This is the complete ACR TI-RADS reference chart in one place. It covers every point value across the five ultrasound feature categories, the TR1 to TR5 classification thresholds, estimated malignancy risk for each category, and the exact nodule sizes that trigger a biopsy or follow-up recommendation. Bookmark this page for quick reference during reporting.

Feature Scoring Chart

The ACR TI-RADS system scores thyroid nodules across five ultrasound features. Select one option from each of the first four categories, and all that apply from Echogenic Foci. Add the points together for the total score.

1. Composition

Feature Points
Cystic or almost completely cystic 0
Spongiform 0
Mixed cystic and solid 1
Solid or almost completely solid 2
Cannot be determined (calcification) 2
For clinicians
Assign “cannot be determined” (2 points) when dense calcification prevents assessment of internal composition. Do not default to “solid” — use the explicit indeterminate option.

2. Echogenicity

Feature Points
Anechoic 0
Hyperechoic or isoechoic 1
Hypoechoic 2
Very hypoechoic 3
Cannot be determined 1
For patients
Echogenicity describes how bright or dark the nodule appears on ultrasound. Darker nodules score higher because cancers tend to appear darker than normal thyroid tissue. Read more in our hypoechoic thyroid nodule guide.

3. Shape

Feature Points
Wider-than-tall 0
Taller-than-wide 3

Shape is measured on a transverse image. A nodule taller than it is wide grows against tissue planes, a pattern more common in malignancy. This single feature earns 3 points and can shift a nodule by one or two categories.

4. Margin

Feature Points
Smooth 0
Ill-defined 0
Lobulated or irregular 2
Extra-thyroidal extension 3
Cannot be determined 0

5. Echogenic Foci (select all that apply)

Feature Points
None or large comet-tail artifacts 0
Macrocalcifications 1
Peripheral (rim) calcifications 2
Punctate echogenic foci 3
For clinicians
This is the only additive category. A nodule with both macrocalcifications and punctate foci scores 1 + 3 = 4 from foci alone. Large comet-tail artifacts (>1 mm, in cystic components) are considered benign colloid and score 0.

TI-RADS Category Chart

Once you have the total points from all five features, the sum determines the TI-RADS category:

Total Points Category Suspicion Level Estimated Malignancy Risk
0 TR1 Benign ~0.3%
2 TR2 Not suspicious ~1.5%
3 TR3 Mildly suspicious ~4.8%
4 to 6 TR4 Moderately suspicious ~9.1%
7 or more TR5 Highly suspicious ~35%

For a detailed explanation of each category, see our guides: TR1 and TR2 · TR3 · TR4 · TR5

Size-Based Management Thresholds

The TI-RADS category alone does not decide the next step. The nodule maximum diameter determines whether biopsy, follow-up, or no action is recommended:

Category FNA Biopsy Follow-Up Ultrasound Follow-Up Schedule No Action
TR1 Not needed Not needed Not needed All sizes
TR2 Not needed Not needed Not needed All sizes
TR3 2.5 cm or larger 1.5 to 2.4 cm 1, 3, 5 years Under 1.5 cm
TR4 1.5 cm or larger 1.0 to 1.4 cm 1, 2, 3, 5 years Under 1.0 cm
TR5 1.0 cm or larger 0.5 to 0.9 cm Annual up to 5 years Under 0.5 cm
For patients
This table explains why your doctor might recommend watching a small nodule rather than biopsying it, even if the category sounds concerning. A TR4 nodule under 1 cm, for example, is typically monitored rather than biopsied.

Use the Calculator

Enter your nodule features and size into the TI-RADS calculator to see the category, risk, and recommendation calculated automatically. To understand your result, see what your TI-RADS score means.

Source

All values on this chart are from the ACR TI-RADS 2017 white paper: Tessler FN, Middleton WD, Grant EG, 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. This chart is an independent educational reference and is not endorsed by the ACR.