What this calculator does
The TI-RADS calculator (Thyroid Imaging Reporting and Data System) adds up the published ACR TI-RADS points a radiologist assigns to a thyroid nodule seen on ultrasound. Five features are each scored against fixed, published point values: composition, echogenicity, shape, margin and echogenic foci. The points sum to a total that maps to a risk level from TR1 (benign) to TR5 (highly suspicious).
This reproduces the American College of Radiology's published ACR TI-RADS scoring criteria (Tessler et al., 2017) for information and reference, not as a substitute for a radiologist reading the actual ultrasound image. The five features scored here, and the resulting TR level, are determined by a radiologist examining the nodule directly. A patient cannot generate a meaningful TI-RADS score from symptoms alone; the inputs come from the ultrasound images themselves.
The formula
Each of the five categories carries fixed points from the published criteria: composition from 0 (cystic) to 2 (solid); echogenicity from 0 (anechoic) to 3 (very hypoechoic); shape 0 (wider than tall) or 3 (taller than wide); margin from 0 (smooth) to 3 (extra-thyroidal extension); and echogenic foci from 0 (none) to 3 (punctate foci), with points added for every type of foci present. The five totals are summed into an overall TI-RADS score, which maps to a TR1 to TR5 level, each with its own published fine-needle aspiration (FNA) and follow-up size threshold.
| Term | Meaning |
|---|---|
| TI-RADS | Thyroid Imaging Reporting and Data System, a standardised ultrasound scoring system published by the American College of Radiology. |
| TR level | The overall risk category, TR1 through TR5, that the summed points map to. |
| FNA | Fine-needle aspiration biopsy, the tissue-sampling procedure that TI-RADS size thresholds help decide whether to recommend. |
| Echogenic foci | Bright spots within the nodule on ultrasound, such as calcifications, which carry different point values depending on their pattern. |
The inputs explained
| Field | What to enter |
|---|---|
| Composition | How solid or cystic the nodule appears on ultrasound, as assessed by the radiologist. |
| Echogenicity | How bright or dark the nodule appears relative to surrounding thyroid tissue. |
| Shape | Whether the nodule is wider than it is tall, or taller than it is wide, on the ultrasound image. |
| Margin | The nodule's edge characteristics: smooth, ill-defined, lobulated/irregular, or extending beyond the thyroid. |
| Echogenic foci (add points for every type present) | The pattern of bright spots seen within the nodule, if any. |
| Nodule size (largest dimension) (cm) | The largest measured dimension of the nodule, used against the published FNA and follow-up size thresholds. |
When to use it
Reviewing a radiology report
A thyroid ultrasound report that states a TI-RADS score can be checked against the underlying feature descriptions here, to see exactly how the published points added up to that total.
Understanding an FNA recommendation
The published size thresholds explain why two nodules with the same TR level can receive different biopsy recommendations, since the threshold depends on both the TR level and the nodule's size.
Following a nodule over time
If a nodule is monitored with repeat ultrasounds, recalculating the score after each scan shows whether the recorded features, and therefore the risk level, have changed.
Worked examples
Every figure in the tables below is produced by this page’s own calculator at build time, so the numbers and the tool always agree. Select any row to load that scenario.
How the total score maps to a TR level
Echogenicity varied on its own, with every other category held at its lowest point value, to show how the total moves through the published TR1 to TR3 boundaries.
| Echogenicity points | TI-RADS points | Risk level |
|---|---|---|
| 0 | 0 points | TR1 (benign) |
| 1 | 1 points | TR2 (not suspicious) |
| 2 | 2 points | TR2 (not suspicious) |
| 3 | 3 points | TR3 (mildly suspicious) |
How the FNA size guidance changes with nodule size at TR4
A nodule scoring 4 points (TR4), shown across a range of sizes against the published TR4 thresholds.
| Nodule size | Risk level | Published size threshold guidance |
|---|---|---|
| 0.6 cm | TR4 (moderately suspicious) | Below both the 1 cm follow-up threshold and the 1.5 cm FNA threshold for TR4 (moderately suspicious) |
| 0.9 cm | TR4 (moderately suspicious) | Below both the 1 cm follow-up threshold and the 1.5 cm FNA threshold for TR4 (moderately suspicious) |
| 1 cm | TR4 (moderately suspicious) | Follow-up threshold reached (1 cm or more); below the 1.5 cm FNA threshold |
| 1.2 cm | TR4 (moderately suspicious) | Follow-up threshold reached (1 cm or more); below the 1.5 cm FNA threshold |
| 1.5 cm | TR4 (moderately suspicious) | FNA threshold reached (1.5 cm or more for TR4 (moderately suspicious)) |
| 1.8 cm | TR4 (moderately suspicious) | FNA threshold reached (1.5 cm or more for TR4 (moderately suspicious)) |
Questions
Can I work out my own TI-RADS score from symptoms?
No. Every input in this calculator, composition, echogenicity, shape, margin and echogenic foci, is assessed by a radiologist directly from the ultrasound image, not from symptoms a patient can observe. This tool is for understanding a score that has already been assigned, not for generating one from scratch.
What do the TR1 to TR5 levels mean?
They are the published ACR TI-RADS risk categories, running from TR1 (benign) through TR2 (not suspicious), TR3 (mildly suspicious) and TR4 (moderately suspicious) to TR5 (highly suspicious), based on the summed points from the five ultrasound features.
Does a higher TI-RADS score mean cancer?
No. TI-RADS estimates the likelihood that a nodule warrants sampling or monitoring based on its ultrasound appearance; it does not diagnose cancer. Only a biopsy, typically fine-needle aspiration, can establish a tissue diagnosis.
Why does the same TR level sometimes get a different recommendation?
Because the published FNA and follow-up thresholds combine both the TR level and the nodule's size. A small TR4 nodule can fall below the FNA threshold while a larger one at the same TR level meets it, which is why size is entered alongside the five scored features.
For another fixed, published clinical scoring tool, see the CHA₂DS₂-VASc calculator. For a kidney-function estimate using a similarly published equation, see the eGFR calculator.