TIRADS

Question 1

What are the TIRAD categories?

pneumonic: SCEEM

Answer 1

1. Shape
2. Composition
3. Echogenicity
4. Echogenic Foci
5. Margins

Question 2

TIRADS shapes?

Answer 2

1. Wider than tall
2. Taller than wide

Question 3

TIRADS composition?

Answer 3

1. Cystic or almost completely cystic
2. Spongiform
3. Mixed cystic and solid (complex)
4. Mostly or completely solid

Question 4

TIRADS echogenicity?

Answer 4

1. Anechoic
2. Hyper or isoechoic (compared to parenchyma)
3. Hypoechoic
4. Very hypoechoic (more hypoechoic than compared to surrounding strap muscles)

Question 5

TIRADS echogenic foci?

Answer 5

1. None or large comet-tail (>1mm)
2. Macrocalcifications (> or = 2mm)
3. Peripheral rim calcification
4. Punctate calcifications (<2mm or comet tail <1mm)

Question 6

TIRADS margins?

Answer 6

1. Smooth
2. Ill-defined
3. Lobulated or irregular
4. Extra thyroidal extension

Question 7

How much of the nodule should be filled with tiny cystic spaces to be considered spongiform?

Answer 7

More than 50%

Question 8

How much of the nodule should be filled with tiny cystic spaces to be considered spongiform?

Answer 8

More than 50%

Question 9

When scanning, you notice that the nodule appears spongiform but also contains macro calcs or peripheral calcs, what do you do?

Answer 9

DO NOT classify as spongiform when other suspicious criteria is present.

Question 10

What should you classify a nodule when echogenicity can’t be clearly determined?

Answer 10

Isoechoic

Question 11

When a nodule is very hypoechoic, what do other structure do we compare it to?

Answer 11

Surrounding strap muscle

Question 12

What shape of nodule is most suspicious?

Answer 12

When it is taller than it is wide

Question 13

When margins can’t be determined, what should you report?

Answer 13

ill-defined border

Question 14

If composition cannot be clearly determined, how should it be reported?

Answer 14

Solid

Question 15

When would you comment on TIRADS when a nodule is between 5-10 mm?

Answer 15

If a nodule is between 5-10mm and appears HIGHLY suspicious (TIRADS 5 level), then we would use the descriptors

Question 16

How large should a nodule be to give TIRADS descriptors?

Answer 16

Greater than 1cm

Question 17

Most common complication of FNA?

Answer 17

Bleeding or infection

Question 18

What cancers lack specificity of FNA?

Answer 18

1. Hurthle cell carcinoma
2. Lymphoma
3. Follicular cell carcinoma

Question 19

What cancers are best detected using FNA?
(hint: MAP)

Answer 19

1. Medullary
2. Anaplastic
3. Papillary