US Neck (Soft Tissue) — Dictation, Appropriateness, and Dose for Residents

1. The Neck Ultrasound Read: More Than Just TI-RADS Juggling

You’ve got a full list of outpatient neck ultrasounds. The third one of the day shows three distinct thyroid nodules, and the attending wants a full ACR TI-RADS 2.0 workup on each one. You’re trying to remember if peripheral rim calcifications are 2 points or if that was only for irregular margins. Getting it right isn’t just academic — it’s the difference between a 6-month follow-up and a fine-needle aspiration biopsy. When I was a PGY-2, I’d sometimes just eyeball the score and hope for the best, but you only need one attending to call you out on a miscalculated TR score to learn that lesson for good. This guide is built to make those reads faster, more accurate, and less stressful. For more tools like this, check out the residents and fellows resource hub we maintain.

2. What a Neck Ultrasound Covers and What Attendings Look For

A comprehensive neck ultrasound is the workhorse for evaluating superficial neck structures. It’s the first-line study for any palpable lump, goiter, or suspected parathyroid issue. Your attending isn’t just looking for a measurement; they expect a systematic evaluation that answers specific clinical questions. They want to see a report that clearly addresses the thyroid, parathyroids, salivary glands, and cervical lymph node chains.

Based on the American College of Radiology (ACR) Appropriateness Criteria for Thyroid Disease and Neck Mass-Adenopathy, ultrasound is the definitive initial imaging modality. Your report should confidently answer:

• Thyroid Nodules: What is the size, location, and ACR TI-RADS classification for every nodule?
• Cervical Lymphadenopathy: Are the nodes reactive or do they have suspicious features (rounded, loss of fatty hilum, cystic change, abnormal vascularity)?
• Parathyroid Adenoma: Is there a discrete, hypoechoic, hypervascular mass posterior to the thyroid consistent with an adenoma?
• Salivary Glands: Is there evidence of sialolithiasis, inflammation, or a discrete mass in the parotid or submandibular glands?
• Congenital Cysts: Is there a fluid collection in a typical location for a branchial cleft or thyroglossal duct cyst?
• Other Soft Tissues: Is there an abscess, lipoma, or other superficial mass?

While excellent for these indications, remember that ultrasound is not the first choice for evaluating deep neck space infections or the full substernal extent of a large goiter — that’s CT territory.

3. Radiology Report Template for Neck Ultrasound (Thyroid, Parathyroid, Soft Tissue)

Use this template as a starting point for your macros. The key is to be systematic. Document everything, even the normal structures, so the ordering clinician knows you looked.

Technique

Real-time grayscale and color Doppler ultrasound evaluation of the neck was performed using a high-frequency linear transducer. The thyroid gland, parathyroid regions, and visualized cervical lymph node chains were assessed.

Findings

THYROID GLAND:
Right Lobe: Measures [___] x [___] x [___] cm. Parenchymal echotexture is [homogeneous/heterogeneous]. No discrete nodules.
Left Lobe: Measures [___] x [___] x [___] cm. Parenchymal echotexture is [homogeneous/heterogeneous]. No discrete nodules.
Isthmus: Measures [___] mm in AP dimension. Normal.
Vascularity: Normal background vascularity on color Doppler interrogation.

THYROID NODULES:
If present, describe each nodule separately (Nodule 1, Nodule 2, etc.)
Nodule 1: Located in the [upper/mid/lower] pole of the [right/left] lobe.
Measures: [___] x [___] x [___] cm.
Composition: [cystic/spongiform (0), mixed (1), solid (2)]
Echogenicity: [anechoic (0), iso/hyperechoic (1), hypoechoic (2), very hypoechoic (3)]
Shape: [wider-than-tall (0), taller-than-wide (3)]
Margin: [smooth/ill-defined (0), lobulated/irregular (2), extrathyroidal extension (3)]
Echogenic Foci: [none, comet-tail artifacts (0), macrocalcifications (1), peripheral rim calcifications (2), microcalcifications (3)]
ACR TI-RADS Score: [Total Points], TR Category [TR#]

PARATHYROID:
No discrete hypoechoic mass is seen in the expected locations of the parathyroid glands posterior to the thyroid.

CERVICAL LYMPH NODES:
Multiple subcentimeter lymph nodes are seen in cervical levels [e.g., II, III, IV], which appear reactive with preserved fatty hila.
(If suspicious nodes are present): A [rounded/enlarged] lymph node is seen in level [___] measuring [___] x [___] cm, demonstrating [loss of fatty hilum, cystic change, peripheral vascularity, microcalcifications].

SALIVARY GLANDS:
The visualized portions of the parotid and submandibular glands are symmetric and homogeneous in echotexture. No sialolithiasis or focal mass.

OTHER FINDINGS:
The visualized major vessels are patent. No large soft tissue mass or fluid collection.

Impression

1. [e.g., Multinodular goiter without suspicious features.]
2. Nodule in the [location] of the [right/left] thyroid lobe, measuring [size], classified as ACR TI-RADS [TR#] ([Total Points]).

• TR5 (≥7 pts): FNA recommended for nodules ≥1 cm. Follow-up for nodules ≥0.5 cm.
• TR4 (4-6 pts): FNA recommended for nodules ≥1.5 cm. Follow-up for nodules ≥1 cm.
• TR3 (3 pts): FNA recommended for nodules ≥2.5 cm. Follow-up for nodules ≥1.5 cm.

3. [e.g., No sonographic evidence of parathyroid adenoma.]
4. [e.g., Nonspecific cervical lymphadenopathy, likely reactive.]

4. Free Template Sources for When You’re Off-Platform

Building your own macro library is a rite of passage. But you don’t have to start from scratch. If you’re looking for templates beyond this guide, two great free repositories exist, curated by radiologists for radiologists.

• RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty. (https://radreport.org/)
• Radiology Templates (AU): An excellent, clean resource maintained by Australian radiologists with a focus on practical, clear templates. (https://www.radiologytemplates.com.au/home-page/)

These are solid resources for building out your personal toolkit, especially during training.

5. The Next-Level Move: Free-Form Dictation to Structured Report

The biggest time sink in a complex neck US isn’t the scan; it’s the dictation. Toggling between your PACS viewer and the dictation window to fill out every TI-RADS field for multiple nodules is a drag. This is where AI-powered dictation assistants can streamline your workflow. Instead of clicking through a structured template, you can dictate the positive findings in free form: “Mid-pole left lobe shows a 1.6 cm solid, hypoechoic, taller-than-wide nodule with microcalcifications.” The software then parses this, calculates the TI-RADS score, and populates the structured report automatically.

Tools like GigHz Precision AI are designed for this exact purpose. It uses pre-loaded ACR and society-backed templates to ensure your report is clean, complete, and uses the right terminology. This approach helps you focus on the image interpretation, not the clerical work of filling out a form.

6. How Much Radiation Does a Neck Ultrasound Deliver?

This is an easy one for patient counseling: a neck ultrasound delivers no ionizing radiation. It is one of the safest imaging modalities available.

The estimated effective dose is 0 mSv. This makes it ideal for pediatric patients, pregnant patients, and for serial follow-up of thyroid nodules without accumulating radiation exposure. The American College of Radiology Radiation Reference Level (RRL) for this exam is “O” for None.

7. Neck Ultrasound Protocol — Transducer, Sweeps, and Measurements

A high-quality neck ultrasound depends on meticulous technique. The protocol involves a systematic survey of all relevant structures using a high-frequency transducer to maximize resolution of these superficial structures. The patient should be supine with a roll under their shoulders to gently extend the neck.

The core of the exam is a complete survey of the thyroid, followed by a targeted evaluation of any abnormalities and a broader look at the surrounding lymph nodes and glands.

Common protocol pitfalls: Using a transducer with too low a frequency will result in poor resolution of small nodules and microcalcifications. Conversely, a very high-frequency probe may not provide enough penetration to see the posterior aspect of the thyroid or deep structures in patients with large necks. Always optimize your frequency and focal zone.

8. The 3-Months-Free Offer for Radiology Residents and Fellows

Look like a rockstar on your reports. We’re offering 3+ months of free access to GigHz Precision AI for all radiology residents and fellows. You can dictate your positive findings in free form, and the AI will generate a clean, structured report using the latest ACR and society templates, with the appropriate Clinical Decision Support (CDS) firing automatically.

All we ask in return is your feedback so we can keep improving the product for trainees. The signup is simple — no credit card, no long forms. To get started, just provide these three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or fellowship specialty)
3. Your training program / hospital name

We’ll get you set up right away. To get started, apply for the residents free-access program.

9. Frequently Asked Questions

Is GigHz Precision AI HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. No patient-identifying information is required to use the tool for generating structured report text, which you can then copy into your PACS/RIS.

Do I need my hospital’s IT department to set it up?

No. It’s a browser-based tool that requires no local installation. It works on any modern web browser, including the one on your call-room computer or personal iPad.

Does it work with PowerScribe or other dictation systems?

Yes. It works alongside your existing dictation system. You generate the structured impression or findings in the GigHz web interface and then simply copy/paste the text into your PowerScribe (or other) report.

Can I use it on my phone or iPad?

Yes, the platform is fully responsive and designed to work on desktops, tablets, and mobile devices, making it accessible whether you’re at a workstation or on the go.

Can I customize the templates?

Yes. While the system comes pre-loaded with standard ACR and society-backed templates, you can create, modify, and save your own custom templates to match your institution’s or your personal preferences.

What happens after my residency or fellowship ends?

Trainee accounts are for the duration of your training. After you graduate, you can transition to a standard attending physician account. We offer discounts for recent graduates.