title: Thyroid Biopsy Specialists: A Quality Initiative to Reduce Wait Times and Improve Adequacy Rates.
abstract: OBJECTIVE
  To develop and implement a program where selected sonographers would be trained to perform thyroid biopsies independently under the supervision of a radiologist, with the goal of improving efficiency and quality.
  
  
  METHODS
  Institutional research ethics board approval was obtained for this retrospective study, with waiver of informed consent. After approval from the relevant regulatory bodies, four sonographers successfully completed a training program and began to perform all thyroid biopsies (with informed consent) in a room adjacent to the main radiologist-run biopsy room, where the radiologist was available for backup as needed. In the preimplementation period (January 2010 to April 2011), 1321 nodules were biopsied, 29 of which included on-site cytopathology assessment. In the postimplementation period (August 2011 to July 2012), 1347 nodules were biopsied, 103 of which underwent on-site cytopathology assessment. Wait times and adequacy rates were calculated for both periods.
  
  
  RESULTS
  Patient wait times decreased from a mean of 80-90 days before implementation of the thyroid biopsy specialist program to 20-30 days afterward. The percentage of adequate samples improved from 74.6% (985 of 1321 nodules) to 78.6% (1059 of 1347 nodules), with a P value of .015 (74.1% [957 of 1292 nodules] to 77.5% [964 of 1244 nodules] when excluding nodules with on-site cytopathology assessment, P = .0497). The percentage of malignant samples showed no significant change in the two time periods, 5.1% (68 of 1321 nodules) before implementation of the program versus 5.4% (73 of 1347 nodules) after implementation, P = .823 (5.1% [66 of 1292 nodules] vs 5.3% [66 of 1244 nodules] in the respective time periods when excluding nodules with on-site cytopathology assessment, P = .888). No major procedural complications occurred.
  
  
  CONCLUSIONS
  Sonographers can be successfully trained to perform ultrasonography-guided thyroid biopsies safely under the supervision of a radiologist, which can improve wait times and adequacy rates.
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Sangeet
authors.initials: S
authors.lastname: Ghai
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Stefanie Y
authors.initials: SY
authors.lastname: Lee
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Patrice M
authors.initials: PM
authors.lastname: Bret
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Ravi J
authors.initials: RJ
authors.lastname: Menezes
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Scott L
authors.initials: SL
authors.lastname: Boerner
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Yongheng
authors.initials: Y
authors.lastname: Jia
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Kulsoom A
authors.initials: KA
authors.lastname: Maan
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Rudolf
authors.initials: R
authors.lastname: Boci
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Wasim
authors.initials: W
authors.lastname: Javed
authors.affiliation: From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
authors.forename: Mostafa
authors.initials: M
authors.lastname: Atri
mesh_terms: D006801:Humans; D061705:Image-Guided Biopsy; D058996:Quality Improvement; D012189:Retrospective Studies; D013038:Specialization; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000473:pathology*; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000592:standards