Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Lam LY (1), Chu KM (1), Chek CW (1), Fung KH (1), Ko KWS (1), Poon WL (1)
Affiliation :
(1) Department of Radiology and Imaging, Queen Elizabeth Hospital
Introduction :
Thyroid nodules are common, occurring in up to 68% of thyroid ultrasound. However, most thyroid nodules are benign and small malignant nodules exhibit indolent behaviour. Therefore, not all nodules warrant fine needle aspiration (FNA) examination. Overbooking of FNA causes long waiting time, unnecessary patient risks and cost. A risk stratification system improves the documentation and assists clinical management.
We implemented the ACR Thyroid Imaging Reporting and Data System (ACR TI-RADS) in August 2022 after consultations with surgeons and endocrinologists. Education to radiologists, radiographers and clinicians with development of structured reporting template for thyroid ultrasound were carried out before the commencement.
Objectives :
This project aims to improve the quality of thyroid ultrasound reports in our department, provide guidance on management and improve our service in terms of waiting time.
Methodology :
Retrospective review of consecutive thyroid ultrasound studies in April 2022 (pre-implementation) and July 2023 (post-implementation) were performed. Cases with thyroidectomy and paediatric patients were excluded. The ultrasound reports were assessed on whether (1) descriptors (composition, echogenicity, shape, margins and echogenic foci) and (2) management recommendations were included.
The number of requests and waiting time for FNA of thyroid nodules during the periods before (September 2021 to August 2022) and after (September 2022 to August 2023) the implementation were also compared.
Result & Outcome :
The same number (134) of consecutive ultrasound reports with thyroid nodules were included in the pre- and post-implementation periods respectively. Only 17.9% pre-implementation reports contain all descriptors, while 97.8% post-implementation reports incorporated ACR TI-RADS reporting templates and included all descriptors (p < 0.00001). Management recommendations are found in 10.4% of pre-implementation reports and 65.8% of post-implementation reports (p < 0.00001).
With the implementation of ACR TI-RADS, the number of FNA requests has reduced from 1016 before to 792 after implementation (p = 0.0025). The median waiting time for FNA dropped from 523 days to 159 days before and after the implementation (p = 0).
In conclusion, the use of a risk stratification model can improve the quality of thyroid ultrasound reports, provide guidance on management and improve service quality in terms of waiting time.
