ACR TI-RADS Thyroid Nodule
Point-based risk stratification of thyroid nodules on ultrasound, per the 2017 ACR TI-RADS white paper. Select all five feature categories and enter the nodule size for management guidance. Decision-support only — always verify clinically.
Point system, management thresholds & citation
Scoring: Five categories. Composition, echogenicity, shape, and margin are single-choice. Echogenic foci is multi-select — all points add.
TR levels: 0–1 pts = TR1 (benign, ~0.3%); 2 pts = TR2 (~1.5%); 3 pts = TR3 (~4.8%); 4–6 pts = TR4 (~9.1%); ≥7 pts = TR5 (~35%).
Management thresholds:
TR3: FNA ≥ 2.5 cm; follow-up ≥ 1.5 cm.
TR4: FNA ≥ 1.5 cm; follow-up ≥ 1.0 cm.
TR5: FNA ≥ 1.0 cm; follow-up ≥ 0.5 cm.
Special rules: Purely cystic or spongiform = TR1, no action at any size. Any nodule < 0.5 cm = no FNA or follow-up regardless of level.
Citation: 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.
Select all five feature categories to see the ACR TI-RADS level and management recommendation.