Aperivue RADS

Thyroid US Report Generator

Structured reporting with TIRADS scoring · Multi-nodule · PACS-ready output

Nodule Assessment

Nodules

Size (cm)

××cm
Composition

Internal content of the nodule

Echogenicity

Relative to thyroid parenchyma

Shape

Assessed on transverse image

Margin

Nodule border characteristics

Echogenic Foci

Select the most suspicious finding

TR1Benign

0 points

Risk

<2%

FNA: No FNA

Follow-up: No follow-up needed.

Auto-generated from findings

THYROID ULTRASOUND

COMPARISON: None available.

FINDINGS:

Thyroid Gland:
Right lobe: not measured. Left lobe: not measured. Isthmus: not measured.

Nodules:
1. Nodule 1 (Not specified):
   Cystic or almost completely cystic, Anechoic, Wider-than-tall, Smooth, None or large comet-tail artifacts.
   ACR TI-RADS: TR1 (Benign). Malignancy risk: <2%.

Cervical Lymph Nodes: No suspicious cervical lymphadenopathy.

IMPRESSION:
1. Nodule 1 (Not specified): TR1 (Benign). No FNA

ACR TI-RADS (2017) — point-based categories

Malignancy risk and size-based management by ACR TI-RADS category, mirroring this calculator's own scoring engine. Thresholds reflect the FNA / follow-up size cut-offs the calculator applies.

CategoryMalignancy riskSize-based management
ACR TR1 (Benign)<2%No FNA; no follow-up needed.
ACR TR2 (Not Suspicious)~2%No FNA; no follow-up needed.
ACR TR3 (Mildly Suspicious)~5%FNA if ≥ 2.5 cm; follow-up if ≥ 1.5 cm.
ACR TR4 (Moderately Suspicious)5–20%FNA if ≥ 1.5 cm; follow-up if ≥ 1.0 cm.
ACR TR5 (Highly Suspicious)>20%FNA if ≥ 1.0 cm; follow-up if ≥ 0.5 cm.

Key decision rules (ACR TI-RADS)

  • Points are summed across five feature categories: composition, echogenicity, shape, margin, and echogenic foci.
  • Composition (0–2), echogenicity (0–3), shape (wider-than-tall 0, taller-than-wide 3), and margin (0–3) each contribute, plus the single most suspicious echogenic-foci finding (0–3).
  • Total points map to a category: 0 = TR1, 1–2 = TR2, 3 = TR3, 4–6 = TR4, and ≥ 7 = TR5.
  • FNA versus follow-up is then decided by nodule size within the category, using the size thresholds in the table above.
  • Higher categories carry both higher malignancy risk and lower size thresholds for biopsy.

2021 K-TIRADS — pattern-based categories

Malignancy risk and management by 2021 K-TIRADS category (Ha et al., Korean J Radiol 2021), mirroring this calculator's own scoring engine. The calculator scores nodules from K-TIRADS 2; category 1 (no nodule) is listed for completeness.

CategoryMalignancy riskSize-based management
K-TIRADS 1 (No nodule)No nodule (not assessed)Not applicable.
K-TIRADS 2 (Benign)<3%Biopsy not routinely indicated; US follow-up at 2–5 years depending on size.
K-TIRADS 3 (Low Suspicion)3–10%FNA if > 2.0 cm; US at 1, 3, and 5 years.
K-TIRADS 4 (Intermediate Suspicion)10–40%FNA if > 1.0–1.5 cm; US at 1, 3, and 5 years.
K-TIRADS 5 (High Suspicion)>60%FNA if > 1.0 cm; US every 6 months for 1–2 years, then yearly.

Key decision rules (2021 K-TIRADS)

  • Composition and echogenicity first define the base pattern; pure cysts and iso-/hyperechoic spongiform nodules are K-TIRADS 2 (benign).
  • Three suspicious US features are assessed: punctate echogenic foci, nonparallel orientation (taller-than-wide), and irregular margin.
  • A solid hypoechoic nodule with any suspicious feature is K-TIRADS 5; a solid hypoechoic nodule without any suspicious feature is K-TIRADS 4.
  • A partially cystic or iso-/hyperechoic nodule is K-TIRADS 4 if any suspicious feature is present, otherwise K-TIRADS 3.
  • An entirely calcified nodule is classified as K-TIRADS 4.
  • Within each category, FNA versus follow-up is decided by nodule size using the thresholds in the table above.

EU-TIRADS — feature-based categories

Malignancy risk and size-based management by EU-TIRADS category (Russ et al., Eur Thyroid J 2017), mirroring this calculator's own scoring engine.

CategoryMalignancy riskSize-based management
EU-TIRADS 1 (Benign)<1%No FNA; no follow-up needed.
EU-TIRADS 2 (Not Suspicious)0–3%No FNA; no follow-up needed.
EU-TIRADS 3 (Low Risk)2–4%FNA if ≥ 2.0 cm; follow-up if ≥ 1.0 cm.
EU-TIRADS 4 (Intermediate Risk)6–17%FNA if ≥ 1.5 cm; follow-up if ≥ 1.0 cm.
EU-TIRADS 5 (High Risk)>26%FNA if ≥ 1.0 cm; consider FNA if < 1.0 cm with suspicious features.

Key decision rules (EU-TIRADS)

  • Category is driven by composition and echogenicity, with a single high-risk modifier.
  • A purely cystic nodule is EU-TIRADS 1, and a spongiform nodule is EU-TIRADS 2 (no/very low risk).
  • A solid, isoechoic or hyperechoic nodule with no high-risk features is EU-TIRADS 3 (low risk).
  • A solid, mildly hypoechoic nodule with no high-risk features is EU-TIRADS 4 (intermediate risk).
  • A markedly hypoechoic nodule, or a mildly hypoechoic nodule with high-risk features, is EU-TIRADS 5 (high risk).
  • Within each category, FNA versus follow-up is decided by nodule size using the thresholds in the table above.

Disclaimer: This tool is for educational and research purposes only. It is not a medical device and has not been cleared or approved by the FDA, KFDA/MFDS, or any regulatory authority. It is not intended for clinical diagnosis or treatment decisions. It does not replace professional medical judgment. Always correlate with clinical findings and institutional protocols.

References: ACR TI-RADS — Tessler et al., JACR 2017. K-TIRADS — Ha et al., Korean J Radiol 2021;22(12):2094-2123. EU-TIRADS — Russ et al., Eur Thyroid J 2017.