Thyroid US Technologist Worksheet St Vincents Riverside Southside Clay St Johns Imaging Center Arlington ER Westside ER Beach ER Optimal Forbes Southside Clay Mandarin Westside St Johns Town Center Orange Park Patient Name: MMI: Age: History/Symptoms: Neck Pain Abnormal TFTs Fam Hx of Thyroid Ca Weight ↑ ↓ Neck Swelling Hyperthyroidism Thyroid Nodule R L Radioiodine Therapy Difficulty Swallowing Hypothyroidism Thyroid FNA R L Parathyroid Disease Thyroid Enlargement Head/Neck Radiation Energy ↑ ↓ Calcium ↑ ↓ homogeneous heterogeneous nml vascularity hypervascular x x cm Right Lobe homogeneous heterogeneous nml vascularity hypervascular x x cm Left Lobe mm Isthmus Indicate nodule position by
placing number on diagram. Document up to 6 most suspicious nodules. Do not measure cystic or almost entirely cystic nodules unless they are very large as they are always benign. Nodule 1 x x mm solid / cystic / complex / hypo / iso / hyper Nodule 2 x x mm solid / cystic / complex / hypo / iso / hyper Nodule 3 x x mm solid / cystic / complex / hypo / iso / hyper Nodule 4 x x mm solid / cystic / complex / hypo / iso / hyper Nodule 5 x x mm solid / cystic / complex / hypo / iso / hyper Nodule 6 x x mm solid / cystic / complex / hypo / iso / hyper TI-RADS Nodule Features - The More Points The More Suspicious The Nodule Composition cystic or almost entirely cystic (0), spongiform (0), mixed solid/cystic (1), solid (2) anechoic (0), hyper/isoechoic (1), hypoechoic (2), very hypoechoic to strap muscles (3) Echogenicity wider-than-tall (0), taller-than-wide (3) Shape smooth (0), ill-defined (0), lobulated (2), irregular (2), extends outside thyroid (3) Margin Echogenic Foci none (0), large comet tail (0), macrocalcs (1), rim calcs (2), punctate echogenic foci (3) Sonographer's Impression: Sonographer's Name, Date & Time:

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Not Intended for Treatment Planning MI-0605
(Revised 6/2025) Tech Wrksht - "Thyroid US Chrtform"