ACR TI-RADS Calculator (Educational Tool)
Estimate a thyroid nodule TI-RADS score by selecting ultrasound features below.
What is TI-RADS?
TI-RADS (Thyroid Imaging Reporting and Data System) is a structured method used to estimate the likelihood of malignancy in thyroid nodules seen on ultrasound. By assigning points to specific sonographic characteristics, clinicians can classify nodules into categories (TR1 to TR5) and decide whether surveillance or fine-needle aspiration (FNA) should be considered.
The goal of TI-RADS is simple: reduce unnecessary biopsies while still identifying nodules that need closer evaluation.
How this calculadora tirads works
1) Feature scoring
The calculator adds points from five feature groups:
- Composition (cystic, mixed, or solid)
- Echogenicity (from anechoic to very hypoechoic)
- Shape (wider-than-tall vs taller-than-wide)
- Margins (smooth, irregular, or extrathyroidal extension)
- Echogenic foci (calcification-related findings)
2) Category mapping
The total points are mapped to a TI-RADS category:
- 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)
3) Size-based action guidance
A key strength of TI-RADS is that risk category alone is not enough. Nodule size is also integrated to suggest whether follow-up imaging or biopsy threshold may be reached.
Reference follow-up and FNA thresholds used in this tool
- TR1: No routine FNA.
- TR2: No routine FNA.
- TR3: Follow-up if ≥ 1.5 cm; consider FNA if ≥ 2.5 cm.
- TR4: Follow-up if ≥ 1.0 cm; consider FNA if ≥ 1.5 cm.
- TR5: Follow-up if ≥ 0.5 cm; consider FNA if ≥ 1.0 cm.
Why structured scoring matters
In daily practice, thyroid ultrasound reports can vary in wording and detail. Structured systems like TI-RADS improve consistency by forcing clear feature-based documentation. This supports better communication between radiology, endocrinology, surgery, and primary care.
A standardized score also helps longitudinal care. If a patient repeats ultrasound in 12 months, a consistent framework makes trend detection more reliable.
Practical interpretation tips
Look at the full clinical picture
TI-RADS is an imaging framework, not a standalone diagnosis. Age, symptoms, growth pattern, prior radiation exposure, family history, and laboratory findings all matter.
Use quality imaging and reporting
Small differences in wording can change the score. For example, margin description or subtle punctate foci can shift category and management pathway. High-quality ultrasound technique and clear reporting remain essential.
Recognize gray zones
Some nodules sit near threshold values. For those cases, multidisciplinary review and shared decision-making with the patient are often appropriate.
Frequently asked questions
Is TR5 always cancer?
No. TR5 means higher suspicion, not certainty. Cytology, clinical context, and follow-up findings determine the final diagnosis.
Can a low TI-RADS category still need attention?
Yes. Even lower categories may warrant follow-up if there are symptoms, rapid growth, compressive effects, or clinician concern.
Does this calculator replace my radiologist?
Absolutely not. This is a guide to support understanding and discussion. Official interpretation should come from licensed clinicians.
Bottom line
A good calculadora tirads can speed up decision support, improve consistency, and help communicate risk clearly. Use it as a structured companion to expert judgment—not as a substitute.