TI-RADS calculator
Choose the ultrasound features of a thyroid nodule to get its ACR TI-RADS points, level and recommendation, then copy the summary.
A radiologist has not yet reviewed this calculator. It is for education and drafting, not for clinical decisions. It follows ACR TI-RADS 2017. Check every result against the guideline.
Needed for TR3 to TR5.
Choose every feature to see the TI-RADS level.
Follows the ACR TI-RADS white paper (Tessler et al, 2017). The calculator runs in your browser, and your answers are never sent anywhere. It is not made or endorsed by the American College of Radiology.
When TI-RADS does not apply
- Children
- Nodules that are avid on FDG PET
- Suspicious lymph nodes
- Known risk factors for thyroid cancer, such as MEN 2
- Nodules already biopsied: use the biopsy result as well as the level
Under review
A radiologist has not yet checked these points. Until then the calculator behaves as described here.
- Follow-up intervals. The result says follow-up and gives the size band. It leaves out the white paper's intervals: TR3 at 1, 3 and 5 years, TR4 at 1, 2, 3 and 5 years, and TR5 every year for up to 5 years.
- Small comet-tail artifacts. In the white paper, punctate echogenic foci include foci with small comet-tail artifacts in solid components. The option does not say so yet.
- Size limit. Above 10 cm the calculator gives no recommendation and asks you to check the units. ACR TI-RADS sets no upper size.
- Cystic nodules. A cystic or almost completely cystic nodule is given TR1 and its other features are not scored, so one with punctate echogenic foci cannot be scored here. The white paper says these nodules merit no points and that every nodule above 0 points merits at least 2, but its chart writes "do not add further points" for spongiform only. The ACR's alternative flowchart does the same as the calculator: cystic, almost completely cystic and spongiform nodules go straight to TR1.
- More than one nodule. Each nodule is scored on its own. The white paper says to biopsy no more than two nodules, the ones with the highest point totals that meet the size for FNA, and to follow no more than four. The calculator does not apply those limits.
Common questions
- How is an ACR TI-RADS score worked out?
- Each nodule gets points for composition, echogenicity, shape, margin and echogenic foci. Add them up: 0 points is TR1, 2 is TR2, 3 is TR3, 4 to 6 is TR4, and 7 or more is TR5.
- When does ACR TI-RADS recommend FNA?
- TR3 at 2.5 cm or larger, TR4 at 1.5 cm or larger, and TR5 at 1 cm or larger. TR1 and TR2 need no FNA.
- When does ACR TI-RADS recommend follow-up?
- TR3 from 1.5 cm, TR4 from 1 cm and TR5 from 0.5 cm, up to the size where FNA applies. A nodule below those sizes needs neither. For TR5 nodules of 5 to 9 mm, the white paper adds that biopsy may be appropriate under certain circumstances, decided between the referring physician and the patient.
- Why can't I score the other features of a cystic nodule?
- The calculator gives a cystic or almost completely cystic nodule 0 points and TR1, as it does a spongiform one. The white paper says cystic nodules merit no points because they are almost universally benign. Its chart writes "do not add further points" for spongiform only, but the ACR's alternative flowchart sends cystic, almost completely cystic and spongiform nodules straight to TR1, which is what the calculator does.
- Why is there no level for 1 point?
- The chart gives TR1 for 0 points and TR2 for 2 points. The white paper says every nodule above 0 points merits at least 2, because a mixed cystic and solid nodule (1 point) gains at least 1 more for echogenicity.
- Do echogenic foci points add together?
- Yes. It is the one category where you choose all that apply. Rim calcifications with punctate echogenic foci score 2 plus 3, which is 5 points.
Also useful: the Bosniak calculator, and how radiologists use Dictation Daddy.
Dictate every report. No hospital contract required.
Dictation Daddy types wherever your cursor is, spells medical terms correctly and needs no voice training. The free trial covers your first 100 dictations.
Runs in your browser. No download or signup to try it.