TI-RADS Calculator

Created by Łucja Zaborowska, MD, PhD candidate
Reviewed by Bogna Szyk and Jack Bowater
Last updated: Feb 15, 2022

The TIRADS 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 find out what the TI-RADS chart is and discover the ACR TI-RADS 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 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 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.

Try our other tools for descriptive scales:

How to calculate the TIRADS radiology score?

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 TIRADS 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.

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:

  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)

Discover our wide range of emergency scale calculators: 🚨

Łucja Zaborowska, MD, PhD candidate
Thyroid properties
Composition
Cystic/Spongiform
Echogenicity
Anechoic
Shape
Wider-than-tall
Margin
Smooth/Ill defined
Presence of echogenic foci:
None or large comet-tail artifacts
No
Macrocalcifications
No
Peripheral (rim) calcifications
No
Punctate echogenic foci
No
Results
Score
TI-RADS level:   TR1, Benign 🟢
Risk of malignacy: 0.3%

Recommendations:

◉ No need for the fine needle aspiration.
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