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ACR TI-RADS

Classifies thyroid nodules using the five ACR ultrasound feature groups and maximum diameter to determine FNA or follow-up criteria.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

ACR TI-RADS 2017; benign composition rule checked against the ACR worksheet on 2026-10-03

The ACR TI-RADS 2017 classification uses the nodule’s ultrasound findings and greatest diameter. Cystic or spongiform composition receives no points from the other groups. The official FAQ distinguishes previously biopsied nodules and PET-positive nodules: biopsy results and clinical context can change management and are not inputs to this calculator. The category and size thresholds are not a histological diagnosis.

Required fields: 0/7 completed

Complete all required fields. Optional fields are marked.

Composition required

Echogenicity required

Shape (on a transverse image) required

Margin required

Echogenic foci: macrocalcifications (1) required

Echogenic foci: peripheral (rim) calcifications (2) required

Punctate echogenic foci (3) required

Maximum nodule diameter (optional)cm · range 0.1–10

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Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Composition
Echogenicity
Shape (on a transverse image)
Margin
Echogenic foci: macrocalcifications (1)
Echogenic foci: peripheral (rim) calcifications (2)
Punctate echogenic foci (3)
Maximum nodule diameter (optional) · cm

5/5 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Cystic, almost completely cystic and spongiform nodules receive 0 points (TR1); do not add points from other categories.

Add the points for composition, echogenicity, shape, margin and echogenic foci (for foci, add all present types; none or large comet-tail artifacts = 0).

TR1: 0 points · TR2: 2 points · TR3: 3 points · TR4: 4–6 points · TR5: 7 or more.

References

Identifier: acr-ti-rads

Original clinical content: Brazilian Portuguese.

Method version

ACR TI-RADS 2017; benign composition rule checked against the ACR worksheet on 2026-10-03

acr-ti-rads@native-2026-10-04+9b676506c507

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (5)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Composition: Cystic or almost completely cystic (0)
Echogenicity: Anechoic (0)
Shape (on a transverse image): Wider than tall (0)
Margin: Smooth (0)
Echogenic foci: macrocalcifications (1): No
Echogenic foci: peripheral (rim) calcifications (2): No
Punctate echogenic foci (3): No

{
  "comp": "cistico",
  "eco": "anecoico",
  "forma": "larga",
  "margem": "lisa",
  "macro": false,
  "periferica": false,
  "puntiforme": false
}

Expected result

{
  "score": 0,
  "tr": 1
}

Actual result

{
  "score": 0,
  "tr": 1,
  "paaf": false
}

Case 2

reference-002

Inputs

Composition: Spongiform (0)
Echogenicity: Hyperechoic or isoechoic (1)
Shape (on a transverse image): Wider than tall (0)
Margin: Smooth (0)
Echogenic foci: macrocalcifications (1): No
Echogenic foci: peripheral (rim) calcifications (2): No
Punctate echogenic foci (3): No

{
  "comp": "espongiforme",
  "eco": "hiper",
  "forma": "larga",
  "margem": "lisa",
  "macro": false,
  "periferica": false,
  "puntiforme": false
}

Expected result

{
  "score": 0,
  "tr": 1
}

Actual result

{
  "score": 0,
  "tr": 1,
  "paaf": false
}

Case 3

reference-003

Inputs

Composition: Mixed cystic and solid (1)
Echogenicity: Hyperechoic or isoechoic (1)
Shape (on a transverse image): Wider than tall (0)
Margin: Smooth (0)
Echogenic foci: macrocalcifications (1): Yes
Maximum nodule diameter (optional): 2.5 cm
Echogenic foci: peripheral (rim) calcifications (2): No
Punctate echogenic foci (3): No

{
  "comp": "misto",
  "eco": "hiper",
  "forma": "larga",
  "margem": "lisa",
  "macro": true,
  "tamanho": 2.5,
  "periferica": false,
  "puntiforme": false
}

Expected result

{
  "score": 3,
  "tr": 3
}

Actual result

{
  "score": 3,
  "tr": 3,
  "paaf": true
}

Case 4

reference-004

Inputs

Composition: Solid or almost completely solid (2)
Echogenicity: Hypoechoic (2)
Shape (on a transverse image): Wider than tall (0)
Margin: Smooth (0)
Maximum nodule diameter (optional): 1.2 cm
Echogenic foci: macrocalcifications (1): No
Echogenic foci: peripheral (rim) calcifications (2): No
Punctate echogenic foci (3): No

{
  "comp": "solido",
  "eco": "hipo",
  "forma": "larga",
  "margem": "lisa",
  "tamanho": 1.2,
  "macro": false,
  "periferica": false,
  "puntiforme": false
}

Expected result

{
  "score": 4,
  "tr": 4
}

Actual result

{
  "score": 4,
  "tr": 4,
  "paaf": false
}

Case 5

reference-005

Inputs

Composition: Solid or almost completely solid (2)
Echogenicity: Very hypoechoic (3)
Shape (on a transverse image): Taller than wide (3)
Margin: Lobulated or irregular (2)
Punctate echogenic foci (3): Yes
Maximum nodule diameter (optional): 1 cm
Echogenic foci: macrocalcifications (1): No
Echogenic foci: peripheral (rim) calcifications (2): No

{
  "comp": "solido",
  "eco": "muitohipo",
  "forma": "alta",
  "margem": "irregular",
  "puntiforme": true,
  "tamanho": 1,
  "macro": false,
  "periferica": false
}

Expected result

{
  "score": 13,
  "tr": 5
}

Actual result

{
  "score": 13,
  "tr": 5,
  "paaf": true
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

Specific oncological application

Thyroid nodule classification for risk assessment. The population, thresholds and implementation review remain tied to the ACR source.

Applications: Early detection and risk assessment