Thyroid imaging
TI-RADS Nodule Scoring
Assign points across composition, echogenicity, shape, margin, and echogenic foci to determine the TI-RADS category and management plan. Based on ACR TI-RADS 2017 consensus.
Use maximal dimension on ultrasound.
Total points
4
ACR TI-RADS category
TR4
Moderately suspicious
Recommendation
Recommend surveillance ultrasound.
How to Use This Calculator
Review ultrasound descriptors
Assign each category according to the ACR lexicon: composition, echogenicity, shape, margin, and echogenic foci.
Sum points
The calculator adds each feature’s points to determine the TI-RADS category (TR1–TR5).
Apply size-based management
Use nodule maximum dimension to decide on fine-needle aspiration or follow-up per TI-RADS thresholds.
Formula
Total score = Composition points + Echogenicity points + Shape points + Margin points + Echogenic foci points.
Category mapping:
- 0 points → TR1 (Benign)
- 2 points → TR2 (Not suspicious)
- 3 points → TR3 (Mildly suspicious)
- 4–6 points → TR4 (Moderately suspicious)
- ≥7 points → TR5 (Highly suspicious)
Refer to ACR TI-RADS (2017) for detailed definitions.
Full Description
The ACR TI-RADS system standardizes thyroid ultrasound reporting by assigning points to sonographic features. Higher scores correlate with malignancy risk and guide management, balancing detection of thyroid cancer against unnecessary biopsies. Accurate feature assessment and consistent reporting reduce variability across radiologists and facilitate multidisciplinary care.
Always correlate with clinical context, such as patient history, cytology results (Bethesda system), and molecular testing. Patients with compressive symptoms or suspicious lymph nodes warrant closer evaluation regardless of TI-RADS category.
Frequently Asked Questions
How precise should nodule measurements be?
Use the largest dimension on ultrasound, recorded to the nearest millimeter. TI-RADS thresholds reference maximum size.
What if features do not fit neatly into categories?
When in doubt, err on the side of the more suspicious descriptor and document reasoning in the report.
Do TI-RADS recommendations override clinician judgment?
No. TI-RADS is a guideline. Final decisions should incorporate patient factors, comorbidities, and multidisciplinary input.
How does TI-RADS compare with EU-TIRADS or ATA guidelines?
All systems stratify risk similarly but with different scoring. Choose the guideline adopted by your institution for consistency.