{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T10:14:12Z","timestamp":1777976052361,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Detection of thyroid nodules is increasing. The American College of Radiology Thyroid Image Reporting and Data System (ACR TI\u2010RADS) purports to decrease unnecessary thyroid fine needle aspiration (FNA) in selected retrospective groups. Limited reports of real\u2010world performance suggest otherwise. This large series compares our real\u2010world outcomes pre\u2010 and post\u2010implementation of ACR TI\u2010RADS for thyroid ultrasound (US) reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>ACR TI\u2010RADS was adopted at our tertiary institution in 2018. In this retrospective observational study, all patients undergoing thyroid US were divided into pre\u2010TIRADS (2014\u20132017) and post\u2010TIRADS (2019\u20132022) groups. We analyzed US, FNA, surgery rates, pathological outcomes, and cost data. A subset of post\u2010TIRADS patients was analyzed for US findings and adherence to ACR TI\u2010RADS recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our study included 13,156 patients. Post\u2010TIRADS, the total number of thyroid US decreased (9112 vs. 10,811). Also, the post\u2010TIRADS group had a significantly larger proportion of patients with only one US performed (70.8% vs. 62.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Both groups had a similar number of FNAs and surgeries performed. The surgically proven malignancy rate, median tumor size, and stage were similar. The total healthcare cost of all these procedures was higher in the post\u2010TIRADS group ($4,772,158.00) versus the pre\u2010TIRADS group ($4,280,081.98). In the subset analysis, adherence to ACR TI\u2010RADS was noted in 444\/635 patients (69.9%, 95% CI 66.2%\u201373.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While the implementation of ACR TI\u2010RADS has led to a reduction in follow\u2010up thyroid US, the rate of thyroid FNAs and surgery at our institution has not reduced. Further confirmatory research in other populations in the real world is required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70453","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T04:21:34Z","timestamp":1771820494000},"page":"2370-2378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Outcomes Following the Implementation of\n                    <scp>ACR TI<\/scp>\n                    \u2010\n                    <scp>RADS<\/scp>\n                    for Evaluation of Thyroid Nodules"],"prefix":"10.1002","volume":"136","author":[{"given":"Yun","family":"Zhao","sequence":"first","affiliation":[{"name":"Group Finance Analytics Singapore Health Services  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai Xun","family":"Yew","sequence":"additional","affiliation":[{"name":"Group Finance Analytics Singapore Health Services  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing Ying","family":"See","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head &amp; Neck Surgery Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan En\u2010Howe","family":"Tan","sequence":"additional","affiliation":[{"name":"Group Finance Analytics Singapore Health Services  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanda","family":"Venkatanarasimha","sequence":"additional","affiliation":[{"name":"Department of Vascular and Interventional Radiology Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chow Wei","family":"Too","sequence":"additional","affiliation":[{"name":"Department of Vascular and Interventional Radiology Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuet Wah","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Vascular and Interventional Radiology Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui Sei","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Vascular and Interventional Radiology Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heng Wai","family":"Yuen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head &amp; 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