The diagnosis of pulmonary nodules: comparison between standard and inverse digitized images and conventional chest radiographs

Sheline, M E; Brikman, Inna; Epstein, DM; Mezrich, JL; Kundel, Harold L.; Arenson, RL

doi:10.2214/ajr.152.2.261

Cited by 48 publications

(43 citation statements)

References 1 publication

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“…By comparing the ability to identify pulmonary nodules on conventional plain chest radiographs, standard (bones white) digitized images and inverse-intensity (bones black) images, Sheline et al (38) found that inverse-intensity image can have some benefits in lesion recognition.…”

Section: Improving Techniquesmentioning

confidence: 99%

Missed lung cancer: when, where, and why?

Ciello

Franchi²,

Contegiacomo³

et al. 2017

Diagn Interv Radiol

141

106

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L ung cancer accounts for 1.59 million deaths per year worldwide (1). It has one of the poorest survival outcomes of all cancers, with over two-thirds of patients diagnosed at an advanced stage, when curative treatment is no longer feasible. Early diagnosis of lung cancer is the main goal to improve survival. Patients with non-small cell lung cancer (NSCLC) at an operable stage have higher survival rates than those presenting with metastatic disease, with five-year survival of 71%-77% for stage IA and 58% for stage IB (2).Initial identification of lung cancer in asymptomatic patients usually occurs on chest radiography or chest computed tomography (CT). When missed on imaging, lung cancer is inclined to progress from early-stage to advanced-stage disease, particularly if many years pass between radiologic exams (3), with potential medicolegal consequences.Legal actions involving malignancies of the bronchus or lung represent the sixth most common medicolegal issue, and among radiologists it is the second most common cause for litigation (4). About 90% of presumed mistakes in pulmonary tumor diagnosis occurred on chest radiography, only 5% on CT examinations, and the remaining 5% on other imaging studies (4).Awareness of the possible causes for overlooking a pulmonary lesion can help radiologists to reduce the occurrence of this eventuality. In this review, we analyze factors leading to a misdiagnosis of lung cancer mainly on chest radiography, and we discuss the impact of misdiagnosis on prognosis, its medicolegal implications, and methods to reduce the incidence of missed lung cancer. Finally, we briefly analyze the possible causes of errors on CT scans and potential aids. Factors leading to missed lung cancer on chest radiographyFormerly, different authors recognized the burden of missed lung cancer on radiography of the thorax. Indeed, early studies on the analysis of factors leading to overlooked lung lesions date back to the middle of last century. Despite extensive technological advancement, this issue is currently present and not much has changed since then. Factors that contribute to missed lung cancer on chest X-ray can be classified as deriving from observer error, tumor characteristics, and technical considerations. C H E S T I MAG I N G R E V I E W ABSTRACTMissed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer ...

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Section: Improving Techniquesmentioning

confidence: 99%

Missed lung cancer: when, where, and why?

Ciello

Franchi²,

Contegiacomo³

et al. 2017

Diagn Interv Radiol

141

106

View full text Add to dashboard Cite

show abstract

“…11 Conversely, inverse grayscale can make tubes 12 and soft tissue abnormalities 13 easier to detect but at the expense of the more familiar black on white x-ray pattern. 14 Furthermore, some investigators showed that masses can be better detected 15 because inverse grayscale provides a``second-look'' where the radiologist has another chance to pick up subtle tumors. Problems with excessive reading room ambient light or re¯ective glare on the monitor screen can be minimized by the inverse grayscale images.…”

Section: Discussionmentioning

confidence: 99%

Automated Hands-Free Image Manipulation and Viewing: A Useful Macro Feature that Assists Radiologists in the Viewing of Chest and Extremity Digital Radiographs

Koenker

Grover²

2002

Journal of Digital Imaging

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The authors present an adaptation of the macro recording feature on the Siemens Magic View 1000 workstation, which, with the click of one button, launches a macro that performs 3 clinically useful image manipulations. Using a Magic View 1004 Siemens unix workstation, the following Macro sequence was programmed: (1) select all images, (2) reverse grayscale, (3) edge enhancement, (4) display full-resolution all screens, (5) reverse grayscale, (6) enable zoom/pan function. This sequence of commands takes 11 seconds to complete for a 2-view chest x-ray, and 16 seconds for a 3-view hand series. A pause occurs while the CPU performs the edge enhancement algorithm; this "pause" is used to provide time for the radiologist to assess the images. The time to implement and view these manipulations is reduced dramatically with the automatic viewing macro. More importantly, because the macro takes over the workstation operation, radiologist attention can be focused totally on image assessment and interpretation. Automatic hands-free image manipulation can improve the speed and accuracy of radiologist interpretation for both chest and extremity digital radiography.

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“…[4][5][6] The use of image processing to enhance image information content is also being investigated. [7][8][9] Even if diagnostic performance with PACS displays were equal to (or better than) that achieved with film, it does not by itself guarantee that physician performance (and possibly, patient care) will be unchanged.…”

mentioning

confidence: 99%

The digital imaging workstation.

et al. 1990

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Picture archiving and communication systems (PACS) are expected to convert film-based radiology into a computer-based digital environment, with associated cost savings and improved physician communication.The digital workstation will be used by physicians to display these ''soft-copy'' images; however, difficult technical challenges must be met for the workstation to compete successfully with the familiar viewbox. Issues relating to image perception and the impact on physicians' practice must be carefully considered. The spatial and contrast resolutions required vary according to imaging modality, type of procedure, and class of user. Rule-based software allows simple physician interaction and speeds image display. A consensus appears to be emerging concerning the requirements for the PACS workstation. Standards such as the American College of Radiology/National Electrical Manufacturers' Association Digital Imaging and Communication Standard are facilitating commercial applications. Yet much careful study is needed before PACS workstations will be fully integrated into radiology departments.

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The diagnosis of pulmonary nodules: comparison between standard and inverse digitized images and conventional chest radiographs

Cited by 48 publications

References 1 publication

Missed lung cancer: when, where, and why?

Missed lung cancer: when, where, and why?

Automated Hands-Free Image Manipulation and Viewing: A Useful Macro Feature that Assists Radiologists in the Viewing of Chest and Extremity Digital Radiographs

The digital imaging workstation.

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