insignificant ITNs and lastly, to ensure proper workup for clinically significant ITNs.

Methods/Materials: The white paper was used as the reporting standard for ITNs on CT. ‘’Thyroid’’ was used a keyword to search in the RIS for a retrospective review of consecutive CT reports in the period of November to December 2022, 121 cases were found and were assessed for compliance with ACR white paper and radiologists’ reporting style.
The result of first audit cycle was presented in a departmental meeting in March 2022. The white paper was introduced to all radiologists and they were advised to report ITNs accordingly. Radiologists were advised to mention the actual size of ITNs and avoid ambiguous wording such as 'tiny' or 'small'. 119 cases were found and assessed in the second cycle of audit, performed in the period of July to August 2022.

Results: The overall compliance to ACR white paper increased from 79% to 91%. US recommended unnecessarily for clinically insignificant ITNs reduced from 78% to 17%. More clinically-significant ITNs got recommended US according to the ACR white paper, increased from 25% to 56%. More radiologists mentioned the actual size of ITNs in reports, increased from 56% to 75% and less ambiguous wordings were used in report, reduced from 35% to 7%.

Conclusions: Our radiologists showed increased awareness of the ACR white paper recommendations for ITNs. Overall compliance to the ACR white paper was increased from 79% to 91%. Greater consistency in reporting and managing ITNs detected in CT was observed.