Score thyroid nodules using ACR TI-RADS, with point breakdown, TI-RADS level, and FNA/follow-up reference thresholds rather than a stand-alone biopsy decision.
The ACR Thyroid Imaging Reporting and Data System (TI-RADS) is a standardized framework for risk-stratifying thyroid nodules on ultrasound. It assigns points for composition, echogenicity, shape, margins, and echogenic foci, then translates the total into a TI-RADS level and a size-based reference threshold for follow-up or FNA review.
Thyroid nodules are common, while malignancy is much less common. The value of TI-RADS is that it helps organize the ultrasound features consistently so not every incidental nodule is treated the same way.
This calculator is most useful as a point-tabulation worksheet. Formal imaging interpretation, local radiology practice, thyroid history, and cytology still matter when deciding whether a nodule actually proceeds to biopsy or surveillance.
TI-RADS is useful because it turns a descriptive ultrasound impression into a repeatable point total. This calculator reduces arithmetic mistakes and makes the size-threshold context explicit, but it should still be read as a radiology worksheet rather than a biopsy order set.
TI-RADS Points = Composition (0-2) + Echogenicity (0-3) + Shape (0-3) + Margin (0-3) + Echogenic Foci (0-3) TR1: 0 pts | TR2: 2 pts | TR3: 3 pts | TR4: 4-6 pts | TR5: ≥ 7 pts FNA reference thresholds: TR3 ≥ 2.5 cm | TR4 ≥ 1.5 cm | TR5 ≥ 1.0 cm
Result: TI-RADS TR5 (7 points) — FNA reference threshold met on this worksheet
Solid (2) + hypoechoic (2) + wider-than-tall (0) + smooth (0) + punctate echogenic foci (3) = 7 points, which maps to TR5. At 15 mm, the nodule is above the common ACR TR5 FNA size threshold of 1.0 cm.
The main advantage of TI-RADS is consistency. It gives radiologists and clinicians a shared vocabulary for describing how suspicious a nodule looks and when size starts to matter.
The ACR system does not rely on suspicion score alone. A lower-risk nodule generally needs to be larger before FNA enters the conversation, while a higher-risk nodule can cross the threshold at a smaller size.
TI-RADS is part of the radiology interpretation layer. Patient history, prior growth, compressive symptoms, thyroid function, cytology, and endocrinology follow-up still determine what actually happens next.
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This page assigns points across the five ACR TI-RADS feature groups, sums the total, and maps the result to TR1 through TR5. When a nodule size is entered, it compares that size with the ACR follow-up and FNA threshold bands so the imaging finding can be reviewed in the same framework used in the white paper.
The result is an ultrasound risk-stratification worksheet, not a stand-alone biopsy order. Endocrine history, interval growth, prior cytology, compressive symptoms, thyroid function, and clinician judgment still matter beyond the TI-RADS category itself.
Taller-than-wide shape and punctate echogenic foci contribute the most points individually. They are high-signal features in the ACR system, though the full score still depends on the rest of the nodule.
No. TI-RADS is designed partly to reduce unnecessary biopsies by pairing feature-based suspicion with size thresholds. Many nodules fall into follow-up or no-FNA ranges.
TI-RADS describes imaging suspicion, not cytology. If FNA is performed, the next step depends on the cytology result, prior imaging, symptoms, and endocrinology or surgical context.
Yes. A solid isoechoic nodule with otherwise bland features can still land in TR3 and still be malignant, which is one reason TI-RADS is a structured risk system rather than a binary benign/malignant label.
Those patterns are associated with low malignancy risk in the ACR framework, so they do not add suspicious-feature points.