ACR TI-RADS
Ultrasound-based risk stratification for thyroid nodules. Sum points across five feature categories (all that apply for echogenic foci; choose one for the rest) to assign TR1–TR5, then apply size-based FNA and follow-up thresholds.
2017·reviewed 2026-07-01
- When multiple nodules are present, classify no more than four (generally those with the highest TR levels); recommend FNA for no more than two. Each nodule is scored independently.
- Measure nodules in three axes; use the maximum diameter for FNA/follow-up thresholds.
Leave all unchecked for “none / large comet-tail” (0 points).
Drives the FNA / follow-up threshold.
Total points4
TR4Moderately suspicious
Enter the nodule size to get the FNA / follow-up recommendation.
Sources
- Tessler FN, 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.
Educational reference for clinicians — not medical advice. Verify against the primary source before acting on it; guidelines change. Final decisions rest with the interpreting physician and your institution's protocols.