TIRADS-Calculator

TIRADS is an abbreviation which stands for Thyroid Imaging Reporting and Data System. It is a scoring system used by radiologists who perform ultrasound scans on the thyroid gland of patients who have suspected growths/nodules on them. Based on the appearance of the thyroid gland on the scan, different features are noted & given points for variations. This score can be used to assess the risk of chances of possible malignancy (cancer) in the thyroid and the need to perform further testing on the gland in the form of a Fine Needle Aspiration Cytology (FNAC) or a wedge biopsy. 

 A TIRADS calculator evaluates thyroid nodule cancer risk based on ultrasound features like composition, echogenicity, shape, margin, and echogenic foci. Each feature is scored, with the total score placing the nodule into a TIRADS category (TR1-TR5). Higher TIRADS levels indicate a greater malignancy risk, guiding decisions on biopsy or monitoring. A trained radiologist can use the calculator efficiently.

The TRIADS Calculator has several key benefits for trauma and emergency care:

Healthcare professionals can use the TIRADS Calculator by inputting specific patient details, including:

After entering the information, the calculator provides a TRIADS score, representing the likelihood of severe outcomes. This score is then used to determine the most appropriate care pathway, including immediate surgical intervention, close monitoring, or intensive care.

Every nodule visualised by ultrasound can be characterised based on its appearance in an ultrasound scan into the following 5 categories.

Composition

Echogenicity

Shape

Margin

Echogenic Foci 

Each of these categories is counted separately and has a points system as follows.

The next step is to add the points from all the categories. 

Based on the score, the status of the nodule is categorised as follows: 

0 points - TR1 

2 points - TR2

3 points - TR3

4-6 points - TR4

7 or more points - TR5

TR1 indicates that the nodule is Benign (non-cancerous) and does not require an FNAC. This corresponds to 0.3 % risk of malignancy.

TR2 indicates that the nodule is Not Suspicious, and does not require an FNAC. This corresponds to 1.5 % risk of malignancy.

TR3 indicates a Mildly Suspicious nodule. An FNAC is recommended if the nodule size is more than 2.5cm. If it's between 1.5 and 2.5 cm, then periodic follow-up of the nodule's progression is done to watch for an increase in size. Follow-up intervals are 1,3 and 5 years from the first visit. This corresponds to a 4.8 % risk of malignancy.

TR4 indicates a Moderately Suspicious nodule. If the size is more than 1.5 cm, then FNAC is done. Follow-up is done if the size is between 1 and 1.5 cm. Follow up at 1, 2, 3, and 5 years. This corresponds to a 9.1 % risk of malignancy.

TR5 means Highly Suspicious. Here, an FNAC is done for any nodule over 1 cm in size. Those more than 1 cm are followed up closely. A 5-year yearly follow-up is recommended. This corresponds to a 35 % risk of malignancy.The maximum score is 17. The higher the score, the higher the risk of malignancy and the worse the prognosis. 

If there are multiple nodules, all are categorised, and FNAC samples are the two with the highest TIRADS scores. These might not necessarily be the most extensive nodules. Follow-up examination forms a vital part of diagnosis and treatment. Some nodules with even a higher TIRADS score may not be feasible for an FNAC. These patients are closely followed up to look for significant enlargement. Significant enlargement is defined as a 50% increase in the volume or a more than 2mm/20% increase in two different dimensions of the nodule from previous findings.

Here are some of the limitations of the TIRADS Calculator :

Always exercise caution while selecting any option with a higher score and make sure to cross-check your findings.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.