Tips for improving consistency of thyroid nodule interpretation with ACR TI-RADS

Thyroid nodules are very common in the general population. Most are benign and even those that are malignant are typically slow-growing and do not require treatment. Overdiagnosis and overtreatment of thyroid nodules has resulted in significant healthcare costs. ACR TI-RADS was developed to address these concerns, and reduce the number of unnecessary biopsies and follow-up intervals. ACR TI-RADS offers a point-based risk stratification system centered on five sonographic features: consistency, echogenicity, shape, margins and echogenic foci. While the system has noticeable benefits and comparable accuracy with other available risk stratification systems (ATA, EU-TIRADS and K-TIRADS), there are inherent challenges relating to suboptimal inter-reader agreement. In this article, we include 10 educational tips that may be helpful to the ultrasound practitioner for improving the consistency of nodule interpretation with ACR TI-RADS.