???Single-Exposure??? Dual Energy Digital Radiography in the Detection of Pulmonary Nodules and Calcifications

Oestmann, J W; Greene, Reginald; Jt, Rhea; Rosenthal, H.; Rm, Koenker; Cl, Tillotson; Kd, Pearsen; Hill, James W.; Rh, Velaj

doi:10.1097/00004424-198907000-00002

Cited by 25 publications

(16 citation statements)

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“…Theoretically, differences of the incidental spectra generated for high and low energies with both modalities show advantageous results for the dual-exposure technique due to wider energy separation [19]. However, some studies claim that single exposure should be superior to the dual-exposure technique, since it markedly decreases motion misregistration artifacts [21] and generates better control of scatter radiation [22], and on the other hand, the dual-exposure technique has been found by previous authors to be superior compared to the single-shot technique in terms of soft tissue and bone contrast as well as signal-to-noise ratio [19].…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…Dual-energy radiography with energy subtraction (ES) has been developed to produce soft tissue images of the chest and, thus, to eliminate or reduce the disturbing effects of the ribs and the clavicles. Though the method has been shown to improve the detection rate and diagnostic confidence for both calcified and non-calcified lung nodules, it can also increase the number of falsepositive (FP) findings in human observer studies [3][4][5][6]. Computer-aided detection (CAD) programs are increasingly used to yield a secondary opinion in reading chest radiographs in detecting and characterizing pulmonary nodules [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Improved detection of pulmonary nodules on energy-subtracted chest radiographs with a commercial computer-aided diagnosis software: comparison with human observers

et al. 2009

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Improved detection of pulmonary nodules on energy-subtracted chest radiographs with a commercial computer-aided diagnosis software: comparison with human observers Abstract Objective: To retrospectively analyze the performance of a commercial computer-aided diagnosis (CAD) software in the detection of pulmonary nodules in original and energy-subtracted (ES) chest radiographs. Methods: Original and ES chest radiographs of 58 patients with 105 pulmonary nodules measuring 5-30 mm and images of 25 control subjects with no nodules were randomized. Five blinded readers evaluated firstly the original postero-anterior images alone and then together with the subtracted radiographs. In a second phase, original and ES images were analyzed by a commercial CAD program. CT was used as reference standard. CAD results were compared to the readers' findings. True-positive (TP) and false-positive (FP) findings with CAD on subtracted and nonsubtracted images were compared. Results: Depending on the reader's experience, CAD detected between 11 and 21 nodules missed by readers. Human observers found three to 16 lesions missed by the CAD software. CAD used with ES images produced significantly fewer FPs than with nonsubtracted images: 1.75 and 2.14 FPs per image, respectively (p=0.029). The difference for the TP nodules was not significant (40 nodules on ES images and 34 lesions in nonsubtracted radiographs, p=0.142). Conclusion: CAD can improve lesion detection both on energy subtracted and non-subtracted chest images, especially for less experienced readers. The CAD program marked less FPs on energy-subtracted images than on original chest radiographs.

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“…In previous studies, DE techniques employing storage phosphor plates or phosphor/photodiode detectors have proven advantages in the detection of solitary pulmonary nodules and chest calcifications [2,4,5]. Despite these promising results, these systems have not gained wide acceptance because of inconsistent image quality or difficulties in handling or processing of the images [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Despite these promising results, these systems have not gained wide acceptance because of inconsistent image quality or difficulties in handling or processing of the images [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

Clinical results of CsI-detector-based dual-exposure dual energy in chest radiography

et al. 2003

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The aim of this study was to compare the sensitivity and specificity of digital chest radiography alone with digital chest radiography combined with dual-energy chest radiography in the detection of small non-calcified pulmonary nodules. Standard and dual-energy radiographs were obtained with a flat-panel digital chest system. Four radiologists reviewed digital posteroanterior chest radiographs in random order either alone or in conjunction with dual-energy soft tissue and bone images. Twenty patients with a total of 59 pulmonary nodules (median 0.5 cm, range 0.3-2.5 cm) confirmed by computed tomography (HU < or =100) were included. A level of confidence for each diagnosis was documented using a rating scale of 1-5. Brunner and Langer's test was performed for statistical analysis. Subgroup analysis was performed for nodules greater than 1 cm, 1-0.5 cm, and <0.5 cm. For posteroanterior chest radiography, sensitivity was 33%, positive predictive value 83%, specificity 81%, and negative predictive value 30%. Review in conjunction with dual-energy images resulted in a sensitivity of 42%, positive predictive value 88%, specificity 85%, and negative predictive value 34%. The increase of nodule detection overall as well as for different size categories was significant (p<0.05). The increase of the confidence level rating was also significant (p<0.001). Dual energy added to standard posteroanterior chest radiography significantly improves the sensitivity, specificity, and confidence in detection of small non-calcified pulmonary nodules.

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???Single-Exposure??? Dual Energy Digital Radiography in the Detection of Pulmonary Nodules and Calcifications

Cited by 25 publications

References 0 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

Improved detection of pulmonary nodules on energy-subtracted chest radiographs with a commercial computer-aided diagnosis software: comparison with human observers

Clinical results of CsI-detector-based dual-exposure dual energy in chest radiography

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