ACR TI-RADS (Thyroid Imaging Reporting and Data System)

When it activates

Scribeable activates a calculator from the encounter. The ACR TI-RADS (Thyroid Imaging Reporting and Data System) can activate when the transcript or pasted chart context documents any of these:

• Thyroid nodule evaluation
• Thyroid ultrasound interpretation
• Thyroid biopsy decision
• Thyroid incidentaloma workup
• Thyroid cancer risk assessment

Inputs the note needs

1 input. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

Points from 5 ultrasound features — Composition: cystic/spongiform=0, mixed=1, solid=2. Echogenicity: anechoic=0, hyper/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, extra-thyroidal extension=3. Echogenic foci: none/comet-tail=0, macrocalcifications=1, peripheral/rim=2, punctate=3. TR1 (0pts)=benign, TR2 (2pts)=not suspicious, TR3 (3pts)=mildly suspicious, TR4 (4-6pts)=moderately suspicious, TR5 (>=7pts)=highly suspicious.

Interpretation

TR1: Benign — no FNA. TR2: Not suspicious — no FNA. TR3: Mildly suspicious — FNA if >=2.5cm, follow-up if >=1.5cm. TR4: Moderately suspicious — FNA if >=1.5cm, follow-up if >=1.0cm. TR5: Highly suspicious — FNA if >=1.0cm, follow-up if >=0.5cm. Malignancy risk: TR1 <2%, TR2 <2%, TR3 ~5%, TR4 5-20%, TR5 >20%.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Tessler 2017.

• Tessler FN et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White PaperTessler et al. (ACR TI-RADS) 2017 · 2017 · ACR · Consensus · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the ACR TI-RADS (Thyroid Imaging Reporting and Data System) (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a ACR TI-RADS (Thyroid Imaging Reporting and Data System) value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.

Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.

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Can activate in: Internal Medicine, Surgery, ENT / Otolaryngology, Endocrinology, Radiology & Interventional Radiology.