🦋 Thyroid Nodule ACR TI-RADS & FNA Decision
Score thyroid-nodule ultrasound features per ACR TI-RADS (TR1–5) and get an FNA or follow-up recommendation from the level and nodule size. Instant, browser-side.
Thyroid Nodule ACR TI-RADS & FNA Decision
Composition
Echogenicity
Shape (aspect ratio)
Margin
Echogenic foci: macrocalcifications (+1)
Echogenic foci: peripheral/rim calcifications (+2)
Echogenic foci: punctate echogenic foci / microcalcifications (+3)
Maximum nodule diameter (cm)
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
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.