A theoretical expression for the variance of scatterer size estimates is derived for a modified least squares size estimator used in conjunction with a reference phantom method for backscatter coefficient measurement. A Gaussian spatial autocorrelation function is assumed. Simulations and phantom experiments were performed to verify the results for backscatter and size variances. The dependence of size estimate errors upon free experimental parameters is explored. Implications of the findings for the optimization of scatterer size estimation are discussed. The utility of scatterer size parametric imaging is examined through the signal to noise ratio comparison with standard ultrasonic B-mode imaging.