T I R A D S
No solid component or nearly all fluid
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Evidence-based calculations Used in clinical settings worldwide Regular monitoring recommended
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Why: This calculation helps assess important health parameters for clinical and personal wellness tracking.
How: Enter your values above and the calculator will apply validated formulas to compute your results.
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🟢 Simple Cyst (TR1)
Classic benign thyroid cyst - no FNA needed regardless of size
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🟢 Spongiform Nodule (TR2)
Benign-appearing spongiform nodule - reassuring features
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🟡 Solid Isoechoic (TR3)
Mildly suspicious solid nodule - FNA if ≥2.5 cm
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🟠 Hypoechoic with Irregular Margins (TR4)
Moderately suspicious nodule - FNA if ≥1.5 cm
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🔴 Very Hypoechoic with Microcalcifications (TR5)
Highly suspicious nodule - FNA recommended if ≥1 cm
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Sample Nodule Scenarios
🟢 Simple Cyst (TR1)
Classic benign thyroid cyst - no FNA needed regardless of size
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🟢 Spongiform Nodule (TR2)
Benign-appearing spongiform nodule - reassuring features
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🟡 Solid Isoechoic (TR3)
Mildly suspicious solid nodule - FNA if ≥2.5 cm
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🟠 Hypoechoic with Irregular Margins (TR4)
Moderately suspicious nodule - FNA if ≥1.5 cm
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🔴 Very Hypoechoic with Microcalcifications (TR5)
Highly suspicious nodule - FNA recommended if ≥1 cm
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Enter Ultrasound Features
ACR TI-RADS Features
Nodule Characteristics
TI-RADS Assessment Results
Total Score
points
TI-RADS Category
Moderately Suspicious
Malignancy Risk
estimated risk
Recommendation
Size: 1.5 cm
Management Recommendation
FNA biopsy recommended (nodule ≥1.5 cm for TR4)
Feature Score Breakdown
| Composition | Solid or almost completely solid | 2 points |
| Echogenicity | Hypoechoic | 2 points |
| Shape | Wider-than-tall | 0 points |
| Margin | Smooth | 0 points |
| Echogenic Foci | None or large comet-tail artifacts | 0 points |
| Total Score | 4 points |
TI-RADS Analysis Dashboard
Score Distribution by Feature
Malignancy Risk by Category
Your Category Position
Size-Based Management Thresholds
Step-by-Step Calculation
Composition: "Solid or almost completely solid" = 2 points
Echogenicity: "Hypoechoic" = 2 points
Shape: "Wider-than-tall" = 0 points
Margin: "Smooth" = 0 points
Echogenic Foci: "None or large comet-tail artifacts" = 0 points
Total = 2 + 2 + 0 + 0 + 0 = 4 points
Score of 4 → TR4 (Moderately Suspicious)
Malignancy Risk: 5-20%
Nodule Size: 1.5 cm
FNA threshold for TR4: ≥1.5 cm
Follow-up threshold for TR4: ≥1 cm
Recommendation: FNA Biopsy
For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
— WHO
— CDC
What is ACR TI-RADS?
The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is a standardized ultrasound-based risk stratification system for thyroid nodules. It uses ultrasound features to assign points and categorize nodules by malignancy risk, guiding biopsy decisions.
Points-Based System
Each ultrasound feature is assigned points. The total determines the TI-RADS category (TR1-TR5).
5 Features Assessed:
Composition, Echogenicity, Shape, Margin, Echogenic Foci
Risk Categories
Five categories from TR1 (benign) to TR5 (highly suspicious) with corresponding malignancy risks.
Risk Range:
TR1/2: <2% | TR3: 2-5% | TR4: 5-20% | TR5: >20%
Size-Based Management
FNA biopsy and follow-up recommendations are based on both TI-RADS category and nodule size.
Goal:
Reduce unnecessary biopsies while detecting significant cancers
How Does TI-RADS Scoring Work?
TI-RADS assigns points to specific ultrasound features. Higher points indicate features more commonly seen in malignant nodules. The total score determines the category and guides management.
🔬 Feature Scoring Guide
Lower Risk Features (0-1 pts)
- • Cystic composition (0 pts)
- • Spongiform appearance (0 pts)
- • Anechoic (0 pts)
- • Wider-than-tall shape (0 pts)
- • Smooth margins (0 pts)
- • Hyperechoic/Isoechoic (1 pt)
Higher Risk Features (2-3 pts)
- • Solid composition (2 pts)
- • Hypoechoic (2 pts) / Very hypoechoic (3 pts)
- • Taller-than-wide (3 pts)
- • Irregular margins (2 pts)
- • Extra-thyroidal extension (3 pts)
- • Microcalcifications (3 pts)
When to Use TI-RADS
TI-RADS should be used for every thyroid nodule detected on ultrasound to standardize reporting and guide management decisions.
Incidental Nodules
Nodules found during imaging for other reasons (CT, MRI, PET) need ultrasound characterization and TI-RADS scoring.
Palpable Nodules
Nodules felt on physical examination should be evaluated with ultrasound and TI-RADS to guide biopsy decisions.
Follow-up Nodules
Previously benign-appearing nodules being monitored should be reassessed with TI-RADS at each follow-up.
TI-RADS Scoring and Management
ACR TI-RADS Categories
| Category | Points | Risk | FNA Threshold | Follow-up |
|---|---|---|---|---|
| TR1 - Benign | 0 points | <2% | None | None |
| TR2 - Not Suspicious | 2 points | <2% | None | None |
| TR3 - Mildly Suspicious | 3 points | 2-5% | ≥2.5 cm | ≥1.5 cm |
| TR4 - Moderately Suspicious | 4-6 points | 5-20% | ≥1.5 cm | ≥1 cm |
| TR5 - Highly Suspicious | ≥7 points | >20% | ≥1 cm | ≥0.5 cm |
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