Atlas of thyroid ultrasonography, Newborn and infant ultrasonographic screening in medical practice, Online course

by PoCUS for family doctors, Ultrasound Oncologic Screening Project, The PoCUS Guidelines for Family Doctors.

The brief description of the project THYROSCREEN:

Screening of the thyroid pathology of the high-risk population at the level of Primary Care in Austria

Project presentation: - Integrated Thyroid Ultrasound Screening in Family Medicine

Acronym – THYROSCREEN

PARTNERS: EUVEKUS, THE ULTRASOUND WORKING GROUP IN FAMILY MEDICINE, AEDUS

              Dear colleagues, our story began over 20 years ago, when we were in contact with professors from Mannheim who were promoting the German ultrasound school in Europe. Also, we collaborated in the general ultrasound competencies training at the Pediatrics II Clinic of the University of Medicine in Timisoara and we had the idea of developing an intelligent medical software such as imaging diagnostic algorithms to facilitate ultrasound practice at the level of primary health care.

             To make this software, we needed a good expertise in ultrasound field, a standardization of the ultrasound practice, a real base in an informatical field and much passion. A few years ago, I implemented this software who was realized in a period of 15 years of experiments, updates and finally through my collaboration with Syonic-IcMed, I brought it to a professional standard in the field and titled this concept "The Smart Thyroid Ultrasound Software".  

             I believe that the future of Family Medicine will be that of the "ultrasound clinic examination" in which, besides the patient's history and anamnesis, the objective clinical examination can be complemented by US-visualization of various parenchymal organs, to increase the accuracy of the positive or differential diagnosis in outpatient medicine.

              After making this software, we moved to the second stage of our project, and we performed a regional monocentric ultrasound screening at regional level, where we obtained surprising results in more than 5000 patients with thyroid oncology risk with a prevalence of pathology thyroid over 38%, which justifies the importance of the problem raised by us. The accuracy of the proposed method was 95%.

              We have now reached the third stage of our project, to which we invite you to participate and which will be a National Integrated Thyroid Screening - Acronym THYROSCREEN. In this initiative, we want to apply a standardized thyroid pathology screening protocol to reduce thyroid morbidity and thyroid cancer mortality. The presence of multiple risk factors in our country, especially after the Chernobyl nuclear accident, has led to an increasing prevalence of diffuse or focal thyroid disease and an increased incidence of thyroid cancers in contrast to the low incidence observed at the level world.

               The protocol is addressed to physicians, being stratified on three levels:

• Level I includes primary care provided by family doctors. They will initially evaluate the general population and the risk of patients developing a thyroid pathology, through a questionnaire with 10 questions, offered at the time of presentation in the cabinet. Based on this questionnaire, patients at risk of developing thyroid pathologies will be included in our screening program. The selected patient group will be given an imaging examination by cervical ultrasound by our family physicians, included and prepared by us for this screening. Your patient data will be entered into a diagnostic algorithm or intelligent software for calculating lesion risk for the presence of thyroid cancer. We have developed a standardized working methodology protocol for the family doctor. Your results will be reviewed by a specialist in thyroid ultrasound and elastography that will be transmitted through a telemedicine system developed by us. We will organize a special training program for making thyroid ultrasound at the basic level and using Smart Thyroid Ultrasound Software.

•  Level II is represented by endocrinologists, their role being to verify and confirm the assessment made by the family doctor. Also, in the endocrinological consultation, suspected malignant lesions are evaluated preoperatively by fine needle aspiration puncture (FNAB) and cytological examination, respectively to request additional investigations useful for diagnosis and appropriate treatment.

• Level III is represented by the surgeon. Following surgical treatment, indicated by level II specialists, follows the histopathological evaluation of paraffin, which will bring definitive diagnosis and allow for a comparative analysis of the preoperative diagnosis offered by the cytology exam, thus requiring pathologist's expertise. Finally, we will correlate the data obtained at Level I, II, III with the "Gold - Standard" method (histopathological examination) to evaluate and validate the accuracy of the primary screening method.

               This project aims to enlist about 10-20 family doctors from different regions (urban or rural), 4-5 endocrinologists, 2-3 pathologists and 2-3 surgeons from national university centers.

               Level I, family doctors, will be co-opted into the project and included in an ultrasound training program within the EUVEKUS partner.

               Level II, Endocrinologists and Cytologists will be co-opted into this project as experts to analyze the collected data, to decide and to make FNABs,  and to decide the therapeutical protocol depending on the results.

               Level III, surgeons and pathologist, will be co-opted in the project to perform the surgical interventions established according to the protocol and to establish the diagnosis of certainty.

                Data collection and analysis will be performed in the collection, analysis, and data transmission software by associated partners experienced in the previous monocentric thyroid screening. As a leading partner, we want to increase the visibility of national primary medicine by publishing scientific articles in internationally rated journals, participating in national and international conferences and congresses, and recognizing us as initiators of an early diagnosis algorithm of thyroid neoplasm as well and future endowment of family physicians with ultrasonographic and elastographic exploration equipment and computerized infrastructure for the early diagnosis of thyroid pathology.

Our story continues ...

Dr. Iacob Mihai Sorin.
President of EUVEKUS.