ACR TI-RADS Calculator
Use this tool to estimate an ACR TI-RADS score for a thyroid nodule from ultrasound features and nodule size.
What this ACR TI-RADS calculator does
The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) helps radiologists and clinicians standardize thyroid nodule risk assessment based on ultrasound findings. This calculator adds the points from each ultrasound category and returns:
- Total TI-RADS points
- TI-RADS level (TR1 to TR5)
- General management suggestion based on nodule size (follow-up vs FNA threshold)
ACR TI-RADS point system (quick reference)
| Category | Feature examples | Points |
|---|---|---|
| Composition | Cystic/spongiform to solid | 0 to 2 |
| Echogenicity | Anechoic, isoechoic, hypoechoic, very hypoechoic | 0 to 3 |
| Shape | Wider-than-tall or taller-than-wide | 0 or 3 |
| Margin | Smooth/ill-defined to irregular or extra-thyroidal extension | 0 to 3 |
| Echogenic foci | Macrocalcifications, rim calcifications, punctate foci | 0 to 3+ (summed in this tool) |
Result categories
- TR1: 0 points (benign)
- TR2: 1–2 points (not suspicious)
- TR3: 3 points (mildly suspicious)
- TR4: 4–6 points (moderately suspicious)
- TR5: 7+ points (highly suspicious)
Biopsy and follow-up thresholds used by this calculator
Based on common ACR TI-RADS guidance for maximum nodule diameter:
- TR1 / TR2: No FNA, usually no routine follow-up for risk alone.
- TR3: Follow-up if ≥ 1.5 cm; FNA if ≥ 2.5 cm.
- TR4: Follow-up if ≥ 1.0 cm; FNA if ≥ 1.5 cm.
- TR5: Follow-up if ≥ 0.5 cm; FNA if ≥ 1.0 cm.
How to use this thyroid nodule calculator
- Enter ultrasound features from your report (composition, echogenicity, shape, margin, foci).
- Input the largest nodule diameter in centimeters.
- Click Calculate TI-RADS.
- Review points, TR category, and management threshold suggestion.
Important clinical notes
This tool is for educational and decision-support use only. It does not replace clinical judgment, formal radiology interpretation, endocrinology consultation, or pathology. Management can differ based on patient history, prior imaging, suspicious lymph nodes, symptoms, comorbidities, and institutional protocols.
If ultrasound findings are uncertain or discordant, discuss final risk and biopsy decisions with a qualified clinician.