TI-RADS Calculator
The ACR Thyroid Imaging Reporting and Data System (TI-RADS) helps radiologists and clinicians decide whether a thyroid nodule needs a biopsy or just monitoring. Enter the ultrasound characteristics of a thyroid nodule to get its TI-RADS level and the recommended next step.
ACR TI-RADS assigns points based on five ultrasound feature categories: composition, echogenicity, shape, margin, and echogenic foci. The total points map to one of five TI-RADS levels (TR1 through TR5), each carrying a different risk of malignancy and a size-based recommendation for fine needle aspiration (FNA) biopsy or follow-up imaging.
The scoring works like this: each category contributes 0 to 3 points, and the points are summed. TR1 (0 points) means benign, and no further workup is needed. TR2 (2 points) is not suspicious. TR3 (3 points) is mildly suspicious, with FNA suggested only for nodules 2.5 cm or larger. TR4 (4 to 6 points) is moderately suspicious, with FNA at 1.5 cm. TR5 (7 or more points) is highly suspicious, with FNA at 1.0 cm.
Features most associated with malignancy include solid composition, very hypoechoic echogenicity, taller-than-wide shape, irregular margins, and punctate echogenic foci (possible microcalcifications). A purely cystic or spongiform nodule is almost always benign.
This tool is for educational reference. Clinical decisions should always involve a qualified radiologist or endocrinologist who can correlate ultrasound findings with the patient's history.