Comparison of Radiologist and CAD Performance in the Detection of CT-confirmed Subtle Pulmonary Nodules on Digital Chest Radiographs

Bley, Thorsten Alexander; Baumann, Tobias; Saueressig, Ulrich; Pache, Gregor; Treier, Markus; Schaefer, Oliver; Neitzel, Ulrich; Langer, Mathias; Kotter, Elmar

doi:10.1097/rli.0b013e318168f705

Cited by 28 publications

(13 citation statements)

References 20 publications

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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.…”

Section: Methodsmentioning

confidence: 99%

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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Section: Methodsmentioning

confidence: 99%

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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“…Several authors have suggested that computer-aided detection (CAD) may help radiologists to detect pulmonary nodules. However, high numbers of false-positives identified by early versions of CAD software on standard posteroanterior (PA) chest images limited the clinical utility of this technology [1][2][3]. Meziane et al [4] indicated that CAD software improved recall rates and diagnostic accuracy particularly in cases with small pulmonary nodules and inexperienced readers.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Computer-Aided Detection (CAD) Effectiveness in Pulmonary Nodule Identification Using Different Methods of Bone Suppression in Chest Radiographs

Novak

Gilkeson

et al. 2013

J Digit Imaging

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This study aimed to compare the diagnostic effectiveness of computer-aided detection (CAD) software (OnGuard™ 5.2) in combination with hardware-based bone suppression (dual-energy subtraction radiography (DESR)), software-based bone suppression (SoftView™, version 2.4), and standard posteroanterior images with no bone suppression. A retrospective pilot study compared the diagnostic performance of two commercially available methods of bone suppression when used with commercially available CAD software. Chest images from 27 patients with computed tomography (CT) and pathology-proven malignant pulmonary nodules (8-34 mm) and 25 CT-negative patient controls were used for analysis. The Friedman, McNemar, and chi-square tests were used to compare diagnostic performance and the kappa statistic was used to evaluate method agreement. The average number of regions of interest and false-positives per image identified by CAD were not found to be significantly different regardless of the bone suppression methods evaluated. Similarly, the sensitivity, specificity, and test efficiency were not found to be significantly different. Agreement between the methods was between poor and excellent. The accuracy of CAD (OnGuard™, version 5.2) is not statistically different with either DESR or SoftView™ (version 2.4) bone suppression technology in digital chest images for pulmonary nodule identification. Low values for sensitivity (<80 %) and specificity (<50 %) may limit their utility for clinical radiology.

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“…With this CAD technique, similar to reports on chest CT (5-7), several studies generally indicate that CAD can indeed improve the detection rate of subtle lung nodules on chest radiograph (8-15). However, these studies evaluated the performance of a CAD system only (10, 12), reported the results of observer performance test only with sensitivities (6, 7, 11), or conventional receiver operating characteristic analysis that does not require the localization of nodules (5, 8). Most recently, de Hoop et al (16) reported that CAD did not significantly improve observer performance in nodule detection on chest radiograph mainly because readers had difficulty in differentiating TP from FP CAD markings.…”

Section: Introductionmentioning

confidence: 99%

Computer-Aided Detection of Malignant Lung Nodules on Chest Radiographs: Effect on Observers' Performance

et al. 2012

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ObjectiveTo evaluate the effect of computer-aided detection (CAD) system on observer performance in the detection of malignant lung nodules on chest radiograph.Materials and MethodsTwo hundred chest radiographs (100 normal and 100 abnormal with malignant solitary lung nodules) were evaluated. With CT and histological confirmation serving as a reference, the mean nodule size was 15.4 mm (range, 7-20 mm). Five chest radiologists and five radiology residents independently interpreted both the original radiographs and CAD output images using the sequential testing method. The performances of the observers for the detection of malignant nodules with and without CAD were compared using the jackknife free-response receiver operating characteristic analysis.ResultsFifty-nine nodules were detected by the CAD system with a false positive rate of 1.9 nodules per case. The detection of malignant lung nodules significantly increased from 0.90 to 0.92 for a group of observers, excluding one first-year resident (p = 0.04). When lowering the confidence score was not allowed, the average figure of merit also increased from 0.90 to 0.91 (p = 0.04) for all observers after a CAD review. On average, the sensitivities with and without CAD were 87% and 84%, respectively; the false positive rates per case with and without CAD were 0.19 and 0.17, respectively. The number of additional malignancies detected following true positive CAD marks ranged from zero to seven for the various observers.ConclusionThe CAD system may help improve observer performance in detecting malignant lung nodules on chest radiographs and contribute to a decrease in missed lung cancer.

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Comparison of Radiologist and CAD Performance in the Detection of CT-confirmed Subtle Pulmonary Nodules on Digital Chest Radiographs

Abstract: The CAD system's diagnostic sensitivity in detecting pulmonary nodules of 5 to 15 mm of size was superior to the 1 of radiologists. The CAD system may be used for assisting the radiologist in the detection of lung nodules on digital chest radiographs.

Cited by 28 publications

References 20 publications

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

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

A Comparison of Computer-Aided Detection (CAD) Effectiveness in Pulmonary Nodule Identification Using Different Methods of Bone Suppression in Chest Radiographs

Computer-Aided Detection of Malignant Lung Nodules on Chest Radiographs: Effect on Observers' Performance

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