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Technical conditions

Professional considerations

Lack of biological standard and also of exact definitions

In most ultrasound characteristics we lack a biological standard to which the feature can be compared. In such situation, a consensual interpretation would have a fundamental role. This consensus could be based on uniform and as exact as possible definitions. Unfortunately, a definition of such quality is not given in most cases by the guidelines.

It follows that the interpretation of the author of an ultrasound atlas is necessarily subjective and debatable.


The most voluminous and perhaps the most important chapter focuses mainly on individual ultrasound characteristics of nodular goiters. Essentially, this deconstruction serves only educational purposes. In the everyday practice, an investigator evaluates the ultrasound pattern as a whole.

Don't let you deceive!

The world of scientific and educational materials

All guidelines and their TIRADS systems pretend as to the interpretation of ultrasound characteristics would be clear in most cases.

It has not been recognized that the definitions on which the interpretation is based are not uniform in many cases.

Images in textbooks and other publications are preselected. These materials usually not include difficult-to-analyze patterns or large nodules which are more difficult to display in image.

Education is almost exclusively based on the analysis of still images.

The real-world examination

Different interpretations of the same cases are frequently justified.

We must also be able to interpret difficult-to-display patterns, large goiters, and nodules occurring in not ideal situations, e.g. in obese or short-necked or previously operated patients.

The basis of ultrasound learning is not still images but high-definition videos which in contrast to the former, can almost fully replicate the real-world situation.

Rule of thumb based on three considerations


The most important role of ultrasound is the selection of patients for FNA. The main goal of the last 15 years has been to reduce the number of unnecessary cytological examinations.

Cytology is one of the cheapest tests that hardly burdens the patient more than a simple blood sample.

As with all tests, cytology should be performed for appropriate reasons.

Final conclusion

If a patient derives a reasonable benefit from performing the cytology, it should be performed regardless e.g. of a TIRADS score. We are responsible for the patient and not for a system.