<b>Dual-Energy Chest Radiography with a Flat-Panel Digital Detector:</b> Revealing Calcified Chest Abnormalities

Fischbach, Frank; Freund, Torsten; Röttgen, R; Engert, Ulrike; Félix, R.; Ricke, Jens

doi:10.2214/ajr.181.6.1811519

Cited by 71 publications

(57 citation statements)

References 18 publications

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“…Previous studies have suggested potential improvements for the detection of non-calicified as well as calcified lung nodules by cesium-iodide (CsI) detector-based dualexposure dual-energy chest radiography compared to standard chest radiography alone [3].…”

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confidence: 99%

CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

et al. 2008

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To assess both sensitivity and specificity of digital chest radiography alone and in conjunction with dual-exposure dual-energy chest radiography for the detection and classification of pulmonary nodules. One hundred patients with a total of 149 lung nodules (3-45 mm; median, 11 mm) confirmed by CT were included in this study. Dual-exposure dual-energy chest radiographies of each patient were obtained using a CsI detector system. Experienced board-certified chest radiologists from four different medical centers in Europe reviewed standard chest radiographs alone and in conjunction with dual-energy images blinded and in random order. The reviewers rated the probability of presence, calcification and malignancy of all lung nodules on a five-point rating scale. Lesions detected were identified by applying a specific coordinate system to enable precise verification by the study leader. A receiver-operating characteristic (ROC) analysis was performed. In addition to the 149 true-positive CT proven lesions, 236 false-positive lung nodules were described in digital chest radiographies in conjunction with dual-energy chest radiographies. The cumulative sensitivity of chest radiography in conjunction with dual energy was 43%, specificity was 55%. For digital radiography alone, sensitivity was 35% and specifity was 83%. For the dual energy system, positive predictive value was 58%, and negative predictive value was 66% compared to the digital radiography with a positive predictive value of 59% and a negative predictive value of 65%. Areas under the curve in a ROC analysis resulted in 0.631 (95% confidence interval =0.61 to 0.65) for radiography with dual energy and 0.602 (95% confidence interval =0.58 to 0.63) for digital radiography alone. This difference was not statistically significant. For the detection of lesion calcification or the determination of malignancy, ROC analysis also failed to show significant differences. CsI-based flat-panel dual-exposure dual-energy imaging added to standard chest radiography did not show statistically significant improvement for the detection of pulmonary nodules, nor the identification of calcifications, nor the determination of malignancy.

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Section: Introductionmentioning

confidence: 99%

CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

et al. 2008

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“…Up till now, the literature mostly has documented the better detection of calcified pulmonary nodules using the dual exposure technique or older single-shot exposure systems [6][7][8][9][10][11][12][13][14]. The latter, despite promising initial results, fell into disfavor because of their cumbersome handling and inconsistent image quality.…”

Section: Introductionmentioning

confidence: 99%

Single-exposure dual-energy subtraction chest radiography: Detection of pulmonary nodules and masses in clinical practice

et al. 2007

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The purpose of this retrospective study was to evaluate the impact of energy subtraction (ES) chest radiography on the detection of pulmonary nodules and masses in daily routine. Seventy-seven patients and 25 healthy subjects were examined with a single exposure digital radiography system. Five blinded readers evaluated first the nonsubtracted PA and lateral chest radiographs alone and then together with the subtracted PA soft tissue images. The size, location and number of lung nodules or masses were registered with the confidence level. CT was used as standard of reference. For the 200 total lesions, a sensitivity of 33.5-52.5% was found at non-subtracted and a sensitivity of 43.5-58.5% at energy-subtracted radiography, corresponding to a significant improvement in four of five readers (p<0.05). However, in three of five readers the rate of false positives was higher with ES. With ES, sensitivity, but not the area under the alternative freeresponse receiver operating characteristics (AFROC) curve, showed a good correlation with reader experience (R=0.90, p=0.026). In four of five readers, the diagnostic confidence improved with ES (p=0.0036). We conclude that single-exposure digital ES chest radiography improves detection of most pulmonary nodules and masses, but identification of nodules <1 cm and false-positive findings remain a problem.

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“…On the other hand, computer-aided detection (CAD) techniques have been developed for chest radiography, analogous to those used with chest CT, to aid in the detection of lung nodules. Studies have analyzed the diagnostic gain from bone subtraction or suppression and CAD separately [7][8][9][10][11][12][13] Z. Szucs-Farkas received fees from the Riverain Technologies Group for collecting anonymized patient data for a different reader study. That study is not related to the current investigation in any way.…”

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Comparison of Dual-Energy Subtraction and Electronic Bone Suppression Combined With Computer-Aided Detection on Chest Radiographs: Effect on Human Observers' Performance in Nodule Detection

Szücs-Farkas

Schick

Cullmann

et al. 2013

American Journal of Roentgenology

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very few series have dealt with a combination of these techniques [14,15]. The feasibility of software-only bone suppression on conventional chest radiography in combination with CAD has not been tested to date. Furthermore, of the studies in the literature, most investigators selected image collections in which each image contained only one lesion, a scenario that often does not correspond to the patient collective encountered during daily routine.The aim of the current investigation was to compare the effect of dual-energy subtraction and recently developed bone suppression software alone and in combination with CAD on the diagnostic performance of human observers in lung nodule detection. Materials and MethodsThis retrospective study was performed according to the regulations of the institutional review board and required no informed consent. C onventional chest radiography is still the most frequently performed initial imaging evaluation used worldwide to exclude pulmonary nodules because of its wide accessibility, low cost, and low radiation dose. In past decades, several technical innovations were introduced to improve the sensitivity of this modality. In addition to dual-energy subtraction radiography, other new software techniques have been shown to be capable of decreasing or completely removing the overprojection of bones, mainly of the clavicles and ribs, that significantly hampers the detection of pulmonary nodules on projection radiographs [1][2][3][4][5][6]. On the other hand, computer-aided detection (CAD) techniques have been developed for chest radiography, analogous to those used with chest CT, to aid in the detection of lung nodules. Studies have analyzed the diagnostic gain from bone subtraction or suppression and CAD separately [7][8][9][10][11][12][13] Z. Szucs-Farkas received fees from the Riverain Technologies Group for collecting anonymized patient data for a different reader study. That study is not related to the current investigation in any way. Comparison of Dual-Energy C a r d io p u lm o n a r y I m ag i ng • O r ig i n a l R e s e a rc hOBJECTIVE. The objective of our study was to compare the effect of dual-energy subtraction and bone suppression software alone and in combination with computer-aided detection (CAD) on the performance of human observers in lung nodule detection. MATERIALS AND METHODS.One hundred one patients with from one to five lung nodules measuring 5-29 mm and 42 subjects with no nodules were retrospectively selected and randomized. Three independent radiologists marked suspicious-appearing lesions on the original chest radiographs, dual-energy subtraction images, and bone-suppressed images before and after postprocessing with CAD. Marks of the observers and CAD marks were compared with CT as the reference standard. Data were analyzed using nonparametric tests and the jackknife alternative free-response receiver operating characteristic (JAFROC) method.RESULTS. Using dual-energy subtraction alone (p = 0.0198) or CAD alone (p = 0.0095) improved the detection ra...

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Dual-Energy Chest Radiography with a Flat-Panel Digital Detector: Revealing Calcified Chest Abnormalities

Abstract: Dual-energy images added to standard posteroanterior chest radiographs significantly improve the detection of calcified chest lesions.

Cited by 71 publications

References 18 publications

CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

Single-exposure dual-energy subtraction chest radiography: Detection of pulmonary nodules and masses in clinical practice

Comparison of Dual-Energy Subtraction and Electronic Bone Suppression Combined With Computer-Aided Detection on Chest Radiographs: Effect on Human Observers' Performance in Nodule Detection

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