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1. Composition (Select One)

2. Echogenicity (Select One)

3. Shape (Select One)

4. Margin (Select One)

5. Echogenic Foci (Select All That Apply)

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About

The ACR TI-RADS (Thyroid Imaging Reporting and Data System) is a risk stratification system used by radiologists and endocrinologists to determine the malignancy risk of thyroid nodules found on ultrasound. By assigning points to five specific ultrasound features, the system classifies nodules into categories ranging from benign to highly suspicious.

This tool simplifies the scoring process. Clinicians simply select the observed characteristics in each category—Composition, Echogenicity, Shape, Margin, and Echogenic Foci. The calculator instantly computes the total point sum, assigns the corresponding TR level (TR1 through TR5), and displays the official ACR management recommendation regarding biopsy thresholds and follow-up intervals. This reduces cognitive load and ensures adherence to clinical guidelines.

TI-RADS thyroid radiology nodule

Formulas

The Total Risk Score is the sum of points from five categories:

Score = Composition + Echogenicity + Shape + Margin + Foci

Reference Data

TR LevelPointsRisk CategoryBiopsy Threshold (Size)
TR10 pointsBenignNo biopsy required
TR22 pointsNot SuspiciousNo biopsy required
TR33 pointsMildly Suspicious≥ 2.5 cm (FNA) / ≥ 1.5 cm (Follow-up)
TR44-6 pointsModerately Suspicious≥ 1.5 cm (FNA) / ≥ 1.0 cm (Follow-up)
TR5≥ 7 pointsHighly Suspicious≥ 1.0 cm (FNA) / ≥ 0.5 cm (Follow-up)

Frequently Asked Questions

According to ACR guidelines, if multiple types of echogenic foci are present, you should add the points for all of them. For example, if both 'Peripheral calcifications' and 'Punctate echogenic foci' are present, sum their points.
Some categories, like Shape (Wider-than-tall), have a default baseline of 0 points. You only select an option if the suspicious feature is present. If the nodule is not taller-than-wide, the points remain 0.
No. This tool is a decision support aid for trained medical professionals. It strictly applies the ACR TI-RADS logic but does not account for clinical history or other patient factors.