Almost every time a governing body makes recommendations to institute a new reporting system, the amount of work multiplies. And, the advent of Thyroid Imaging Reporting And Data System (TI-RADS) is no different. Yes, I believe that the new reporting system has the potential to decrease unnecessary biopsies. And, new software dictation systems will eventually reduce the extra time that we spend on each case. But until that time, radiologists surrender their lives to increasing the verbiage and size of their thyroid dictations.
Imagine a patient with four significant thyroid nodules (not that uncommon). Then, tack on all the TI-RADS descriptors. (Check out the TI-RADS worksheet in this link from the ACR). Add on a final categorization and analysis of each thyroid nodule. Finally, compare the dictation size with the old dictation styles (in the past, you probably just measured the nodule size and consistency.) You are talking about an order of magnitude change in the radiologist’s time per dictation. And, yes, there are programs online that can calculate the scores for you. But, using these programs also takes additional clicks and time out of your day.
Big Deal Right?
No big deal. I mean, what is an extra 3-5 minutes per thyroid dictation, right? Well, multiply that number times 3, 5, or 10 depending on the number of thyroid ultrasounds you do in a day. That time racks up. It’s no longer that we are talking about 3-5 minutes more. Instead, we are tacking on 15 minutes to 50 minutes more per day. In an age where all the systems are trying to cut budgets, and radiologists need to increase efficiency to the nth degree. This increase in the workday doesn’t cut it.
Moreover, one of the most expensive links in the chain of an imaging center is the time of the radiologist. You are now increasing that time substantially. Fifteen minutes per day (on the low side) times five days per week times 40 weeks per year equals 3000 minutes of our time per year. Or, in other words, we are talking about 50 hours in a year. If you assume that a radiologist makes 300 dollars an hour, that small reporting change is instead costing 15,000 dollars per year per radiologist. Then, think about the costs to all radiologists (multiply that number by five or ten thousand). That’s not an insubstantial amount of dough!
What Is The Point Of This Exercise?
Well, let’s get to the bigger picture. I am trying to make the point that changing the requirements for radiologist reports is not just another inconsequential change. Instead, forcing us to modify the way we report cases for the good of society can substantially increase the costs to the system. So, we need to ask the governing bodies (like the ACR) to consider these points and take action to decrease the time and expense when they institute such a change.
How Can A New Reporting System Like TI-RADS Take Into Account The Radiologist’s Time?
There will be more reporting requirements to improve patient care. And, TI-RADS is only one requirement in a litany of many more to come. That’s fine. But, before initiating a new reporting system, organizations such as the American College of Radiology (ACR) should provide embedded software to compensate for the radiologist’s time. For instance, for those of us that use Powerscribe for dictation, when the ACR rolls out a new reporting system, provide the radiologist templates and artificial intelligence to simplify reporting.
So, in the case of TI-RADS, how can we restore the time of the radiologist? Well, take one of those TI-RADS calculators and embed it into the dictation software. And, create templates for thyroid ultrasound that will take the extra descriptive verbiage of a thyroid nodule and spit out a final assessment. Or, add a menu of options in a report-like configuration using the TI-RADS features to our dictation software to create a final report. These steps can decrease the costs and the radiologist’s time taken for the new reporting requirements by more than half.
Back To The Real World
Unfortunately, often, we, as radiologists, need to figure it all out on our own. We are left flailing about trying to work out how to decrease the time of reporting when these new change occur. It shouldn’t be this way. If we have to incorporate an entirely new type of report, and for a good clinical reason, the ACR should also take responsibility to help to restore the radiologist’s time. It’s not just decreasing radiologist’s leisure time with the family at stake. It’s also millions of dollars of cost to the system!
