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Thyroid Nodule Evaluation (ACR TI-RADS)

Thyroid Nodule Evaluation (ACR TI-RADS): Thyroid Nodule on Ultrasound → Composition (0-2 pts) → Echogenicity (0-3 pts) → Shape (0-3 pts) → Margin (0-3 p...

Pathway Overview

12 steps

Algorithm Steps

12 total

  1. 01Start

    Thyroid Nodule on Ultrasound

    Assess composition, echogenicity, shape, margin, foci

  2. 02Action

    Composition (0-2 pts)

    Cystic/spongiform (0), Mixed (1), Solid (2)

  3. 03Action

    Echogenicity (0-3 pts)

    Anechoic (0), Hyper/iso (1), Hypo (2), Very hypo (3)

  4. 04Action

    Shape (0-3 pts)

    Wider than tall (0), Taller than wide (3)

  5. 05Action

    Margin (0-3 pts)

    Smooth (0), Ill-defined (0), Lobulated (2), Extrathyroidal (3)

  6. 06Action

    Echogenic Foci (0-3 pts)

    None (0), Macrocalc (1), Peripheral (2), Punctate (3)

  7. 07Decision

    Calculate Total Points

  8. 08End

    TR1: Benign (0 pts)

    No FNA needed

  9. 09End

    TR2: Not Suspicious (2 pts)

    No FNA needed

  10. 10End

    TR3: Mildly Suspicious (3 pts)

    FNA if ≥2.5cm, follow if ≥1.5cm

  11. 11End

    TR4: Mod Suspicious (4-6 pts)

    FNA if ≥1.5cm, follow if ≥1.0cm

  12. 12End

    TR5: Highly Suspicious (≥7 pts)

    FNA if ≥1.0cm, follow if ≥0.5cm

Guideline Source

ACR TI-RADS: Thyroid Imaging Reporting and Data System

DOI: 10.1016/j.jacr.2017.01.046View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Does not apply to diffuse thyroid disease
  • Limited for purely cystic nodules
  • Clinical context may modify approach

Applicable Regions

USAUUKEUKR

EU: EU-TIRADS slightly different point system

KR: K-TIRADS validated for Korean population

US: ACR TI-RADS standard; ATA guidelines also widely used

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the Thyroid Nodule Evaluation (ACR TI-RADS)?

The Thyroid Nodule Evaluation (ACR TI-RADS) is a diagnostic clinical algorithm for Radiology. It provides a structured decision tree to guide clinical decision-making, based on ACR TI-RADS: Thyroid Imaging Reporting and Data System.

What guideline is the Thyroid Nodule Evaluation (ACR TI-RADS) based on?

This algorithm is based on ACR TI-RADS: Thyroid Imaging Reporting and Data System (DOI: 10.1016/j.jacr.2017.01.046).

What are the limitations of the Thyroid Nodule Evaluation (ACR TI-RADS)?

Known limitations include: Does not apply to diffuse thyroid disease; Limited for purely cystic nodules; Clinical context may modify approach. Individual patient factors may require deviation from these recommendations.

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