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ACR TI-RADS Calculator

Thyroid Imaging Reporting & Data System (2017)

TI-RADS Reference

TI-RADS Categories

Category Points Risk Level
TR1 0 Benign
TR2 1–2 Not Suspicious
TR3 3 Mildly Suspicious
TR4 4–6 Moderately Suspicious
TR5 ≥7 Highly Suspicious

Management Recommendations

Category FNA Follow-up
TR1 No FNA or follow-up
TR2 No FNA or follow-up
TR3 ≥2.5 cm ≥1.5 cm
TR4 ≥1.5 cm ≥1.0 cm
TR5 ≥1.0 cm ≥0.5 cm

Key Definitions

Spongiform
Aggregation of multiple microcystic components comprising >50% of the nodule volume.
Very Hypoechoic
More hypoechoic than the strap muscles (darker than surrounding musculature).
Punctate Echogenic Foci
Non-shadowing, echogenic foci smaller than calcifications; may represent microcalcifications or back of colloid crystals.
Extra-thyroidal Extension
Frank invasion of nodule beyond the thyroid capsule into adjacent soft tissue or structures.
Comet-tail Artifacts
V-shaped echogenic artifacts >1 mm arising from colloid crystals; considered benign.
ACR TI-RADS White Paper

Important Notes:

  • This tool is for educational purposes and clinical decision support only.
  • Clinical correlation, patient history, and institutional guidelines should always be considered.
  • Management recommendations follow ACR TI-RADS 2017 criteria.
  • ACR recommends FNA of no more than 2 nodules (the highest-risk) per exam.

Based on ACR TI-RADS 2017 — Tessler FN et al., JACR 2017;14(5):587-595

Reference: ACR TI-RADS White Paper