Jasser Abu-Giemi Jasser Abu-Giemi

🩺 TI-RADS Ultrasound Examples: Understanding Each Scoring Characteristic

Keywords: TI-RADS examples, thyroid ultrasound features, TI-RADS composition echogenicity shape margin foci, ACR TI-RADS scoring, thyroid nodule ultrasound examples

Introduction

When learning the ACR TI-RADS system, visual examples are key to understanding how each ultrasound feature contributes to the overall score.
Below are descriptions and image placeholders for each of the five TI-RADS characteristics with notes on how they affect scoring.

You can view the full scoring reference on the ACR TI-RADS Guidelines (Radiopaedia).

1️⃣ Composition

TI-RADS assigns 0–2 points based on how solid or cystic a nodule is.

TypeDescriptionPoints

  • Cystic or almost completely cysticAnechoic, fluid-filled, thin walls. Usually benign colloid cyst.0

  • Spongiform>50% small cystic spaces; classic benign pattern.0

  • Mixed cystic and solidBoth fluid and soft-tissue components visible.1

  • Solid or almost completely solidHypoechoic, dense tissue with minimal cystic change.2

2️⃣ Echogenicity

Echogenicity measures how bright or dark the nodule is compared to normal thyroid tissue.

TypeAppearancePoints

  • AnechoicCompletely black (fluid-filled) — cystic lesions.0

  • Isoechoic or Hyperechoic Same or brighter than thyroid parenchyma.1

  • HypoechoicDarker than thyroid tissue, brighter than strap muscles.2

  • Very HypoechoicEqual to or darker than adjacent strap muscles — more suspicious.3

3️⃣ Shape

Shape is one of the most critical indicators of malignancy.

ShapeAppearancePoints

  1. Wider-than-tallThe nodule’s width (transverse) is greater than its height (AP). Usually benign.0

  2. Taller-than-wideHeight exceeds width on transverse view — suggests invasive growth.3

4️⃣ Margins

Margins show how well-defined or irregular the edges of the nodule are.

Margin Type

  • Smooth Clear, even contour. Benign.0

  • Ill-defined Fuzzy edges; can occur in benign or malignant nodules.0

  • Lobulated or Irregular Jagged, uneven outline suggesting infiltration.2

  • Extrathyroidal Extension Nodule breaks capsule or extends into surrounding tissue.3

5️⃣ Echogenic Foci

These small internal echoes help identify calcifications or colloid artifacts.

Foci Type

  • None or Large Comet-Tail Artifact Benign colloid reflection.0

  • Macrocalcifications Large bright echoes with posterior shadowing.1

  • Peripheral / Rim Calcifications Calcified rim around the nodule.2

  • Punctate Echogenic FociTiny bright dots (microcalcifications) — more suspicious.3

Putting It All Together

Each characteristic contributes to a total TI-RADS score:

  • 0 points → TR1 (benign)

  • 2 points → TR2 (not suspicious)

  • 3 points → TR3 (mildly suspicious)

  • 4–6 points → TR4 (moderately suspicious)

  • ≥7 points → TR5 (highly suspicious)

Once you’ve assessed your nodule, enter these findings into the TI-RADS Calculator to instantly view your total score, malignancy risk, and recommended follow-up interval.

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Jasser Abu-Giemi Jasser Abu-Giemi

How the TI-RADS System Works: Understanding Thyroid Nodule Scoring

Keywords: how TI-RADS works, ACR TI-RADS explained, TI-RADS thyroid ultrasound, TI-RADS scoring system, thyroid nodule risk classification, ACR TI-RADS calculator

What Is TI-RADS?

The Thyroid Imaging Reporting and Data System (TI-RADS) is a standardized method developed by the American College of Radiology (ACR) to classify thyroid nodules found on ultrasound.
Its goal is simple: make thyroid nodule reporting consistent, evidence-based, and easy to interpret across sonographers, radiologists, and referring clinicians.

Instead of vague terms like “slightly suspicious” or “needs follow-up,” TI-RADS assigns points to specific ultrasound features. These points add up to a category (TR1–TR5) that reflects the likelihood of malignancy and helps determine whether fine-needle aspiration (FNA) or follow-up imaging is recommended.

If you’d like to review the official source, you can read the
👉 ACR TI-RADS guidelines on Radiopaedia
for full scoring tables and management recommendations.

The Five Key Features of TI-RADS

The ACR system evaluates five ultrasound features, each worth a certain number of points:

  • Composition: Cystic (0), Spongiform (0), Mixed (1), Solid (2)

  • Echogenicity: Anechoic (0), Hyperechoic/Isoechoic (1), Hypoechoic (2), Very Hypoechoic (3)

  • Shape: Wider than tall (0), Taller than wide (3)

  • Margin: Smooth (0), Ill-defined (0), Lobulated/Irregular (2), Extrathyroidal extension (3)

  • Echogenic Foci: None (0), Large comet tail (0), Macrocalcifications (1), Peripheral/rim calcifications (2), Punctate echogenic foci (3)

Each selected option contributes to the total score.

TI-RADS Categories and What They Mean

TR1 – Benign (0 points)
Likelihood of malignancy: ~0%
Recommendation: No FNA or follow-up.

TR2 – Not Suspicious (2 points)
Likelihood of malignancy: ~1.5%
Recommendation: No FNA or follow-up.

TR3 – Mildly Suspicious (3 points)
Likelihood of malignancy: ~4.8%
Recommendation: Follow-up ≥1.5 cm; FNA ≥2.5 cm.

TR4 – Moderately Suspicious (4–6 points)
Likelihood of malignancy: ~9.1%
Recommendation: Follow-up ≥1.0 cm; FNA ≥1.5 cm.

TR5 – Highly Suspicious (≥7 points)
Likelihood of malignancy: ~35%
Recommendation: Follow-up ≥0.5 cm; FNA ≥1.0 cm.

These thresholds are based on the ACR TI-RADS guidelines and can help reduce unnecessary biopsies while ensuring significant nodules are properly investigated.

Why TI-RADS Is Important

Before TI-RADS, thyroid ultrasound reports varied dramatically between practitioners.
Now, using TI-RADS:

  • Sonographers and radiologists speak a common language.

  • Patients receive clear, evidence-based follow-up recommendations.

  • Clinics minimize over-biopsy and streamline workflows.

This consistency improves communication with referring physicians and ultimately leads to better patient outcomes.

How to Apply It in Practice

When performing a thyroid ultrasound:

  1. Identify and document each nodule’s five core features.

  2. Use the TI-RADS Calculator to assign points and automatically determine the category.

  3. Include the category (e.g., TR4) and recommended action in your report.

  4. For follow-up, note the time interval (e.g., TR3 nodules > 1.5 cm → repeat at 1, 3, and 5 years).

Over time, applying TI-RADS consistently will sharpen your diagnostic accuracy and help you build stronger clinical confidence.

Want to Calculate a Score Instantly?

👉 Try the ACR TI-RADS Calculator — a free, easy-to-use tool built by a fellow sonographer to simplify your thyroid reporting workflow.

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Jasser Abu-Giemi Jasser Abu-Giemi

How to use the TI-Rads online calculator

It all begins with an idea.

🧠 How to Use the ACR TI-RADS Online Calculator — and Why It Matters

Keywords: TI-RADS calculator, ACR TI-RADS online calculator, thyroid nodule risk calculator, TI-RADS ultrasound scoring, how to calculate TI-RADS, thyroid ultrasound interpretation

What Is the TI-RADS Calculator?

The TI-RADS (Thyroid Imaging Reporting and Data System) is a standardized scoring system developed by the American College of Radiology (ACR) to help sonographers and radiologists assess thyroid nodules consistently. Each ultrasound feature—such as composition, echogenicity, shape, margin, and echogenic foci—earns points that combine into an overall TI-RADS score. This score helps estimate the risk of malignancy and guides decisions on biopsy or follow-up.

Our ACR TI-RADS Calculator at SonoCalcLab.com lets you enter these features quickly and automatically see:

  • The total TI-RADS points

  • The corresponding TI-RADS category (TR1–TR5)

  • The estimated likelihood of malignancy

  • The recommended follow-up interval or FNA (fine-needle aspiration) threshold

No math, no guesswork—just clear results instantly.

How to Use the TI-RADS Calculator

  1. Select each ultrasound feature

    • Choose the composition (solid, mixed cystic, etc.)

    • Select echogenicity, shape, margin, and echogenic foci

    • Each choice automatically adds points according to the ACR guidelines

  2. View your TI-RADS score
    The calculator instantly totals your score and displays the category (TR1–TR5).

  3. Interpret the results

    • TR1–TR2: Benign or not suspicious

    • TR3: Mildly suspicious (follow-up if ≥1.5 cm)

    • TR4: Moderately suspicious (consider FNA if ≥1.5 cm)

    • TR5: Highly suspicious (FNA if ≥1 cm)

  4. Follow recommended management
    The calculator also displays the recommended ultrasound follow-up intervals (e.g., 1, 3 and 5 years for TR3 nodules > 1.5 cm).

You can use this tool directly in your reporting workflow or as a double-check while documenting thyroid findings.

Why TI-RADS Scoring Matters

Before the ACR introduced TI-RADS, thyroid ultrasound interpretation varied widely between practitioners. By adopting this system:

  • Radiologists and sonographers speak the same language when describing nodules.

  • Patients receive consistent, evidence-based care.

  • Clinics reduce unnecessary biopsies and focus on nodules that truly need follow-up.

Using an online calculator ensures accuracy, speed, and reproducibility—especially when you’re scanning a high volume of patients or training new staff.

Bonus: Simplify Your Workflow

At SonoCalc Lab, the goal is to make radiology tools simple, reliable, and fast. The TI-RADS calculator saves time, standardizes reporting, and reduces error risk.

👉 Try the calculator now at SonoCalcLab.com — or bookmark it for your next thyroid scan.

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