TI-RADS Calculator

The TI-RADS 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 learn about the TI-RADS chart and discover the ACR TI-RADS criteria and recommendations. We'll also talk about the types of lesions 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 whether 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 TI-RADS 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.

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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)

If you are unsure about the thyroid properties, this section is dedicated to clarifications and additional precautions to note when using the TI-RADS radiology calculator.

Inderteminate Features

If thyroid nodules are unclear with calcification, or their composition and echogenecity cannot be determined, they can be considered as solid and isoechoic. As for when the margin cannot be assessed, select ill-defined.

Guidelines on Thyroid Properties

Composition

• Cystic or almost completely cystic nodules are typically benign.
• Spongiform nodules, composed mainly of small cystic spaces, can be considered benign.
• Solid nodules, particularly those with suspicious features, require further investigation.

Echogenicity

• Compare nodule echogenicity to adjacent thyroid tissue. Use the strap muscles as a reference for' very hypoechoic' nodules.

*Anechoic nodules are typically benign.

Shape

• A taller-than-wide shape (measured in the axial plane) is a specific indicator of malignancy.

Margin

• Ill-defined or irregular margins, especially with lobulations or extrathyroidal extension, raise concern for malignancy.

Echogenic Foci

• Types of echogenic foci vary in significance.
• Punctate echogenic foci in solid areas are particularly suspicious and should be assessed in the context of other features.

Other Considerations

• Punctate echogenic foci and a taller-than-wide shape are highly predictive of malignancy and should be evaluated carefully.