🦋 Thyroid Nodule ACR TI-RADS & FNA Decision
UseStandardised malignancy-risk assessment of a thyroid nodule on ultrasound, with FNA/follow-up size thresholds.
SourceTessler FN, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS). J Am Coll Radiol 2017
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Punctate echogenic foci (microcalcifications) add 3 points and strongly raise suspicion.
When to use
Standardised malignancy-risk assessment of a thyroid nodule on ultrasound, with FNA/follow-up size thresholds.
How it works
Sum five features — composition, echogenicity, shape, margin, echogenic foci — into TR1 (0), TR2 (1–2), TR3 (3), TR4 (4–6), TR5 (≥ 7). FNA/follow-up thresholds: TR3 ≥ 2.5/1.5 cm, TR4 ≥ 1.5/1.0 cm, TR5 ≥ 1.0/0.5 cm.
Key points
- Punctate echogenic foci (microcalcifications) add 3 points and strongly raise suspicion.
- ACR generally does not biopsy nodules < 1 cm even when TR5 (active surveillance is an option for 5–9 mm).
- With multiple nodules, assess the 1–2 with the highest TR rather than the largest.
- TR1–2 need no FNA; FNA vs follow-up depends on the size thresholds.
References
- [Guideline / primary source]Tessler FN, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS). J Am Coll Radiol 2017
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Composition | Mixed cystic-solid (1) |
|---|---|
| Echogenicity | Hyper-/iso-echoic (1) |
| Shape (aspect ratio) | Wider-than-tall, ratio < 1 (0) |
| Margin | Lobulated / irregular (2) |
| Echogenic foci: macrocalcifications (+1) | Yes |
| Echogenic foci: peripheral/rim calcifications (+2) | Yes |
| Echogenic foci: punctate echogenic foci / microcalcifications (+3) | Yes |
| Maximum nodule diameter | 1.2 cm |
→DispositionFNA recommended
- TI-RADS total：10 points
- Level：TR5 (Highly suspicious (≥ 20%))
- Max diameter：1.2 cm
| Composition | Cystic / spongiform (0) |
|---|---|
| Echogenicity | Anechoic (0) |
| Shape (aspect ratio) | Wider-than-tall, ratio < 1 (0) |
| Margin | Smooth / ill-defined (0) |
| Echogenic foci: macrocalcifications (+1) | Yes |
| Echogenic foci: peripheral/rim calcifications (+2) | Yes |
| Echogenic foci: punctate echogenic foci / microcalcifications (+3) | Yes |
| Maximum nodule diameter | 1.2 cm |
→DispositionUltrasound follow-up recommended
- TI-RADS total：6 points
- Level：TR4 (Moderately suspicious (5–20%))
- Max diameter：1.2 cm
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Thyroid Nodule ACR TI-RADS & FNA Decision?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Thyroid Nodule ACR TI-RADS & FNA Decision upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Thyroid Nodule ACR TI-RADS & FNA Decision calculated in practice? Can you show a worked example?
- Inputs: Composition Mixed cystic-solid (1), Echogenicity Hyper-/iso-echoic (1), Shape (aspect ratio) Wider-than-tall, ratio < 1 (0), Margin Lobulated / irregular (2), Echogenic foci: macrocalcifications (+1) Yes, Echogenic foci: peripheral/rim calcifications (+2) Yes, Echogenic foci: punctate echogenic foci / microcalcifications (+3) Yes, Maximum nodule diameter 1.2 cm → Result: Disposition FNA recommended（TI-RADS total: 10 points, Level: TR5 (Highly suspicious (≥ 20%)), Max diameter: 1.2 cm） Inputs: Composition Cystic / spongiform (0), Echogenicity Anechoic (0), Shape (aspect ratio) Wider-than-tall, ratio < 1 (0), Margin Smooth / ill-defined (0), Echogenic foci: macrocalcifications (+1) Yes, Echogenic foci: peripheral/rim calcifications (+2) Yes, Echogenic foci: punctate echogenic foci / microcalcifications (+3) Yes, Maximum nodule diameter 1.2 cm → Result: Disposition Ultrasound follow-up recommended（TI-RADS total: 6 points, Level: TR4 (Moderately suspicious (5–20%)), Max diameter: 1.2 cm）