ACR TI-RADS Calculator
Risk-stratify thyroid nodules on ultrasound with ACR TI-RADS, scoring composition, echogenicity, shape, margin, and echogenic foci.
What is TI-RADS?
ACR TI-RADS scores thyroid nodules on ultrasound across five features — composition, echogenicity, shape, margin, and echogenic foci. Points sum to a level TR1 through TR5 which, combined with nodule size, determines whether fine-needle aspiration or follow-up is recommended. This calculator supports the standard (Tessler 2017) and AI-optimized variants.
ACR TI-RADS (Thyroid Nodule)
Standard ACR TI-RADS (Tessler 2017) and AI-Optimized TI-RADS (Wildman-Tobriner 2019)
How to Use
- Pick the variant (Standard ACR or AI-Optimized).
- Score every category. Composition Cystic / Spongiform auto-assigns TR1.
- Echogenic foci is the only multi-select category — points add together.
- Enter each nodule's maximum diameter (cm) — required to copy the report and used for a personalized FNA / follow-up recommendation.
1 Report Details optional Fill these in for a richer, fully tailored full report — they never change the score.
These fields appear in the structured report only. They never affect the live TR score. Leave anything blank and the report keeps its bracketed placeholder text for you to fill in later.
Nodule scoring
Add each nodule, set its size and location, then score its features. Scoring updates live as you go.
Copy report
Copy a one-line impression or the full structured report (matching the standard TI-RADS template) to your clipboard.
About this calculator
Standard ACR TI-RADS (Tessler et al., 2017) scores five ultrasound feature categories on a thyroid nodule and assigns a TR level (TR1-TR5) plus FNA and follow-up size cutoffs. AI-Optimized TI-RADS (Wildman-Tobriner et al., 2019) keeps the same five categories and TR thresholds but reassigns six features to 0 points to improve specificity and reduce unnecessary biopsies, while preserving sensitivity.
- 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. J Am Coll Radiol. 2017;14(5):587-595. doi:10.1016/j.jacr.2017.01.046
- Wildman-Tobriner B, Buda M, Hoang JK, et al. Using Artificial Intelligence to Revise ACR TI-RADS Risk Stratification of Thyroid Nodules. Radiology. 2019;292(1):112-119. doi:10.1148/radiol.2019182128
- Bozkuş A, Başar Y, Güven K. Comparison of the diagnostic performance of the artificial intelligence-based TIRADS algorithm with established classification systems for thyroid nodules. Diagn Interv Radiol. 2025. doi:10.4274/dir.2025.253428
- Buda M. AI TI-RADS system optimized using genetic algorithm. github.com/mateuszbuda/AI-TI-RADS
For educational and reference purposes only. Always consult a qualified radiologist for clinical decisions.
Frequently asked questions
What is ACR TI-RADS?
ACR TI-RADS (Thyroid Imaging Reporting and Data System) is a point-based ultrasound classification for thyroid nodules. Points are assigned for composition, echogenicity, shape, margin, and echogenic foci; the total maps to a TR level from TR1 (benign) to TR5 (highly suspicious).
How does TI-RADS decide on fine-needle aspiration?
The TR level combined with maximum nodule size determines management. Generally, TR3 nodules ≥2.5 cm, TR4 ≥1.5 cm, and TR5 ≥1.0 cm warrant fine-needle aspiration, with smaller nodules followed by ultrasound. TR1 and TR2 nodules typically need no aspiration.
What is the AI-optimized TI-RADS variant?
The AI-optimized variant (Wildman-Tobriner 2019) re-derived the TI-RADS point weights using machine learning to improve specificity while preserving sensitivity, which can reduce unnecessary biopsies. This calculator offers both the standard ACR and AI-optimized scoring.
Does TI-RADS apply to all thyroid nodules?
TI-RADS is designed for assessing thyroid nodules on diagnostic ultrasound in adults. It is not intended for diffuse thyroid disease, and clinical factors or prior cytology may modify management. The calculator is an educational and reporting aid.