ACR TI-RADS (Thyroid Nodule Risk Stratification)

Stratifies a thyroid nodule's malignancy risk from five ultrasound features and, together with nodule size, guides whether fine-needle aspiration, ultrasound surveillance, or no action is warranted.

Composition

Echogenicity

Shape (transverse / axial plane)

Margin

Macrocalcification present (+1)

Peripheral (rim) calcification present (+2)

Punctate echogenic foci / microcalcifications present (+3)

Echogenic foci are additive across types. A large comet-tail artifact (>1 mm) is benign and scores 0 — leave all three unchecked if only that is present.

Nodule maximum diameter (cm)