Abstract
Our goal is to assess the ability of physicians to detect coronary calcifications in dual energy chest X-rays processed by a previously developed advanced algorithm. Because the chest X-ray is the most common imaging procedure, because the presence of coronary calcium provides proof of coronary artery disease, and because adherence to therapy can improve health, successful detection could positively impact healthcare for a large number of patients. Both dual energy chest and corroborative CT calcium score images were acquired. Dual energy images were processed with the advanced techniques, including sliding organ registration, so as to enhance coronary calcifications in two-shot dual energy acquisitions. We performed ROC to determine physicians’ ability to detect coronary calcifications. Since detection might be easier with heavier calcifications, we used various Agatston score cut-points for determining cases actually positive with calcification in the ROC analysis. In many cases, coronary calcifications were made more visible with the advanced processing as compared to conventional processing. At an Agatston cut-point of 300, coronary calcifications were detected with AUC = 0.85. There were marginal effects on detection performance found with increased X-ray exposure, nearby Agatston cut-point values, and coronary artery territory. Coronary calcifications can be detected in dual energy chest X-rays. The ability to detect disease compares very favorably to other accepted screening methods (e.g., X-ray mammography). As the chest X-ray is an already ordered procedure, there is an opportunity to detect a very large number of persons with coronary artery disease at zero or low cost.
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Data availability
Data are owned by the University Hospitals of Cleveland under a grant from GE Healthcare. Data are not publically available.
Code availability
CorCalDx-viz software was developed in house. It is not publically available.
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Acknowledgements
This project was supported by the Case-Coulter Translational Research Partnership (PY15-P410), by the National Heart Lung and Blood Institute under award number R01 HL143484 and by a sponsored research award from General Electric Healthcare. This research is a collaboration between Case Western Reserve University and University Hospitals of Cleveland, Cleveland Medical Center. Special thanks go out to the team at University Hospitals of Cleveland who collected the images used in this work. We thank Katelyn Nye and John Sabol of GE Healthcare for their support on this project. The veracity guarantor, Hao Wu, affirms that to the best of his knowledge that all aspects of this paper are accurate. Software described herein was developed for investigational use. It is not available for clinical usage, nor is it FDA approved.
Funding
This project was supported by the Case-Coulter Translational Research Partnership (PY15-P410) and by a sponsored research award from General Electric Healthcare.
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Song, Y., Wu, H., Wen, D. et al. Detection of coronary calcifications with dual energy chest X-rays: clinical evaluation. Int J Cardiovasc Imaging 37, 767–774 (2021). https://doi.org/10.1007/s10554-020-02072-4
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DOI: https://doi.org/10.1007/s10554-020-02072-4