Tomographic 3D Ultrasound for Thyroid Volumetry-A Comparison Between Multiplanar 2D and 3D Imaging Methods

Background: Accurate thyroid volume measurement is essential for diagnosing and monitoring thyroid disorders and for determining radioiodine therapy dosage. The ellipsoid method applied to two-dimensional B-mode ultrasound (Bmode-2D-US) is the most prevalent clinical approach, yet it is known to suffer from high observer dependence and limited accuracy. Tracked three-dimensional ultrasound (3D-US) is a promising radiation-free alternative, but direct comparisons across modalities under controlled conditions remain scarce. Methods: A custom-built anthropomorphic multi-modality phantom was constructed containing six anatomically realistic thyroid lobe samples molded from segmented MRI data, with ground truth volumes verified by the suspension method and 3D surface scanning. Volume measurements were performed by six observers of varying experience using Bmode-2D-US, electromagnetically tracked 3D-US (EM-3D-US), inertial-measurement-unit-tracked 3D-US (IMU-3D-US), and optically tracked 3D-US (Opt-3D-US), as well as computed tomography (CT) and magnetic resonance imaging (MRI). Inter- and intraobserver variability were assessed using modified Bland-Altman analysis. Results: All three 3D-US methods reduced inter- and intraobserver variability compared to Bmode-2D-US, achieving variability comparable to CT and lower than MRI. Mean accuracy was similar across 3D-US, CT, and MRI. Bmode-2D-US showed strong observer dependence, with operator experience having the most pronounced effect on this method. Among tracked methods, EM-3D-US and Opt-3D-US were least sensitive to operator movement quality, while IMU-3D-US showed somewhat higher sensitivity. Conclusions: Tracked 3D-US is a promising radiation-free alternative to conventional Bmode-2D-US for thyroid volumetry, offering improved reproducibility and accuracy across operators of varying experience in this phantom-based evaluation.