The Value of Digital Tomosynthesis in the Diagnosis of Suspected Pulmonary Lesions on Chest Radiography

Quaia, Emilio; Baratella, Elisa; Cioffi, Vincenzo; Bregant, P.; Cernic, Stefano; Cuttin, R.; Cova, Maria Assunta

doi:10.1016/j.acra.2010.05.009

Cited by 47 publications

(42 citation statements)

References 21 publications

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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%

“…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%

“…All but four studies included an intervention group (pulmonary nodule) and a control group (no pulmonary nodule), and there were four studies that included patients with equivocal or abnormal findings, such as opacity or nodule, on chest radiography. 18,19,24,26 Quality assessment Table 2 outlines the quality assessment of all studies included in the meta-analysis. In all studies but two studies, 17,23 index test was defined as a low risk of bias.…”

Section: Study Characteristics and Patient Populationsmentioning

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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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

See 2 more Smart Citations

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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“…2, 3 Preliminary investigations into the use of tomosynthesis for chest imaging suggest that tomosynthesis is significantly superior to conventional radiographic imaging for the detection of both pulmonary nodules [4][5][6][7][8] and pulmonary mycobacterial lesions. 9 Anatomic detail in conventional backprojection (shift-andadd) tomosynthesis is obscured by tomographic blur from structures located outside the plane of interest.…”

Section: Introductionmentioning

confidence: 99%

The effect of averaging adjacent planes for artifact reduction in matrix inversion tomosynthesis

2013

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Purpose: Matrix inversion tomosynthesis (MITS) uses linear systems theory and knowledge of the imaging geometry to remove tomographic blur that is present in conventional backprojection tomosynthesis reconstructions, leaving in-plane detail rendered clearly. The use of partial-pixel interpolation during the backprojection process introduces imprecision in the MITS modeling of tomographic blur, and creates low-contrast artifacts in some MITS planes. This paper examines the use of MITS slabs, created by averaging several adjacent MITS planes, as a method for suppressing partialpixel artifacts. Methods: Human chest tomosynthesis projection data, acquired as part of an IRB-approved pilot study, were used to generate MITS planes, three-plane MITS slabs (MITSa3), five-plane MITS slabs (MITSa5), and seven-plane MITS slabs (MITSa7). These were qualitatively examined for partialpixel artifacts and the visibility of normal and abnormal anatomy. Additionally, small (5 mm) subtle pulmonary nodules were simulated and digitally superimposed upon human chest tomosynthesis projection images, and their visibility was qualitatively assessed in the different reconstruction techniques. Simulated images of a thin wire were used to generate modulation transfer function (MTF) and slice-sensitivity profile curves for the different MITS and MITS slab techniques, and these were examined for indications of partial-pixel artifacts and frequency response uniformity. Finally, meansubtracted, exposure-normalized noise power spectra (ENNPS) estimates were computed and compared for MITS and MITS slab reconstructions, generated from 10 sets of tomosynthesis projection data of an acrylic slab. The simulated in-plane MTF response of each technique was also combined with the square root of the ENNPS estimate to yield stochastic signal-to-noise ratio (SNR) information about the different reconstruction techniques. Results: For scan angles of 20• and 5 mm plane separation, seven MITS planes must be averaged to sufficiently remove partial-pixel artifacts. MITSa7 does appear to subtly reduce the contrast of highfrequency "edge" information, but the removal of partial-pixel artifacts makes the appearance of low-contrast, fine-detail anatomy even more conspicuous in MITSa7 slices. MITSa7 also appears to render simulated subtle 5 mm pulmonary nodules with greater visibility than MITS alone, in both the open lung and regions overlying the mediastinum. Finally, the MITSa7 technique reduces stochastic image variance, though the in-plane stochastic SNR (for very thin objects which do not span multiple MITS planes) is only improved at spatial frequencies between 0.05 and 0.20 cycles/mm. Conclusions: The MITSa7 method is an improvement over traditional single-plane MITS for thoracic imaging and the pulmonary nodule detection task, and thus the authors plan to use the MITSa7 approach for all future MITS research at the authors' institution.

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Second generation stationary chest tomosynthesis with faster scan time and wider angular span

Billingsley,

Inscoe,

et al. 2024

Medical Physics

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BackgroundDigital tomosynthesis has shown potential for increasing specificity and sensitivity compared to radiography for low‐dose chest imaging. Prior investigation of the s‐DCT system indicated potential, but additional iteration with improved scan speed, power, and angular span was necessary for translation.PurposeThe study aims to demonstrate and characterize a second‐generation stationary digital chest tomosynthesis (s‐DCT) scanner with increased x‐ray energy, tube current, and larger angular span.MethodsThe second‐generation s‐DCT system employed a meter‐long linear carbon nanotube (CNT) source array integrated with a digital detector and patient imaging table. Tube output, focal spot size, modulation transfer function (MTF), artifact spread function (ASF), and imaging performance were evaluated. A lung phantom with simulated nodules was imaged for clinical task‐based demonstration.ResultsThe scanner achieved a 6 s scan time, significantly improved from the prior generation's 16 s. The x‐ray tube exhibited good current stability, with 20.4 ± 0.6 mA tube current and focal spot size aligned with specifications (IEC 0.8). The MTF confirmed enhanced spatial resolution of 2.4 lp/mm, comparable to commercial chest tomosynthesis systems. The ASF indicated improved depth resolution (5.2 mm, previously 9.5 mm). Phantom imaging showcased visualization of both high and low‐attenuation lung nodules.ConclusionThe second‐generation s‐DCT system exhibited improved performance in terms of tube power, scan time, and image quality. Enhanced in‐plane and depth resolution, along with faster imaging, suggest potential clinical benefits for improved diagnoses. Further clinical validation is warranted to ascertain the system's clinical utility.

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The Value of Digital Tomosynthesis in the Diagnosis of Suspected Pulmonary Lesions on Chest Radiography

Cited by 47 publications

References 21 publications

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

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

The effect of averaging adjacent planes for artifact reduction in matrix inversion tomosynthesis

Second generation stationary chest tomosynthesis with faster scan time and wider angular span

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