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• W4372260384 abstract "Journal of Ultrasound in MedicineEarly View Practice ParameterFull Access AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck First published: 05 May 2023 https://doi.org/10.1002/jum.16251AboutReferencesRelatedInformationPDFSections Introduction Indications Qualifications and Responsibilities of Personnel Request for the Examination Specification of the Examination Documentation Equipment Specification Quality and Safety Acknowledgments Collaborative Subcommittees AIUM Clinical Standards CommitteeReferencesPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Introduction The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of clinical practice parameters, and accreditation of practices performing ultrasound examinations. The AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck was developed (or revised) by the American Institute of Ultrasound in Medicine (AIUM) in collaboration with other organizations whose members use ultrasound for performing this examination(s) (see “Acknowledgments”). Recommendations for personnel requirements, the request for the examination, documentation, quality assurance, and safety may vary among the organizations and may be addressed by each separately. This Practice Parameter is intended to provide the medical ultrasound community with recommendations for the performance and recording of high-quality ultrasound examinations. The parameters reflect what the AIUM considers the appropriate criteria for this type of ultrasound examination but are not intended to establish a legal standard of care. Examinations performed in this specialty area are expected to follow the Parameter with recognition that deviations may occur depending on the clinical situation. Indications Indications for an ultrasound (US) examination of the thyroid and extracranial head and neck include, but are not limited to1: Evaluation of the location and characteristics of palpable neck masses and thyroid nodules. Evaluation of abnormalities detected by other imaging examinations, such as thyroid nodules and/or other neck masses that satisfy criteria for a thyroid ultrasound examination that are detected on computed tomography (CT), positron emission tomography (PET), PET/CT, magnetic resonance imaging (MRI), or other ultrasound examinations (eg, carotid duplex).1 Evaluation of the presence, size, location, and sonographic features of the thyroid gland.2 Evaluation of congenital hypothyroidism, including search for and characterization of orthotopic and/or ectopic thyroid tissue.3, 4 Evaluation of patients at high risk for thyroid malignancy. Imaging of previously detected thyroid nodules that meet criteria for follow-up.5 Evaluation of the thyroid gland for suspicious focal pathology before neck surgery for nonthyroidal disease.6 Evaluation of the thyroid gland for suspicious focal pathology before radioiodine ablation of the gland for hyperthyroidism. Evaluation for regional nodal metastases in patients with proven or suspected thyroid carcinoma before surgical or other management.7 Evaluation for recurrent locoregional metastatic disease and/or nodal metastases after lobectomy, hemi- or total thyroidectomy for thyroid carcinoma.5 Evaluation of known or suspected thyroid cancer (usually papillary microcarcinoma not undergoing surgical resection) that is being monitored periodically with ultrasound active surveillance/active monitoring for disease progression (eg, increase in nodule size, development of nodal metastatic disease, or extrathyroidal extension). Guidance for aspiration biopsy or other interventional procedure performed on thyroid abnormalities or other neck masses.8, 9 Evaluation for causes of relevant laboratory abnormalities, such as abnormalities of parathyroid or thyroid function, elevation of thyroglobulin, hypercalcemia, and so on. Assessment of the location, number, and size of enlarged parathyroid glands in patients with known or suspected hyperparathyroidism, including patients who have undergone previous parathyroid surgery or ablative therapy who have recurrent signs or symptoms of hyperparathyroidism.10, 11 Localization of autologous parathyroid gland implants. Evaluation of masses of the parotid and submandibular glands.12, 13 Evaluation of non-neoplastic conditions of the parotid and submandibular glands, including, but not limited to, sialolithiasis, infection, and autoimmune processes.14-16 Nodal evaluation, including staging, evaluation of response to therapy, and monitoring after therapy, in select patients with head and neck malignancies, including, but not limited to, head and neck primary squamous cell carcinoma, primary salivary malignancy, and melanoma.17-19 Evaluation for supraclavicular nodal metastasis in patients with lung cancer or other infraclavicular primary malignancies at risk for metastasis.20, 21 Nodal evaluation in pediatric patients with cervical lymphadenopathy, including, but not limited to, evaluation for necrosis and abscess formation in the setting of acute lymphadenitis.22, 23 Imaging of ultrasound-detectable vascular abnormalities (such as vascular tumors and vascular malformations) of the head and neck.24 Evaluation of torticollis in neonates and infants25; or Evaluation of adult and pediatric head and neck soft tissue masses including, but not limited to, thyroglossal duct cyst, branchial cleft cyst, lymphatic malformation, thymic ectopia/cyst, hemangioma, primary neck masses, including neurogenic tumors (neuroblastoma, schwannoma, neurofibroma), rhabdomyosarcoma, leukemia/lymphoma, metastatic disease (rhabdomyosarcoma, neuroblastoma, thyroid cancer, etc),26 and phlebectasia.27 Qualifications and Responsibilities of Personnel Physicians interpreting or performing this type of ultrasound examination should meet the specified AIUM Training Guidelines28 in accordance with AIUM accreditation policies.29 Sonographers performing the ultrasound examination should be appropriately credentialed30 in the specialty area in accordance with AIUM accreditation policies.29 Physicians not personally performing the examination must provide supervision, as defined by the Centers for Medicare and Medicaid Services Code of Federal Regulations 42 CFR §410.32.31 Request for the Examination The written or electronic request for an ultrasound examination must originate from a physician or other appropriately licensed health care provider or under the provider's direction. The clinical information provided should allow for the performance and interpretation of the appropriate ultrasound examination and should be consistent with relevant legal and local health care facility requirements. Specification of the Examination Sonographic evaluations of the neck may be comprehensive or may be problem-focused, as appropriate for the patient and clinical scenario. Whenever possible, comparison should be made with prior sonograms and/or other appropriate imaging studies. Thyroid Evaluation The examination should be performed with the neck in as much hyperextension as tolerated by the patient, with or without a towel or other support under the neck or shoulders. Upright positioning may be helpful in patients who cannot tolerate neck hyperextension in the supine position. The right and left lobes of the thyroid should be imaged in longitudinal and transverse planes. Recorded images should include transverse images of the superior, mid, and inferior portions of the right and left thyroid lobes; longitudinal images of the medial, mid, and lateral portions of both lobes; and a transverse image of the isthmus. The size of each thyroid lobe should be recorded in three dimensions: anteroposterior (AP), transverse, and longitudinal. The thickness (AP measurement) of the isthmus on the transverse view should be recorded. Color Doppler can be used to supplement grayscale evaluation of either diffuse or focal thyroid abnormalities. It is often necessary to extend imaging to include the soft tissues above the isthmus, for example, to evaluate a pyramidal lobe of the thyroid, a thyroglossal duct cyst, or palpable abnormality. Similarly, it is important to visualize components of the gland that extend toward or into the superior mediastinum. In this effort, use of tightly curved array transducers may be helpful. The roles of strain and shear-wave elastography and contrast-enhanced ultrasound (CEUS), although potentially helpful, have not been established definitively. Thyroid abnormalities should be imaged in a way that allows for reporting and documentation of the following: Localized or diffuse parenchymal echotexture (eg, homogeneous vs heterogeneous) and, if relevant, vascularity (hyperemia) of the thyroid parenchyma should be noted.32, 33 There are multiple thyroid nodule risk-stratification systems (RSSs) in existence. Images of thyroid nodules should be acquired such that relevant focal nodules can be classified based on whatever RSS is used by the interpreting physician. For example, the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) RSS employs the following sonographic features: composition (solid and/or cystic components); echogenicity; size (in AP, transverse, and longitudinal dimensions); margins (smooth, ill-defined, irregular, or demonstrating extrathyroidal extension); nodule orientation (eg, taller than wide); and presence and type of echogenic foci and/or calcifications.8, 34, 35 Although the ultrasound features that determine risk in children are the same as those used in adults, to date, none of the RSSs have been specifically endorsed for the pediatric population.9, 36, 37 Examination of relevant neck compartments for adenopathy may be helpful in determining the need for biopsy in the setting of thyroid nodules. Comprehensive evaluation of central and lateral compartment cervical lymph nodes is strongly recommended for patients with known or suspected thyroid cancer.38, 39 This comprehensive evaluation may occur at the time of the initial thyroid ultrasound, the time of an ultrasound-guided biopsy, or as a separate ultrasound evaluation to assist in potential surgical or other management decisions. Institutions are encouraged to have consistent practices to ensure that patients receive a comprehensive nodal evaluation when indicated (see Section 8). In patients who have undergone lobectomy, hemithyroidectomy (lobectomy and isthmectomy), or thyroidectomy, the thyroid bed should be imaged in transverse and longitudinal planes, and abnormal solid or cystic masses should be measured and reported. Again, examination of relevant neck compartments and the adjacent soft tissue is important to look for locoregional metastatic disease in the setting of prior thyroid malignancy. Patients with known or suspected thyroid malignancy who are undergoing active surveillance or active monitoring with ultrasound must be evaluated for progression (eg, interval increase in surveillance nodule size, development of extrathyroidal extension, multifocal disease, or locoregional nodal metastases).40-43 Cervical Lymph Node Evaluation Sonographic examination of cervical lymph nodes may be comprehensive or focused, as appropriate for the patient and clinical scenario. Specific nodes that are imaged and the extent of imaging documentation will vary based on the clinical indication. Please see above for nodal evaluation with respect to thyroid-related indications. The size and location of abnormal lymph nodes should be documented, and suspicious nodal morphology including, but not limited to, calcification, cysts' focal echogenic areas that are unrelated to a fatty hilum, and abnormal blood flow should be documented.44 Round shape and absence of an echogenic hilum, although reported in malignant nodes, are findings with poor specificity in thyroid cancer.45, 46 Location of abnormal lymph node(s) should be documented with annotations and/or enough visual information to be able to describe the location according to the image-based nodal classification system developed by the American Joint Committee on Cancer and the American Academy of Otolaryngology—Head and Neck Surgery, or in a fashion that allows the referring clinician to convert the location of abnormal nodes to that system.47 Node evaluation should be performed at centers with experienced personnel. Lymph node size varies with nodal compartment (eg, level 2 nodes are often larger than other lateral compartment nodes), and nodal size is often less important in the evaluation of malignancy than nodal morphology. Enlarged cervical nodes can be seen in lymphoma and other malignancies but are often reactive and are seen in acute and chronic infectious and inflammatory disease processes such as postviral syndromes and Hashimoto thyroiditis. In the pediatric population, cervical lymph node size, echotexture, vascularity, and potential nodal suppuration or abscess-formation evaluation are important in the evaluation of acute lymphadenitis.22, 23 Parathyroid Evaluation Parathyroid ultrasound helps guide surgical planning by localizing enlarged parathyroid glands in patients with primary hyperparathyroidism and helping to predict single versus multiple gland enlargement. Examination for suspected parathyroid enlargement due to adenomas, hyperplasia, or, extremely rarely, parathyroid carcinomas should include images posterior to and just inferior to the right and left thyroid lobes, typical parathyroid gland locations. In addition to typical locations, enlarged parathyroid glands and parathyroid adenomas may be ectopic, and the examination may need to be extended to include imaging from the hyoid to the sternum and along the carotid sheath. Abnormalities of the thyroid and cervical nodes should be documented because concomitant thyroid and/or cervical node pathology may be contraindications to minimally invasive parathyroidectomy.10, 11, 48 The examination should be performed with the neck hyperextended and should include longitudinal images from the right and left carotid arteries to the midline, as well as transverse images from the carotid artery bifurcation superiorly to the thoracic inlet inferiorly. Normal parathyroid glands are often not visualized using available sonographic technology; however, enlarged parathyroid glands may be detected. Gentle compression with the ultrasound transducer, asking the patient to swallow during real-time imaging, and the addition of color Doppler imaging (to evaluate for polar rather than central blood flow that is more typical of lymph nodes) are imaging techniques that may make it easier to identify enlarged parathyroid glands. Parathyroid glands may be located below the clavicles or in the mediastinum, and angling smaller footprint, tightly curved array transducers inferiorly from the sternal notch can aid in diagnosis of enlarged inferior parathyroid glands. Approximately 1%–3% of parathyroid adenomas may be retrotracheal; instructing the patient to swallow and/or turn their head to the opposite side may be helpful in identifying these ectopic parathyroid glands. Rarely, parathyroid adenomas may be intrathyroidal. When parathyroid abnormalities are visualized, their number, size, measurements in three dimensions, and location and relationship to the thyroid gland, if applicable, should be documented.6, 49 Parotid and Submandibular Evaluation Sonographic evaluation of the major salivary glands may be comprehensive or focused, as appropriate for the patient and clinical scenario. The parotid and submandibular glands are evaluated in two planes, although anatomic limitations due to the mandible and external ear often require oblique planes. A lower frequency transducer may be helpful to visualize the deep aspects of the parotid gland. Color Doppler may be added, when appropriate, for the evaluation of diffuse or focal abnormalities. Overall echotexture (eg, homogeneous or heterogeneous) and measurements of the parotid and submandibular glands should be performed, when appropriate, such as in the evaluation of autoimmune disease or gland asymmetry. Salivary ductal dilation and calculi should be reported. When possible, a dilated salivary gland duct should be traced to the level of obstruction. Description of focal abnormalities/masses within the salivary glands should include size in three dimensions, margins, echogenicity, composition, and internal blood flow. Intraparotid lymph nodes and their morphologic appearance (normal or abnormal) should be reported.50 Sonographic Guidance of Head and Neck Procedures Sonographic guidance may be used for aspiration and/or biopsy of thyroid/parathyroid/salivary gland abnormalities, lymph nodes, and other masses of the head and neck or for other interventional procedures including, but not limited to, preoperative localization and ultrasound-guided treatment of masses with various ablation methods.51 Documentation Accurate and complete documentation is essential for high-quality patient care. Written reports and ultrasound images/video clips that contain diagnostic information should be obtained and archived, with recommendations for follow-up studies if clinically applicable, in accordance with the AIUM Practice Parameter for Documentation of an Ultrasound Examination.52 Equipment Specification Equipment performance monitoring should be in accordance with the AIUM Routine Quality Assurance of Clinical Ultrasound Equipment.53 Extracranial head and neck ultrasound studies are usually conducted with a linear transducer. The equipment should be adjusted to operate at the highest clinically appropriate frequency, realizing that there is a trade-off between resolution and beam penetration. For most patients, mean frequencies of 10–14 MHz or greater are preferred, although some patients may require a lower-frequency transducer for depth penetration. For evaluation of deep or large structures, a curved transducer may be necessary. For morphologic evaluation of small, superficial lesions, higher frequency transducers, with a small footprint, may be necessary. Additionally, a small-footprint, tightly curved array transducer may be helpful for evaluation of the inferior aspect of the central neck to evaluate for inferior central or upper mediastinal adenopathy and inferior parathyroid glands (Section 5.3). Resolution should be of sufficient quality to evaluate the internal morphology of visible lesions. Doppler frequencies should be set to optimize flow detection. Diagnostic information should be optimized while keeping total sonographic exposure as low as reasonably achievable. Quality and Safety Policies and procedures related to quality assurance and improvement, safety, infection control, and equipment-performance monitoring should be developed and implemented in accordance with the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices.29 ALARA Principle The potential benefits and risks of each examination should be considered. The ALARA (As Low as Reasonably Achievable) principle54 should be observed for factors that affect the acoustical output and by considering transducer dwell time and total scanning time. Further details on ALARA may be found in the current AIUM publication Medical Ultrasound Safety.55 Infection Control Transducer preparation, cleaning, and disinfection should follow manufacturer recommendations and be consistent with the AIUM's Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers Between Patients, Safe Handling, and Use of Ultrasound Coupling Gel.56 Equipment Performance Monitoring Monitoring protocols for equipment performance should be developed and implemented in accordance with the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practice.29 Acknowledgments This parameter was developed by the AIUM in collaboration with the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Radiologists in Ultrasound (SRU). We are indebted to the many volunteers who contributed their time, knowledge, and energy to developing this document. Collaborative Subcommittees AIUM Mark Lupo, MD ACR Michelle L. Melany, MD, FACR, Chair Javad Azadi, MD Helena Gabriel, MD Safwan Halabi, MD SPR Sosamma Methratta, MD Cicero Silva, MD SRU Malak Itani, MD Kathryn McGillen, MD AIUM Clinical Standards Committee James M. Shwayder, MD, JD, Chair Rachel Bo-ming Liu, MD, Vice Chair Bryann Bromley, MD, FAIUM Rachel Bo-ming Liu, MD, FACEP, FAIUM Juliana Gevaerd Martins, MD Creagh T. Boulger, MD, FAIUM John R. Eisenbrey, PhD, FAIUM Rob Goodman, MB, BChir Margarita V. Revzin, MD, MS, FSRU, FAIUM Oliver Daniel Kripfgans, PhD, FAIUM Jean Lea Spitz, MPH, CAE, RDMS, FAIUM, FSDMS Nirvikar Dahiya, MD, FAIUM John Stephen Pellerito, MD, FACR, FAIUM, FSRU Ethan J. Halpern, MD, FAIUM Original copyright, 1994; revised, 1998, 2003, 2006, 2007, 2013, 2014, 2018, 2022 References 1Hoang JK, Langer JE, Middleton WD, et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. 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Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation RecommendedSurveillance following head, neck, and chest radiotherapy: Thyroid ultrasound monitoring for secondary thyroid malignancyCaitlin Kelly MD, Linda Rivard RN, Sharad Salvi MD, Ammar Hayani MD, William Hopkins MD, Sarah O'Brien MD, MSc, Laura Martin MD, Jason Canner DO, Pediatric Blood & CancerHead and neck malignancyAndrew N. Morritt, Marlene S. See, Navid Jallali, Plastic and reconstructive surgery: Approaches and techniques, [1]Planned Neck Dissection after Concomitant Radiochemotherapy for Advanced Head and Neck CancerDouglas K. Frank MD, Kenneth S. Hu MD, Bruce E. Culliney MD, Mark S. Persky MD, Moses Nussbaum MD, Stimson P. Schantz MD, Stephen C. Malamud MD, Roy A. Holliday MD, Azita S. Khorsandi MD, Roy B. Sessions MD, Louis B. Harrison MD, The LaryngoscopeEffect of a second primary thyroid carcinoma on patients with head and neck squamous cell carcinomaAnthony M. Tolisano MD, Christopher Klem MD, Michael B. Lustik MS, Joseph C. Sniezek MD, J. Blake Golden MD, Head & Neck" @default.
• W4372260384 created "2023-05-07" @default.
• W4372260384 date "2023-05-05" @default.
• W4372260384 modified "2023-10-17" @default.
• W4372260384 title "<scp>AIUM</scp> Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck" @default.
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