TI-RADS Calculator

The TIRADS calculator helps you compute the American College of Radiology's (ACR) TI-RADS score, which is used in conjunction with an ultrasound device to assess thyroid nodules.

Read the article below to find out what the TI-RADS chart is and discover the ACR TI-RADS criteria and recommendations. We'll also talk about the types of lesion that can be found during thyroid screening and investigation.

The ACR Thyroid Imaging Reporting and Data System (ACR TI-RADS) is a simple, standardized system used to assess thyroid nodules found during an ultrasound investigation.

TI-RADS in radiology is essential to determine if fine needle aspiration and any subsequent follow up procedures on the lesion are required.

• The TIRADS criteria is based on 5 elements that are counted separately. The higher the score, the worse the prognosis. The maximum number of points is 17.

• If there are multiple lesions, take the samples of the two with the highest TIRADS score, not necessarily the largest ones.

• Significant enlargement of a nodule is defined as a >50% increase in volume or >2 mm/>20% increase in two different dimensions during the follow up examination.

Perform an ultrasound examination and evaluate the findings using the scale presented below. Count all the points.

Single-answer questions:

1. Composition:
   • Cystic or completely cystic/Spongiform : 0 points
   • Mixed cystic and solid: 1 point
   • Solid or almost completely solid: 2 points
2. Echogenicity:
   • Anechoic: 0 points
   • Hyper- or isoechoic: 1 point
   • Hypoechoic: 2 points
   • Very hypoechoic: 3 points
3. Shape: - use the transverse plane
   • Wider than tall: 0 points
   • Taller than wide: 3 points
4. Margin:
   • Smooth/Ill-defined: 0 points
   • Lobulated/irregular: 2 points
   • Extra-thyroidal extension: 3 points

Mutiple possible answers:

5. Echogenic foci:
   • None/Large comet-tail artifact: 0 points
   • Macrocalcifications: 1 point
   • Peripheral/rim calcifications: 2 points
   • Punctate echogenic foci: 3 points

Find your TIRADS category according to the total number of points:

0 points - TI-RADS category 1

• Benign
• No fine needle aspiration (FNA) required

2 points - TI-RADS category 2

• Not suspicious
• No fine needle aspiration (FNA) required

3 points - TI-RADS category 3

• Mildly suspicious
• ≥1.5 cm follow up, ≥2.5 cm FNA - follow up: 1, 3 and 5 years

4-6 points - TI-RADS category 4

• Moderately suspicious
• ≥1.0 cm follow up, ≥1.5 cm FNA - follow up: 1, 2, 3 and 5 years

≥7 points - TI-RADS category 5

• Highly suspicious
• ≥0.5 cm follow up, ≥1.0 cm FNA - annual follow up for up to 5 years

⚕️ An example of the TIRADS assessment of a spongiform thyroid nodule:

1. Composition (spongiform) - 0 points
2. Echogenicity (anechoic) - 0 point
3. Shape (wider than taller) - 0 points
4. Margin (lobulated) - 1 point
5. Echogenic foci (present: macrocalcification, peripheal calcification, puncate foci)- 6 points

Total: 7 points, TI-RADS category 5, 35% risk of malignancy.

Want to try other health-related tools that you may find helpful? Visit the sodium deficit calculator and insulin dosage calculator.

Our thyroid nodule calculator doesn't require much effort - choose the options that best describe the picture from the ultrasound device.

Your results will be shown underneath the calculator. You'll receive:

1. Collected number of points (0-17)
2. TIRADS category (TR1-5)
3. Risk of malignancy for the given category
   • TR1: 0.3%
   • TR2: 1.5%
   • TR3: 4.8%
   • TR4: 9.1%
   • TR5: 35%
4. ACT recommendations (fine needle aspiration + follow up)