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TIRADS Calculator

Updated Nov 10, 2026 By Infinity Calculator Formulas Sources Medical disclaimer
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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 to < 2.5 cm (1, 3, 5 yrs)
TR4Current

Moderately Suspicious

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

Highly Suspicious

  • Points: ≥ 7
  • Risk: ~35%
  • FNA: ≥ 1.0 cm
  • Follow-up: 0.5 to < 1.0 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. This calculator uses ACR TI-RADS, the version created by the American College of Radiology (ACR).1 It uses a simple point system to rate how likely a nodule is to be cancer.

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): TR1 is 0 points, TR2 is 2, TR3 is 3, TR4 is 4 to 6, and TR5 is 7 or more.2 A higher score means a higher risk of thyroid cancer. The system was defined by the American College of Radiology's TI-RADS committee.1

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."

Nodule Size: Enter the largest dimension of the nodule in millimeters. If your measurements were taken in centimeters, 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 lump that grows in the thyroid gland at the front of your neck. The thyroid is a small gland that makes hormones.4 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.

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. Follow-up ultrasound is recommended if it is 1.5 cm or larger but smaller than 2.5 cm.2
  • 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. Follow-up ultrasound is recommended if it is 1 cm or larger but smaller than 1.5 cm.2
  • 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. Follow-up ultrasound every year for up to 5 years is recommended if it is 0.5 cm or larger but smaller than 1 cm.2

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 needle is placed through the skin and guided to the nodule with ultrasound to collect small samples of tissue. The samples are then sent to a lab to see if the nodule is cancerous. The procedure usually takes less than 30 minutes, and the area may be numbed first.4

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, meaning it is made mostly of small cystic spaces. A spongiform nodule is a benign finding, so the points from the other four categories are not counted.3 A cystic or almost completely cystic nodule also scores 0 points for composition, but the points from the other categories are still added.3

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 thyroid blood tests, and your doctor's assessment. Always discuss your results with a qualified healthcare provider.

Formulas used

Total TI-RADS Score 3
S_{\text{total}} = S_{\text{composition}} + S_{\text{echogenicity}} + S_{\text{shape}} + S_{\text{margin}} + S_{\text{foci}}
TI-RADS Classification 2
\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 3
\text{If composition} = \text{Spongiform} \Rightarrow S_{\text{total}} = 0,\; \text{TR Level} = \text{TR1}
Echogenic Foci (Additive) 3
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).

What is the TR1 override and when does it apply?

The TR1 override applies when you select spongiform under composition. A spongiform nodule is classified as TR1 (benign) automatically, and points from the other four categories are not added.3 A nodule that is cystic or almost completely cystic scores 0 points for composition, but points from the other four categories are still added.3

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 a thyroid nodule score points for more than one type of echogenic foci in TI-RADS?

Yes. Echogenic foci is the only TI-RADS category where more than one option can apply. The points are added together. The "None or large comet-tail artifacts" option adds 0 points.3

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.3

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.3

What is the highest possible TI-RADS score?

The highest possible score is 17 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) + macrocalcifications, peripheral rim calcifications and punctate echogenic foci together (1 + 2 + 3), since every echogenic focus that applies is counted. 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. A biopsy (FNA) is the usual test to find out whether a nodule is cancerous, and some nodules need surgery for a definite answer.1

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.

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 but smaller than 25 mm, follow-up ultrasound is recommended at 1, 3, and 5 years. At 25 mm or larger, a biopsy (FNA) is recommended instead. 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 that are 5 mm or larger but smaller than 10 mm, annual ultrasound for up to 5 years is recommended. Nodules 10 mm or larger should be considered for FNA biopsy instead.

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.

Sources

  1. Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. Journal of the American College of Radiology. 2017;14(5):587-595. doi:10.1016/j.jacr.2017.01.046. Accessed September 3, 2026.
  2. Smit J, et al. Cancer risk in thyroid nodules: an analysis of over 1000 consecutive fine needle aspirations. Diagnostics. 2024;14(24):2775. doi:10.3390/diagnostics14242775. Accessed September 3, 2026.
  3. ACR Thyroid Imaging, Reporting and Data System (TI-RADS) Lexicon Directory and Chart. American College of Radiology. TI-RADS chart (p. 2). Accessed October 10, 2026.
  4. Thyroid Tests. National Institute of Diabetes and Digestive and Kidney Diseases. Thyroid nodules and fine needle aspiration biopsy. Accessed November 10, 2026.

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