Accuracy of upper airway volume measurements using different software products: a comparative analysis

Objectives: This study aimed to evaluate the accuracy of airway volume measurements obtained from cone beam computed tomography (CBCT) images using various software programmes, with a focus on assessing the performance of NemoStudio compared to other tools. The estimated volumes were compared with the volume of the solid model's cavity filled with water (gold standard). Methods: A single 3D-printed airway model was created based on CBCT data and scanned 10 times under identical conditions. Volume measurements were performed using semi-automatic segmentation in 4 software programmes (NemoStudio, NNT Viewer, ITK-SNAP, and 3D Slicer). The results were compared to the gold standard using repeated measures analysis of variance, Bland-Altman plots, and post hoc comparisons. Results: Nemo Studio demonstrated a systematic bias and higher variability compared to the gold standard, resulting in lower accuracy than the other software programmes. ITK-SNAP and 3D Slicer showed the highest agreement with the gold standard, while NNT Viewer also exhibited acceptable performance. Statistical analyses revealed significant differences in the accuracy of volume measurements among the software tools (P < .001). Bland-Altman plots highlighted Nemo Studio's broader limits of agreement, emphasizing its deviation from the gold standard. Conclusion: Variability in airway volume measurement accuracy underscores the need for careful software selection and methodological standardization. Further refinement of segmentation algorithms is essential for improved consistency and reliability in clinical applications. Advances in knowledge This study provides the first evaluation of NemoStudio's volumetric accuracy for CBCT-based airway measurements, offering novel insights into software reliability and the impact of algorithm selection in clinical and academic settings.