Role of digital tomosynthesis and dual energy subtraction digital radiography in detecting pulmonary nodules

Kumar, Sarvana G.; Garg, Mandeep; Khandelwal, Niranjan; Gupta, Pankaj; Gupta, Dheeraj; Aggarwal, Ashutosh N.; Bansal, Subash Chand

doi:10.1016/j.ejrad.2015.03.020

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…DTS significantly improved the radiologists' detection performance for smaller nodules compared to CCR. This finding is supported by multiple studies and can be attributed to the multidimensional observation of lesions afforded by DTS (17)(18)(19). However, the operation time in DTS is more prolonged, making it more susceptible to breathing and heart movement than CCR+deep BSI.…”

Section: Discussionsupporting

confidence: 58%

Improved detection of solitary pulmonary nodules on radiographs compared with deep bone suppression imaging

Wu¹,

Chen²,

Zeng³

et al. 2021

Quant Imaging Med Surg

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Background: The present study aimed to investigate whether deep bone suppression imaging (BSI) could increase the diagnostic performance for solitary pulmonary nodule detection compared with digital tomosynthesis (DTS), dual-energy subtraction (DES) radiography, and conventional chest radiography (CCR).Methods: A total of 256 patients (123 with a solitary pulmonary nodule, 133 with normal findings) were included in the study. The confidence score of 6 observers determined the presence or absence of pulmonary nodules in each patient. These were first analyzed using a CCR image, then with CCR plus deep BSI, then with CCR plus DES radiography, and finally with DTS images. Receiver-operating characteristic curves were used to evaluate the performance of the 6 observers in the detection of pulmonary nodules.Results: For the 6 observers, the average area under the curve improved significantly from 0.717 with CCR to 0.848 with CCR plus deep BSI (P<0.01), 0.834 with CCR plus DES radiography (P<0.01), and 0.939 with DTS (P<0.01). Comparisons between CCR and CCR plus deep BSI found that the sensitivities of the assessments by the 3 residents increased from 53.2% to 69.5% (P=0.014) for nodules located in the upper lung field, from 30.6% to 44.6% (P=0.015) for nodules that were partially/completely obscured by the bone, and from 33.2% to 45.8% (P=0.006) for nodules <10 mm. Conclusions:The deep BSI technique can significantly increase the sensitivity of radiology residents for solitary pulmonary nodules compared with CCR. Increased detection was seen mainly for smaller nodules, nodules with partial/complete obscuration, and nodules located in the upper lung field.

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Section: Discussionsupporting

confidence: 58%

Improved detection of solitary pulmonary nodules on radiographs compared with deep bone suppression imaging

Wu¹,

Chen²,

Zeng³

et al. 2021

Quant Imaging Med Surg

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“…24,25,27 Also, several studies demonstrated the effective dose of each modality for standard patient in each study protocol, [9][10][11][12]21 and we found that the radiation dose for DTS was approximately twice that for chest radiography and DTS required a much smaller radiation dose in comparison with CT.…”

Section: Discussionmentioning

confidence: 95%

“…This study included small nodules ,6 mm up to about 80% of the reference standard, whereas other studies included those up to 43-64%. 9,12,25 Regarding the eight lesion-based studies, we compared detection rates rather than sensitivity and specificity because we were able to extract only the number of true positives and the total number of nodules from all but three of them. [24][25][26] However, the inability to extract the number of true-positives, false-positives, true-negatives and false-negatives could be a significant drawback to our study, as this is essential when assessing the appropriateness of utilizing a technique for clinical use.…”

Section: Discussionmentioning

confidence: 99%

“…9,12,25 Regarding the eight lesion-based studies, we compared detection rates rather than sensitivity and specificity because we were able to extract only the number of true positives and the total number of nodules from all but three of them. [24][25][26] However, the inability to extract the number of true-positives, false-positives, true-negatives and false-negatives could be a significant drawback to our study, as this is essential when assessing the appropriateness of utilizing a technique for clinical use. In our meta-analysis, some studies which used CT as the reference standard did not suggest the truenegative number, because they demonstrated only the true-positive number of nodules detected with DTS and chest radiography among nodules detected with CT. 13,22,23 In other studies, sensitivity was estimated on a per-lesion basis, but specificity was exclusively estimated on per-patient basis.…”

Section: Discussionmentioning

confidence: 99%

“…9,11,13,[21][22][23] However, we could extract the total numbers of true positives and the total number of pulmonary nodules, which allowed us to calculate and analyze detection rates. Thus, we identified 7 studies (1017 patients) that presented per-patient results 10,12,[17][18][19][20][21] and 10 studies that presented per-lesion results (2159 lesions) 9,11,13,[21][22][23][24][25][26][27] for meta-analysis. Only one study included both per-patient-and per-lesion-based data.…”

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

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Comparison of digital tomosynthesis and chest radiography for the detection of pulmonary nodules: systematic review and meta-analysis

Kim¹,

Lee²,

Kim³

et al. 2016

The British Journal of Radiology

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Objective: To compare the diagnostic accuracy of digital tomosynthesis (DTS) with that of chest radiography for the detection of pulmonary nodules by meta-analysis. Methods: A systematic literature search was performed to identify relevant original studies from 1 January 1 1976 to 31 August 31 2016. The quality of included studies was assessed by quality assessment of diagnostic accuracy studies-2. Per-patient data were used to calculate the sensitivity and specificity and per-lesion data were used to calculate the detection rate. Summary receiveroperating characteristic curves were drawn for pulmonary nodule detection. Results: 16 studies met the inclusion criteria. 1017 patients on a per-patient basis and 2159 lesions on a per-lesion basis from 16 eligible studies were evaluated. The pooled patient-based sensitivity of DTS was 0.85 [95% confidence interval (CI) 0.83-0.88] and the specificity was 0.95 (0.93-0.96). The pooled sensitivity and specificity of chest radiography were 0.47 (0.44-0.51) and 0.37 (0.34-0.40), respectively. The per-lesion detection rate was 2.90 (95% CI 2.63-3.19). Conclusion: DTS has higher diagnostic accuracy than chest radiography for detection of pulmonary nodules. Chest radiography has low sensitivity but similar specificity, comparable with that of DTS. Advances in knowledge: DTS has higher diagnostic accuracy than chest radiography for the detection of pulmonary nodules.

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The diagnostic value of grey-scale inversion technique in chest radiography

et al. 2022

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Purpose We investigated whether the additional use of grey-scale inversion technique improves the interpretation of eight chest abnormalities, in terms of diagnostic performance and interobserver variability. Material and methods A total of 507 patients who underwent a chest computed tomography (CT) examination and a chest radiography (CXR) within 24 h were enrolled. CT was the standard of reference. Images were retrospectively reviewed for the presence of atelectasis, consolidation, interstitial abnormality, nodule, mass, pleural effusion, pneumothorax and rib fractures. Four CXR reading settings, involving 3 readers were organized: only standard; only inverted; standard followed by inverted; and inverted followed by standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, assessed with the area under the curve (AUC), and their 95% confidence interval were calculated for each reader and setting. Interobserver agreement was tested by Cohen’s K test with quadratic weights (Kw) and its 95%CI. Results CXR sensitivity % for any finding was 35.1 (95% CI: 33 to 37) for setting 1, 35.9 (95% CI: 33 to 37), for setting 2, 32.59 (95% CI: 30 to 34) for setting 3, and 35.56 (95% CI: 33 to 37) for setting 4; specificity % 93.78 (95% CI: 91 to 95), 93.92 (95% CI: 91 to 95), 94.43 (95% CI: 92 to 96), 93.86 (95% CI: 91 to 95); PPV % 56.22 (95% CI: 54.2 to 58.2), 56.49 (95% CI: 54.5 to 58.5), 57.15 (95% CI: 55 to 59), 56.75 (95% CI: 54 to 58); NPV % 85.66 (95% CI: 83 to 87), 85.74 (95% CI: 83 to 87), 85.29 (95% CI: 83 to 87), 85.73 (95% CI: 83 to 87); AUC values 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67), 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67); Kw values 0.42 (95% CI: 0.4 to 0.44), 0.40 (95% CI: 0.38 to 0.42), 0.42 (95% CI: 0.4 to 0.44), 0.41 (95% CI: 0.39 to 0.43) for settings 1, 2, 3 and 4, respectively. Conclusions No significant advantages were observed in the use of grey-scale inversion technique neither over standard display mode nor in combination at the detection of eight chest abnormalities.

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Role of digital tomosynthesis and dual energy subtraction digital radiography in detecting pulmonary nodules

Cited by 14 publications

References 25 publications

Improved detection of solitary pulmonary nodules on radiographs compared with deep bone suppression imaging

Improved detection of solitary pulmonary nodules on radiographs compared with deep bone suppression imaging

Comparison of digital tomosynthesis and chest radiography for the detection of pulmonary nodules: systematic review and meta-analysis

The diagnostic value of grey-scale inversion technique in chest radiography

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