ACR TI-RADS thyroid nodule calculator
Score the five ACR TI-RADS features to get the TR level and the size thresholds for FNA and follow-up. Echogenic foci are additive — select every finding that applies.
TI-RADS levels and size thresholds
| Level | Points | Category | FNA | Follow-up |
|---|---|---|---|---|
| TR1 | 0 points | Benign | — | — |
| TR2 | 1–2 points | Not suspicious | — | — |
| TR3 | 3 points | Mildly suspicious | ≥ 25 mm | ≥ 15 mm |
| TR4 | 4–6 points | Moderately suspicious | ≥ 15 mm | ≥ 10 mm |
| TR5 | 7+ points | Highly suspicious | ≥ 10 mm | ≥ 5 mm |
How the score works
Four categories contribute exactly one value each: composition, echogenicity, shape and margin. Echogenic foci are additive — a nodule with both macrocalcifications and punctate echogenic foci scores both. Sum every point, then read the level off the table above.
Points to watch
- Spongiform scores 0 for composition, but only when the nodule is composed predominantly of small cystic spaces throughout. Partially spongiform nodules do not qualify.
- Taller-than-wide is measured on a transverse image, comparing the anteroposterior with the transverse dimension.
- Punctate echogenic foci are the highest-scoring focus type at 3 points. Distinguish them from the large comet-tail artifacts of colloid, which score 0.
- ACR TI-RADS applies to adults and is not validated for paediatric thyroid nodules.
Related
Source. Tessler FN, et al. J Am Coll Radiol 2017;14(5):587-595. View on PubMed
This calculator, written into your report for you
MyRadAgent drafts the full report - and applies this guideline automatically, with the category and follow-up in the impression. Free trial runs in the browser: 100 reports over 14 days, no card, no IT ticket.
Try it on a report → or watch it live first — no signup →This is a reference implementation of a published guideline, for use by qualified clinicians. It does not account for patient-specific factors and is not a substitute for clinical judgment or a formal radiology consultation. See our full disclaimer.