An Approach for Thyroid Nodule Analysis Using Thermographic Images
Authors: J. R. González, É. O. Rodrigues, C. P. Damião, C. A. P. Fontes, A. C. Silva, A. C. Paiva, H. Li, C. Du, +1 more
Organizations: Computer Science Department, Universidade Federal Fluminense, Av. Milton Tavares de Souzas, s/n—Boa Viagem, Niterói, RJ 24210-330, Brazil · Radiology Department, Hospital Universitário Antônio Pedro (HUAP), Av. Marquês do Paraná, 303, Niterói, RJ, Brazil · Applied Computation Group NCA-UFMA, Universidade Federal do Maranhão, Av. dos Portugueses, São Luís, 1966, MA, Brazil · School of Mathematical Sciences, Shandong Normal University, 88 East Wenhua Road, Jinan, Shandong 250014, People’s Republic of China · School of Mathematical Sciences, University of Jinan, 336 West Road of Nan Xinzhuang, Jinan, Shandong 250022, People’s Republic of China
Thyroid cancer is said to be the second most common type of cancer in female individuals and the third in males by 2030, according to projections. In general, detecting cancer in its early stages improves the chance of survival of the individual. Thermography is a diagnostic tool that has been increasingly used to detect cancer and abnormalities, including that of thyroid. Various methods to segment and detect hot regions in thermograms and, consequently, to detect suspicious tissues present in these images have been proposed. It is well known that medical diagnosis yields a great deal of information. Thus, physicians have to comprehensively analyse and evaluate this information in a short period of time, which is infeasible in most cases. In this work, we perform a general review of thermography , focusing on the thyroid analysis. We propose protocols for image acquisiton and an autonomous registration for thyroid images. We also perform analyses of the image data, which include feature extraction, image processing, and a possible approach for classification of healthy or unhealthy patients. In summary, this work presents a pilot project for detection of tumors in our university hospital, which is part of an effort to support preventive medical actions in our endocrinology department. Under some future adjustments, this project will be submitted for approval by the ethics and research committee of Hospital Universitário Antonio Pedro at Universidade Federal Fluminense (HUAP-UFF) and to the Brazilian Ministry of Health Ethical committee under the name: Evaluation of the importance of thermography to aid diagnosis of thyroid nodules of patients in HUAP-UFF (in Portuguese: Avaliação da importância da termografia no auxílio à investigação diagnóstica de nódulos tireoidianos em pacientes acompanhados no HUAP-UFF).
Thyroid ultrasound diagnosis requires coordinated lesion localization, measurement, risk stratification and reporting, yet most AI systems address these tasks in isolation and provide limited support for clinical review. We present ThyroidXAgent, a clinician-interactive agentic AI system that coordinates specialized diagnostic tools and stores their outputs as an auditable case-level evidence record. The system was developed using OpenThyroidDB, a multicentre, multitask resource integrating approximately 0.3 million ultrasound images and 24,000 paired reports, and was evaluated on 28,458 non-overlapping test cases, including 8,721 cases from 35 centres in the private NHC-MISD-TUS cohort. Across heterogeneous datasets, ThyroidXAgent achieved a mean Dice score of 87.21 percent for nodule segmentation and a mean AUROC of 0.9466 for benign-malignant classification. The same workflow supported lymph-node metastasis prediction and follicular versus papillary thyroid carcinoma classification, with AUROCs of 0.864 and 0.805, respectively. For report generation, evidence-grounded assembly outperformed multimodal language-model baselines across three cohorts. ThyClinScore, a lesion-level clinical semantic metric introduced here, showed the strongest correlation with a location-aware language-model judge. ThyroidXAgent improved physician classification accuracy, increased report diagnostic consistency from 70.3 percent to 86.2 percent, and reduced segmentation and reporting time by 35.9 percent and 27.4 percent, respectively. These findings support auditable, clinician-correctable agentic AI for thyroid ultrasound diagnosis and reporting.
Background: Deep learning models can classify thyroid nodules on ultrasound, but reliable clinical decision support also requires calibrated probabilities, uncertainty estimation, and selective referral, particularly under dataset shift. Methods: We developed a calibrated deterministic five-member deep ensemble for ROI-based thyroid nodule classification and selective image-based triage. TN5000 was used for model development, five-fold cross-validation, member-wise vector-scaling calibration, and fold-specific threshold selection. TN3K served as an independent external dataset-shift evaluation. The framework used ConvNeXt-Tiny with squeeze-and-excitation attention, ensemble-mean malignancy probability, and mutual information (MI) as an ensemble-disagreement score. A three-tier policy assigned images to No-FNA suggestion, FNA recommendation, or radiologist review. Results: On pooled out-of-fold TN5000 predictions, the ensemble achieved AUC-ROC 0.9395, AP 0.9715, ECE 0.0088, and Brier score 0.0813. At 50% nominal MI retention, 7.2% of cases received a No-FNA suggestion, 39.9% an FNA recommendation, and 52.9% radiologist review, with 98.3% No-FNA NPV and 99.83% malignancy capture. On TN3K, AUC-ROC decreased to 0.7870, AP to 0.7254, ECE increased to 0.1899, and Brier score to 0.2281. The frozen TN5000 policy assigned 83.7% to review, 1.0% to No-FNA, and 15.3% to FNA recommendation. No malignant image entered the No-FNA pathway, but FNA-recommendation PPV fell to 76.6%. Conclusion: The framework showed strong internal discrimination and calibration, but limited external threshold transportability. Selective prediction may help identify images unsuitable for automated triage, but local recalibration, threshold validation, and prospective clinical evaluation are required before deployment.
Deep learning (DL) methods dominate thyroid nodule segmentation in ultrasound (US) images, achieving high Dice scores but at the cost of millions of parameters, GPU-dependent training via backpropagation, and limited mathematical tractability. These limitations impede deployment in resource-constrained environments. In this paper, we propose MedSaab-US, a backpropagation-free segmentation framework grounded in the Green Learning paradigm. MedSaab-US extracts multi-scale spatial-frequency features by combining multi-level Discrete Wavelet Transform (DWT) with multi-scale channel-wise Saab (Subspace Approximation with Adjusted Bias) transforms at patch sizes of 5 x 5, 11 x 11, and 21 x 21 pixels. Label-Assisted Greedy (LAG) feature selection retains the most discriminative features, which are fed to an XGBoost classifier for pixel-wise prediction. The Saab transform parameters are determined analytically from data statistics, while XGBoost employs iterative greedy tree construction without requiring backpropagation. Evaluated on the TN3K dataset (2,879 training and 614 test images), MedSaab-US achieves a mean Dice coefficient of 0.4784 +/- 0.2190, precision of 0.5768, and recall of 0.5604, with a model footprint under 500K parameters and CPU-only inference in approximately 0.3 seconds per image. We present this result as an exploratory non-DL baseline for thyroid ultrasound segmentation and analyze the specific challenges posed by isoechoic nodules. An ablation study further quantifies the contribution of each pipeline component, including separate evaluations of LAG feature selection and training-set size.