Thyroid and Neck Ultrasound

What it does

Thyroid and Neck Ultrasound reads a thyroid study: stills or short cine loops of both lobes and the isthmus, a transverse and a longitudinal view of each nodule, and images of the neck nodes. Lobe and plane labels typed on the screen ("LT LOBE TRANS", "SAG") are read as metadata, so the run knows which image shows which nodule and in which plane.

It builds one nodule list for the study. Each nodule is detected and outlined, matched across its transverse and longitudinal images so it counts once, measured in three axes and scored feature by feature with ACR TI-RADS 2017. The points give a TR level, and the nodule's size against that level gives the recommendation: fine-needle aspiration, follow-up or no further action. Lobe volumes and suspicious neck nodes complete the read.

Intended use

Decision support for the reader of a thyroid ultrasound, where risk scoring is a known source of variation between readers and of aspirations that were not needed. The result shows every feature and point behind a TR level, so the reader can check the descriptor that decided it.

Who it is for

Radiologists, endocrinologists, ENT and endocrine surgeons, and sonographers who prepare thyroid worksheets. Developers call the run to fill TI-RADS fields in a reporting system or to triage nodule clinics.

Accepted input

• Stills and cine: DICOM Ultrasound Image and Multi-frame objects, grey-scale with or without colour Doppler.
• Whole studies: a study folder or CD with all thyroid and neck images; non-image objects are skipped.
• On-screen measurements: caliper values typed on the images are read and reconciled with the computed sizes.

Requirements

Requirement	Why
Transverse and longitudinal view of each nodule	Shape (taller-than-wide) and three-axis size need both planes
SequenceOfUltrasoundRegions calibration	TI-RADS recommendations depend on size in centimetres; uncalibrated images give features without size advice
Unobstructed nodule margins	Burned-in calipers drawn over a margin can hide it; such margins are flagged
Lateral and central neck images	Needed for the lymph-node section

Optional context

Age, sex and the clinical question (incidental nodule, known goitre, follow-up of a previously scored nodule) go in clinical_context.

The result

One JSON result in sections with findings, measurements and classifications. Each nodule keeps a stable lesion_id and a location (lobe, upper, mid or lower third, isthmus), and its outline is returned as DICOM SEG.

Section	Content
Nodules	Detection, outline and three-axis size of every nodule, with location and the images it appears on
ACR TI-RADS	Composition, echogenicity, shape, margin and echogenic foci; points, TR1–TR5 level and the FNA or follow-up recommendation by size
Thyroid volume	Lobe and isthmus segmentation, ellipsoid volumes per lobe and a goitre flag
Cervical lymph nodes	Node detection with suspicious features: microcalcifications, cystic change, hyperechoic cortex, peripheral vascularity, round shape
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• Risk scoring: ACR TI-RADS 2017, with the five feature categories, point totals, TR levels and size thresholds for aspiration and follow-up.
• Neck nodes: ETA 2013 guideline on cervical lymph-node ultrasound for the suspicious features.
• DICOM: SR Measurement Report TID 1500; SEG for nodule and gland masks; GSPS calipers on the source images; Encapsulated PDF.
• Terminology: RadElement common data elements for ACR TI-RADS.

Scoring notes

Points from the five feature categories are summed: 0 points is TR1, 2 is TR2, 3 is TR3, 4 to 6 is TR4 and 7 or more is TR5. Large comet-tail artefacts score 0 and punctate echogenic foci score 3, so the run separates them explicitly; this is a frequent point of disagreement between readers.

Level	FNA if the nodule is	Follow-up if the nodule is
TR3	2.5 cm or more	1.5 cm or more
TR4	1.5 cm or more	1.0 cm or more
TR5	1.0 cm or more	0.5 cm or more

A TR level without calibrated size carries features and points but no size-based recommendation.