Pulmonary Nodule Size Evaluation with Chest Tomosynthesis

Johnsson, Åse A.; Fagman, Erika; Vikgren, Jenny; Fisichella, Valeria A.; Boijsen, Marianne; Flinck, Agneta; Kheddache, Susanne; Svalkvist, Angelica; Båth, Magnus

doi:10.1148/radiol.12111459

Cited by 34 publications

(24 citation statements)

References 20 publications

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“…9 Several TOMO phantom studies have reported limited underestimation of the actual size, whereas studies using CT have found underestimated or overestimated nodule sizes. 7,10,11 In the present study, both modalities underestimated the diameters of phantom nodules. TOMO appeared to slightly underestimate the nodule size (mean measurement error, 20.84 mm); however, such an error is clinically relevant because nodule management is based on an absolute nodule size threshold.…”

Section: Discussionsupporting

confidence: 51%

“…Recently, underestimation of nodule size associated with manual measurement of clinical nodules on TOMO has been reported. 7 Svahn et al 16 found that the extent of in-plane artefacts varied linearly with the spherical diameter and relative contrast of Regarding repeatability, the interobserver 95% LOA for measuring TOMO diameters by the pair of radiologists who recorded the most similar results was 20.06 to 0.83 mm, the values were similar to the CT data. These values were slightly less than the variation of 21.3 to 1.5 mm in the measurement of clinical nodules reported by Johnsson et al 7 in 2012.…”

Section: Discussionmentioning

confidence: 62%

“…7 In the cited study, clinical nodules that were considered adequately segmented were investigated. However, missed nodules on simple radiography are usually at the apices, lung bases or in central locations adjacent to vessels.…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary nodule size evaluation with chest tomosynthesis and CT: a phantom study

Shim

Oh²,

Kong³

et al. 2015

BJR

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Solitary lung nodule detection has increased owing to the widespread use of CT imaging. Nevertheless, the most commonly used routine examination for lung nodules continues to be chest radiography, because it uses low radiation doses, is economical and is easy to use. Because chest radiographic images are two-dimensional projections of three-dimensional structures, early lung cancer detection on chest radiographs is often challenging. The projection of pulmonary vessels, bones and part of the mediastinum on lung fields often partially or completely obscures the pulmonary nodules, resulting in failure by the radiologist to detect lung nodules.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 62%

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Pulmonary nodule size evaluation with chest tomosynthesis and CT: a phantom study

Shim

Oh²,

Kong³

et al. 2015

BJR

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“…follow-up of pulmonary nodules. [22][23][24] Finally, owing to the very low dose of DTS, it has been suggested as a suitable technique for lung cancer screening. 25 Three DTS systems for chest tomosynthesis currently exist.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a new system for chest tomosynthesis: aspects of image quality of different protocols determined using an anthropomorphic phantom

Jadidi

Sundín

Aspelin

et al. 2015

BJR

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Cite this article as: Jadidi M, Sundin A, Aspelin P, Båth M, Nyrén S. Evaluation of a new system for chest tomosynthesis: aspects of image quality of different protocols determined using an anthropomorphic phantom. Objective: To compare the image quality obtained with the different protocols in a new chest digital tomosynthesis (DTS) system. Methods: A chest phantom was imaged with chest X-ray equipment with DTS. 10 protocols were used, and for each protocol, nine acquisitions were performed. Four observers visually rated the quality of the reconstructed section images according to pre-defined quality criteria in four different classes. The data were analysed with visual grading characteristics (VGC) analysis, using the vendorrecommended protocol [12-s acquisition time, source-toimage distance (SID) 180 cm] as reference, and the area under the VGC curve (AUC VGC ) was determined for each protocol and class of criteria.Results: Protocols with a smaller swing angle resulted in a lower image quality for the classes of criteria "disturbance" and "homogeneity in nodule" but a higher image quality for the class "structure". The class "demarcation" showed little dependency on the swing angle. All protocols but one (6.3 s, SID 130 cm) obtained an AUC VGC significantly ,0.5 (indicating lower quality than reference) for at least one class of criteria. Conclusion:The study indicates that the DTS protocol with 6.3 s yields image quality similar to that obtained with the vendor-recommended protocol (12 s) but with the clinically important advantage for patients with respiratory impairment of a shorter acquisition time. Advances in knowledge:The study demonstrates that the image quality may be strongly affected by the choice of protocol and that the vendor-recommended protocol may not be optimal.

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“…igital tomosynthesis has been applied to a variety of applications, including breast imaging (1-3), orthopedic imaging (4-8), urologic imaging (9), and chest imaging (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Digital chest tomosynthesis has been available and cleared by the U.S. Food and Drug Administration since 2006.…”

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confidence: 99%

Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules

Dobbins

McAdams

Sabol³

et al. 2017

Radiology

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Purpose:To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods:In this binational, institutional review board-approved, HIPAAcompliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, .4 mm to 6 mm, .6 mm to 8 mm, and .8 mm to 20 mm). Results:Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P , .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P , .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P , .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional chest radiography or tomosynthesis. Conclusion:Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise.Online supplemental material is available for this article. Imaging data were collected from subjects at four tertiary care sitesthree in the United States and one in Sweden. The study (ClinicalTrials.gov no. NCT00963651) was approved by the institutional review board of each institution, and informed consent was obtained from each subject prior to enrollment. The study was compliant with the Health Insurance Portability and Accountability Act. Subjects enrolled were referred for, or had recently undergone,...

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Pulmonary Nodule Size Evaluation with Chest Tomosynthesis

Cited by 34 publications

References 20 publications

Pulmonary nodule size evaluation with chest tomosynthesis and CT: a phantom study

Pulmonary nodule size evaluation with chest tomosynthesis and CT: a phantom study

Evaluation of a new system for chest tomosynthesis: aspects of image quality of different protocols determined using an anthropomorphic phantom

Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules

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