Health calculators

TIRADS Calculator

Updated Jun 25, 2026 By Jehan Wadia
Formulas Medical disclaimer
1. Composition Incomplete
Choose 1
2. Echogenicity Incomplete
Choose 1
3. Shape Incomplete
Choose 1
4. Margin Incomplete
Choose 1
5. Echogenic Foci Incomplete
Choose all that apply (points are additive)
Enter the largest nodule dimension to receive a personalized FNA and follow-up recommendation based on your nodule's size.

Live Results

All five categories complete.
Total Score5 points
TR4 — Moderately Suspicious
Malignancy Risk Estimate~9.1%
FNA Recommendation—
Follow-Up Recommendation—

TI-RADS Category Reference

TR1Current

Benign

  • Points: 0
  • Risk: < 0.3%
  • FNA: None required
  • Follow-up: None required
TR2Current

Not Suspicious

  • Points: 2
  • Risk: ~1.5%
  • FNA: None required
  • Follow-up: None required
TR3Current

Mildly Suspicious

  • Points: 3
  • Risk: ~4.8%
  • FNA: ≥ 2.5 cm
  • Follow-up: ≥ 1.5 cm (1, 3, 5 yrs)
TR4Current

Moderately Suspicious

  • Points: 4–6
  • Risk: ~9.1%
  • FNA: ≥ 1.5 cm
  • Follow-up: ≥ 1.0 cm (1, 2, 3, 5 yrs)
TR5Current

Highly Suspicious

  • Points: ≥ 7
  • Risk: ~35%
  • FNA: ≥ 1.0 cm
  • Follow-up: > 0.5 cm (annual × 5 yrs)

Step-by-Step Solution

Points Contributed by Category

Structured Report

Introduction

The ACR TI-RADS calculator helps doctors decide what to do when a thyroid nodule is found on ultrasound. TI-RADS stands for Thyroid Imaging Reporting and Data System, and it was created by the American College of Radiology (ACR). It uses a simple point system to rate how likely a nodule is to be cancer, similar to how the Child Pugh Calculator uses a scoring system to assess liver disease severity.

The calculator looks at five features of a thyroid nodule: composition, echogenicity, shape, margin, and echogenic foci. Each feature gets a point value. The points are added up, and the total gives the nodule a TI-RADS level from TR1 (benign) to TR5 (highly suspicious). A higher score means a higher risk of thyroid cancer.

Based on the TI-RADS level and the size of the nodule, the tool tells you whether a fine needle aspiration (FNA) biopsy or follow-up ultrasound is recommended. This helps avoid unnecessary biopsies on nodules that are very likely harmless while making sure suspicious nodules get the right attention.

Use this calculator by selecting the ultrasound features you see in each category. Enter the nodule size in millimeters for a full recommendation. The results update instantly as you make your selections. You can also generate and print a structured report for your records.

How to Use Our ACR TI-RADS Calculator

Enter the ultrasound features of your thyroid nodule below. The calculator will give you a total TI-RADS score, a risk level from TR1 to TR5, and recommendations for biopsy and follow-up.

Composition: Pick the one option that best describes what the nodule is made of. A cystic nodule is fluid-filled. A solid nodule has little or no fluid. A spongiform nodule looks like a sponge with tiny cystic spaces.

Echogenicity: Pick the one option that describes how bright or dark the nodule looks on ultrasound compared to the tissue around it. "Hypoechoic" means darker than normal thyroid tissue. "Very hypoechoic" means darker than the nearby strap muscles.

Shape: Pick whether the nodule is wider than tall or taller than wide. Measure this on a transverse (cross-section) view. A taller-than-wide shape adds more points because it raises concern.

Margin: Pick the one option that describes the edge of the nodule. Smooth edges are regular and well-defined. Lobulated or irregular edges are uneven. Extra-thyroidal extension means the nodule grows beyond the thyroid into nearby tissue.

Echogenic Foci: Check all the bright spots you see inside or on the edge of the nodule. You can pick more than one. If there are no bright spots, select "None or large comet-tail artifacts." Do not select "None" along with other options. Note that calcifications found in nodules are distinct from serum calcium levels, which are assessed using a Corrected Calcium Calculator in clinical practice.

Nodule Size: Enter the largest dimension of the nodule in millimeters. If your measurements were taken in centimeters, you can use a Cm To Inches Calculator or simply multiply by 10 to convert. This field is optional, but filling it in lets the calculator tell you if a biopsy (FNA) or follow-up ultrasound is needed based on your nodule's size.

Click Calculate to see your results. Click Generate Report to create a printable summary you can share with your doctor.

What Is the ACR TI-RADS Score?

ACR TI-RADS stands for the American College of Radiology Thyroid Imaging Reporting and Data System. It is a scoring system that doctors use to look at thyroid nodules found on ultrasound. A thyroid nodule is a small lump that grows inside the thyroid gland in your neck. The thyroid is a key part of the endocrine system, the same system evaluated with tools like the a1c Calculator for diabetes management. Most thyroid nodules are not cancer, but some can be. TI-RADS helps doctors decide which nodules need more testing and which ones can be safely watched over time.

How Does TI-RADS Work?

The system scores a thyroid nodule based on five features seen on ultrasound:

  • Composition — Whether the nodule is solid, cystic (fluid-filled), or a mix of both.
  • Echogenicity — How bright or dark the nodule looks compared to the tissue around it.
  • Shape — Whether the nodule is wider than it is tall, or taller than it is wide.
  • Margin — Whether the edges of the nodule are smooth, irregular, or extend beyond the thyroid.
  • Echogenic Foci — Whether there are bright spots inside the nodule, such as calcifications.

Each feature gets a point value. The points are added up to give a total score. The total score places the nodule into one of five categories, from TR1 (benign) to TR5 (highly suspicious). A higher score means a higher chance that the nodule could be cancer. If you need help understanding how risk percentages are calculated, our Percentage Calculator can be a useful reference.

What Do the TI-RADS Categories Mean?

  • TR1 (Benign) — 0 points. The nodule is almost certainly not cancer. No biopsy or follow-up is needed.
  • TR2 (Not Suspicious) — 2 points. The risk of cancer is very low. No biopsy or follow-up is needed.
  • TR3 (Mildly Suspicious) — 3 points. There is a small chance of cancer. A biopsy may be recommended if the nodule is 2.5 cm or larger.
  • TR4 (Moderately Suspicious) — 4 to 6 points. The risk is moderate. A biopsy is usually recommended if the nodule is 1.5 cm or larger.
  • TR5 (Highly Suspicious) — 7 or more points. The risk of cancer is the highest. A biopsy is recommended if the nodule is 1 cm or larger.

What Is a Fine Needle Aspiration (FNA) Biopsy?

When TI-RADS suggests further testing, doctors often perform a fine needle aspiration, or FNA. During this procedure, a thin needle is inserted into the thyroid nodule to collect a small sample of cells. The cells are then checked under a microscope to see if they are cancerous. The procedure is quick, done with ultrasound guidance, and usually causes only mild discomfort.

Special Rules: TR1 Override

Some nodules are classified as TR1 (benign) no matter what the other features look like. This happens when a nodule is spongiform or almost completely cystic. These types of nodules have a very low risk of cancer, so the points from the other four categories are not counted.

Why Nodule Size Matters

The TI-RADS score tells doctors how suspicious a nodule looks. The size of the nodule then helps decide what to do next. A suspicious-looking nodule that is very small may only need follow-up ultrasounds. A larger nodule with the same score may need a biopsy. This is why entering the nodule size into the calculator gives you a more specific recommendation.

Important Note

This calculator is a reference tool based on the ACR TI-RADS guidelines. It does not replace a doctor's judgment. Thyroid nodule management depends on your full medical history, other test results such as kidney function assessed with a GFR Calculator or overall health indicators like your BMI, and your doctor's assessment. Always discuss your results with a qualified healthcare provider.

Formulas used

Total TI-RADS Score
S_{\text{total}} = S_{\text{composition}} + S_{\text{echogenicity}} + S_{\text{shape}} + S_{\text{margin}} + S_{\text{foci}}
TI-RADS Classification
\text{TR Level} = \begin{cases} \text{TR1 (Benign)} & S_{\text{total}} \le 0 \\ \text{TR2 (Not Suspicious)} & 1 \le S_{\text{total}} \le 2 \\ \text{TR3 (Mildly Suspicious)} & S_{\text{total}} = 3 \\ \text{TR4 (Moderately Suspicious)} & 4 \le S_{\text{total}} \le 6 \\ \text{TR5 (Highly Suspicious)} & S_{\text{total}} \ge 7 \end{cases}
TR1 Override Rule
\text{If composition} \in \{\text{Spongiform},\; \text{Cystic}\} \Rightarrow S_{\text{total}} = 0,\; \text{TR Level} = \text{TR1}
Echogenic Foci (Additive)
S_{\text{foci}} = \sum_{i=1}^{n} p_i \quad \text{where } p_i \text{ is the point value of each selected finding}

Frequently asked questions

What does ACR TI-RADS stand for?

ACR TI-RADS stands for American College of Radiology Thyroid Imaging Reporting and Data System. It is a point-based scoring system that helps doctors rate thyroid nodules found on ultrasound from TR1 (benign) to TR5 (highly suspicious).

Is this calculator free to use?

Yes. This ACR TI-RADS calculator is completely free. You can use it as many times as you need, generate reports, and print them at no cost.

Do I need to fill in all five categories to get a result?

Yes. You must select an option in all five categories — composition, echogenicity, shape, margin, and echogenic foci — to get a finalized TI-RADS score. The only exception is when a TR1 override applies.

What is the TR1 override and when does it apply?

The TR1 override applies when you select spongiform or cystic or almost completely cystic under composition. These nodules are classified as TR1 (benign) automatically. Points from the other four categories are ignored because these nodule types have an extremely low cancer risk.

Do I have to enter the nodule size?

No. Nodule size is optional. However, entering it gives you specific recommendations for whether a biopsy (FNA) or follow-up ultrasound is needed based on your nodule's actual size.

Should I enter the nodule size in millimeters or centimeters?

Enter the size in millimeters (mm). If your ultrasound report gives the size in centimeters, multiply by 10. For example, 1.5 cm equals 15 mm.

Which nodule dimension should I enter for size?

Enter the largest dimension of the nodule. This is the single longest measurement from your ultrasound report, regardless of which direction it was measured in.

Can I select more than one option in the echogenic foci category?

Yes. Echogenic foci is the only category where you can pick more than one option. The points are added together. However, do not select "None or large comet-tail artifacts" along with other options — the calculator will flag this as a conflict.

Why am I getting a conflict error in echogenic foci?

You selected "None or large comet-tail artifacts" at the same time as another foci option like macrocalcifications or punctate echogenic foci. These choices contradict each other. Uncheck "None" if the nodule has any bright spots, or uncheck the other options if it does not.

What does spongiform mean?

A spongiform nodule looks like a sponge on ultrasound. It is made up of many tiny cystic (fluid-filled) spaces separated by thin walls. Spongiform nodules are almost always benign and are automatically classified as TR1.

What is the difference between hypoechoic and very hypoechoic?

Hypoechoic means the nodule looks darker than the normal thyroid tissue around it. Very hypoechoic means it looks darker than the strap muscles next to the thyroid. Very hypoechoic scores higher because it is more suspicious for cancer.

What are punctate echogenic foci?

Punctate echogenic foci are tiny bright dots inside the nodule that do not cast a shadow. They may represent microcalcifications, which can be a sign of thyroid cancer. This finding adds 3 points, the highest in the echogenic foci category.

What does extra-thyroidal extension mean?

Extra-thyroidal extension means the nodule has grown beyond the thyroid capsule into nearby soft tissue or blood vessels. This is a concerning finding that adds 3 points under the margin category.

What is the highest possible TI-RADS score?

The highest possible score is 13 points. This would occur if a nodule scored the maximum in every category: solid composition (2) + very hypoechoic (3) + taller than wide (3) + extra-thyroidal extension (3) + peripheral rim calcifications (2). Any score of 7 or above is classified as TR5 (highly suspicious).

Does a high TI-RADS score mean I have thyroid cancer?

No. A high score means the nodule has features that raise concern. Even TR5 nodules have an estimated cancer risk of about 35%, which means most are still not cancer. Only a biopsy (FNA) can confirm whether a nodule is cancerous.

What does it mean if my nodule is TR2?

TR2 means the nodule is not suspicious. It has a very low cancer risk of about 1.5%. No biopsy and no follow-up imaging are needed for TR2 nodules.

Can I use this calculator without an ultrasound?

No. The five features scored by TI-RADS — composition, echogenicity, shape, margin, and echogenic foci — can only be assessed on a thyroid ultrasound. You need an ultrasound report or images to use this tool accurately.

How does the Generate Report button work?

Click Generate Report after completing all five categories. The tool creates a structured text summary with your selections, total score, TI-RADS classification, and recommendations. You can copy it to your clipboard or print it to share with your doctor.

Can I print my TI-RADS report?

Yes. After generating a report, click the Print Report button. This opens your browser's print dialog so you can print the report or save it as a PDF.

What does the Start Over button do?

The Start Over button clears all your selections, resets the nodule size field, and removes any generated report. It lets you begin a new assessment from scratch.

Do results update automatically when I change a selection?

Yes. The calculator updates the total score, TI-RADS classification, risk estimate, and all charts in real time as you change any selection or edit the nodule size.

What is the bar chart showing?

The bar chart shows how many points each of the five categories contributed to your total score. It helps you see which features are driving the nodule's risk level.

What does the gauge chart represent?

The gauge chart gives a visual display of your total TI-RADS score on a scale from 0 to 10. It fills up more as the score increases, making it easy to see at a glance how suspicious the nodule is.

Why does my FNA recommendation say no biopsy is needed even though my score is TR4?

FNA recommendations depend on both the TI-RADS level and the nodule size. For TR4, FNA is only recommended if the nodule is 15 mm or larger. If your nodule is smaller than that, no biopsy is indicated by size alone.

What follow-up schedule is recommended for TR3 nodules?

For TR3 nodules that are 15 mm or larger, follow-up ultrasound is recommended at 1, 3, and 5 years. Nodules smaller than 15 mm do not need routine follow-up under ACR TI-RADS guidelines.

What follow-up schedule is recommended for TR5 nodules?

For TR5 nodules larger than 5 mm, annual ultrasound for up to 5 years is recommended. Nodules 10 mm or larger should also be considered for FNA biopsy.

Can this calculator diagnose thyroid cancer?

No. This calculator estimates risk based on ultrasound features. It cannot diagnose cancer. A definitive diagnosis requires a biopsy and pathology review by a doctor.

Is this tool meant for patients or doctors?

It is designed for both. Radiologists and endocrinologists can use it for quick scoring. Patients can use it to understand their ultrasound findings. However, results should always be reviewed with a qualified healthcare provider.

What should I do if my nodule scores TR5?

Talk to your doctor. A TR5 score means the nodule has highly suspicious features. Your doctor will likely recommend a fine needle aspiration biopsy if the nodule is 10 mm or larger. Further evaluation and management will depend on the biopsy results and your overall health.

Does the calculator save my data?

No. All calculations happen in your browser. No data is saved, stored, or sent to any server. Your selections are cleared when you close the page or click Start Over.