TIRADS Calculator
The TIRADS calculator helps you compute the American College of Radiology's (ACR) TIRADS score, which is used in conjunction with an ultrasound device to assess thyroid nodules.
Read the article below to find out what the TIRADS chart is and discover the ACR TIRADS criteria and recommendations. We'll also talk about the types of lesion that can be found during thyroid screening and investigation.
The role of TIRADS in thyroid lesions' investigation
The ACR Thyroid Imaging Reporting and Data System (ACR TIRADS) is a simple, standardized system used to assess thyroid nodules found during an ultrasound investigation.
TIRADS in radiology is essential to determine if fine needle aspiration and any subsequent follow up procedures on the lesion are required.
💡 Fine needle aspiration (FNA)  part of a fine needle biopsy. A thin needle is inserted into the thyroid, collecting a small sample of cells. The speciment is then stained and assessed under a microscope for any abnormalities, irregular cell nuclei, or other signs of malignacy. 

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.
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How to calculate the TIRADS radiology score?
Perform an ultrasound examination and evaluate the findings using the scale presented below. Count all the points.
Singleanswer questions:
 Composition:
 Cystic or completely cystic/Spongiform : 0 points
 Mixed cystic and solid: 1 point
 Solid or almost completely solid: 2 points
 Echogenicity:
 Anechoic: 0 points
 Hyper or isoechoic: 1 point
 Hypoechoic: 2 points
 Very hypoechoic: 3 points
 Shape:  use the transverse plane
 Wider than tall: 0 points
 Taller than wide: 3 points
 Margin:
 Smooth/Illdefined: 0 points
 Lobulated/irregular: 2 points
 Extrathyroidal extension: 3 points
Mutiple possible answers: 5. Echogenic foci: * None/Large comettail 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  TIRADS category 1
 Benign
 No fine needle aspiration (FNA) required
2 points  TIRADS category 2
 Not suspicious
 No fine needle aspiration (FNA) required
3 points  TIRADS category 3
 Mildly suspicious
 ≥1.5 cm follow up, ≥2.5 cm FNA  follow up: 1, 3 and 5 years
46 points  TIRADS category 4
 Moderately suspicious
 ≥1.0 cm follow up, ≥1.5 cm FNA  follow up: 1, 2, 3 and 5 years
≥7 points  TIRADS 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:
 Composition (spongiform)  0 points
 Echogenicity (anechoic)  0 point
 Shape (wider than taller)  0 points
 Margin (lobulated)  1 point
 Echogenic foci (present: macrocalcification, peripheal calcification, puncate foci) 6 points
Total: 7 points, TIRADS category 5, 35% risk of malignancy.
How to use the ACR TIRADS 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:
 Collected number of points (017)
 TIRADS category (TR15)
 Risk of malignancy for the given category
 TR1: 0.3%
 TR2: 1.5%
 TR3: 4.8%
 TR4: 9.1%
 TR5: 35%
 ACT recommendations (fine needle aspiration + follow up)
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Recommendations:
◉ No need for the fine needle aspiration.