ACR TI-RADS Calculator for Thyroid Nodules

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Select the dominant internal architecture of the nodule. Cystic and spongiform nodules are automatically TR1 regardless of other features.
Compare the nodule brightness to the adjacent normal thyroid parenchyma.
Assessed in the transverse (axial) plane.
Evaluate the entire nodule border.
Select the highest-scoring echogenic focus present. Punctate foci (microcalcifications) carry the highest suspicion.
Enter the largest single dimension of the nodule in centimetres. Used to determine whether FNA or follow-up is indicated. Enter 0 to see thresholds only.
cm
Total ScoreTR3 - Mildly Suspicious
3points

Sum of all five feature category scores

TI-RADS LevelTR3
Malignancy Risk~4.8%
FNA RecommendationNo FNA at this size (threshold is 2.5 cm for TR3)
Follow-up RecommendationNo follow-up at this size (threshold is 1.5 cm for TR3)
Composition Points1
Echogenicity Points2
Shape Points0
Margin Points0
Echogenic Foci Points0
3 pts
TR1 - Benign<1TR2 - Not Suspicious1-3TR3 - Mildly Suspicious3-4TR4 - Moderately Suspicious4-7TR5 - Highly Suspicious7+

This nodule scores 3 points, placing it in TR3 (mildly suspicious) with an estimated malignancy risk of ~4.8%.

  • TR3 nodules are mildly suspicious. FNA is recommended only if the nodule is 2.5 cm or larger, and follow-up ultrasound is suggested for nodules of 1.5 cm or larger.
  • ACR TI-RADS applies to incidentally discovered thyroid nodules in adults. It is not validated for pediatric patients, nodules in a known malignancy context, or previously biopsied nodules.

Next stepCorrelate with clinical context. If the nodule is below the FNA threshold, schedule surveillance imaging as indicated by the nodule size.

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