We present a method to generate synthetic thorax radiographs with realistic nodules from CT scans, and a perfect ground truth knowledge. We evaluated the detection performance of nine radiologists and two convolutional neural networks in a reader study. Nodules were artificially inserted into the lung of a CT volume and synthetic radiographs were obtained by forward-projecting the volume. Hence, our framework allowed for a detailed evaluation of CAD systems’ and radiologists’ performance due to the availability of accurate ground-truth labels for nodules from synthetic data. Radiographs for network training (U-Net and RetinaNet) were generated from 855 CT scans of a public dataset. For the reader study, 201 radiographs were generated from 21 nodule-free CT scans with altering nodule positions, sizes and nodule counts of inserted nodules. Average true positive detections by nine radiologists were 248.8 nodules, 51.7 false positive predicted nodules and 121.2 false negative predicted nodules. The best performing CAD system achieved 268 true positives, 66 false positives and 102 false negatives. Corresponding weighted alternative free response operating characteristic figure-of-merits (wAFROC FOM) for the radiologists range from 0.54 to 0.87 compared to a value of 0.81 (CI 0.75–0.87) for the best performing CNN. The CNN did not perform significantly better against the combined average of the 9 readers (p = 0.49). Paramediastinal nodules accounted for most false positive and false negative detections by readers, which can be explained by the presence of more tissue in this area.

Estimating the lung depth on x-ray images could provide both an accurate opportunistic lung volume estimation during clinical routine and improve image contrast in modern structural chest imaging techniques like x-ray dark-field imaging. We present a method based on a convolutional neural network that allows a per-pixel lung thickness estimation and subsequent total lung capacity estimation. The network was trained and validated using 5250 simulated radiographs generated from 525 real CT scans. Furthermore, we are able to infer the model trained with simulation data on real radiographs.For 35 patients, quantitative and qualitative evaluation was performed on standard clinical radiographs. The ground-truth for each patient's total lung volume was defined based on the patients' corresponding CT scan. The mean-absolute error between the estimated lung volume on the 35 real radiographs and groundtruth volume was 0.73 liter. Additionaly, we predicted the lung thicknesses on a synthetic dataset of 131 radiographs, where the mean-absolute error was 0.27 liter. The results show, that it is possible to transfer the knowledge obtained in a simulation model to real x-ray images.

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