The objective of this research was to determine the sensitivity and specificity of a commercially available computer-aided detection (CAD) system for detection of lung nodule on posterior-anterior (PA) chest radiograph in a varied patient population who are referred to computed tomographic angiogram (CTA) of the chest as a reference standard. Patients who had a PA chest radiograph with concomitant CTA of the chest were included in this retrospective study. The PA chest radiograph was analyzed by a CAD device, and results were recorded. A qualitative assessment of the CAD results was performed using a 5-point Likert scale. The CTA was then reviewed to determine if there were correlative nodules. The presence of a correlative nodule between 0.5 cm and 1.5 cm was considered a positive result. The baseline sensitivity of the system was determined to be 0.707 (95% CI=0.52-0.86), with a specificity of 0.50 (95% CI=0.38-0.76). Positive predictive value was 0.30 (95% CI=0.24-0.49), with a negative predictive value of 0.858 (95% CI=0.82-0.95), and accuracy of 0.555 (95% CI=0.40-0.66). When excluding nodules that were qualitatively determined by a thoracic radiologist to be false positives, the specificity was 0.781 (95% CI=0.764-0.839), the positive predictive value was 0.564 (95% CI=0.491-0.654), the negative predictive value was 0.829 (95% CI=0.819-0.878), and the accuracy was 0.737 (95% CI=0.721-0.801). The use of CAD for lung nodule detection on chest radiograph, when used in conjunction with an experienced radiologist, has a very good sensitivity, specificity, and accuracy.

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