Tirads Calculator
Tirads calculator works out ACR TI-RADS points and TI-RADS level from Composition, Echogenicity of the solid component and Shape. The default figures on this page give ACR TI-RADS points of 4; change any entry and the result, the working and the sources update together.
Your figures
Updates as you typeHow this is worked out
8 steps
- Composition - Solid or almost completely solid: 2 pt.
- Echogenicity - Hypoechoic: 2 pt.
- Shape - Not taller-than-wide: 0 pt.
- Margin - Smooth: 0 pt.
- Echogenic foci - none (0 pt): 0 pt in total (these are additive, not a single choice).
- Total = 2 + 2 + 0 + 0 + 0 = 4 points.
- 4 points is TR4 (Moderately suspicious) on the ACR chart.
- Fine-needle aspiration: TR4 at 1.5 cm is at or above the 1.5 cm threshold.
Point breakdowntable
| category | finding | points |
|---|---|---|
| Composition | Solid or almost completely solid | 2 |
| Echogenicity | Hypoechoic | 2 |
| Shape | Not taller-than-wide | 0 |
| Margin | Smooth | 0 |
| Echogenic foci | none (0 pt) | 0 |
Its 5 worked examples are re-run on every release, last on 15 September 2026. What changed
Sources and references
4 sources
What the tirads calculator calculates
Scores a thyroid nodule under the ACR Thyroid Imaging Reporting and Data System from its ultrasound features, returning the point total, the TR level and the ACR fine-needle-aspiration and follow-up recommendation for the nodule size entered.
How to use this tirads calculator
Enter Composition, Echogenicity of the solid component, Shape and Margin. ACR TI-RADS points updates as you type, and “Use a worked example” loads checked figures you can adjust. Change one figure at a time to see what drives the result.
How the result is worked out
Open “How this is worked out” beside the result for the step-by-step calculation behind ACR TI-RADS points, TI-RADS level and Risk category.
The method follows 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, American College of Radiology, ACR TI-RADS assessment categories chart (alternative chart) - point values, level boundaries and the size thresholds for FNA and follow-up, American College of Radiology, Thyroid Ultrasound Reporting Template using ACR TI-RADS - the per-feature point lists including the "cannot determine" scoring and the follow-up intervals per level and American College of Radiology, Sonographer’s worksheet for ACR TI-RADS - "If cystic or spongiform, do not add further points for other categories".
Solid, very hypoechoic, taller-than-wide, lobulated, punctate foci example
With Composition: solid, Echogenicity of the solid component: very-hypoechoic, Shape: taller-than-wide, Margin: lobulated-irregular, the calculator returns ACR TI-RADS points: 13, TI-RADS level: TR5, FNA at or above: 1. This example is checked against an independent source in the test suite.
What you can compare
Change one input at a time to see how it affects ACR TI-RADS points, TI-RADS level and Risk category. The inputs you can vary are Composition, Echogenicity of the solid component, Shape, Margin, Echogenic foci: macrocalcifications and Echogenic foci: peripheral (rim) calcifications.
Understanding ACR TI-RADS points, TI-RADS level and Risk category
A reporting aid for a qualified radiologist, not a diagnosis. The ACR TI-RADS categories rest on the reader’s own assessment of the ultrasound features, and the recommendation it produces is a starting point that clinical context, patient risk factors and the reporting radiologist override. It has not been reviewed here by a radiologist.
Results are general information, not financial, tax, legal, medical or engineering advice. Check any decision that matters with a qualified professional.
See something wrong? Report a problem with this calculator
Frequently asked questions
What information do I need for the tirads calculator?
You need Composition, Echogenicity of the solid component, Shape, Margin, Echogenic foci: macrocalcifications, Echogenic foci: peripheral (rim) calcifications, Echogenic foci: punctate echogenic foci and Echogenic foci: none, or large comet-tail artifacts only. The page opens with default figures that give ACR TI-RADS points of 4, so you can see the scale before entering your own.
What does this tirads calculator show?
It shows ACR TI-RADS points, TI-RADS level, Risk category, ACR recommendation, FNA at or above, Follow-up at or above, Follow-up schedule and Composition points, with the working and any warnings for your entries.
Can I check how the tirads calculator result was calculated?
Yes. The “How this is worked out” section shows the calculation steps, and the sources section identifies the references used for the method.