European Radiology

, Volume 18, Issue 1, pp 24–31 | Cite as

Single-exposure dual-energy subtraction chest radiography: Detection of pulmonary nodules and masses in clinical practice

  • Zsolt Szucs-Farkas
  • Michael A. Patak
  • Seyran Yuksel-Hatz
  • Thomas Ruder
  • Peter Vock
Chest
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Abstract

The purpose of this retrospective study was to evaluate the impact of energy subtraction (ES) chest radiography on the detection of pulmonary nodules and masses in daily routine. Seventy-seven patients and 25 healthy subjects were examined with a single exposure digital radiography system. Five blinded readers evaluated first the non-subtracted PA and lateral chest radiographs alone and then together with the subtracted PA soft tissue images. The size, location and number of lung nodules or masses were registered with the confidence level. CT was used as standard of reference. For the 200 total lesions, a sensitivity of 33.5–52.5% was found at non-subtracted and a sensitivity of 43.5–58.5% at energy-subtracted radiography, corresponding to a significant improvement in four of five readers (p < 0.05). However, in three of five readers the rate of false positives was higher with ES. With ES, sensitivity, but not the area under the alternative free-response receiver operating characteristics (AFROC) curve, showed a good correlation with reader experience (R = 0.90, p = 0.026). In four of five readers, the diagnostic confidence improved with ES (p = 0.0036). We conclude that single-exposure digital ES chest radiography improves detection of most pulmonary nodules and masses, but identification of nodules <1 cm and false-positive findings remain a problem.

Keywords

Dual-energy scanned projection radiography Pulmonary coin lesion Pulmonary neoplasms 
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References

  1. 1.
    McAdams HP, Samei E, Dobbins J, 3rd, Tourassi GD, Ravin CE (2006) Recent advances in chest radiography. Radiology 241:663–683PubMedCrossRefGoogle Scholar
  2. 2.
    Stewart BK, Huang HK (1990) Single-exposure dual-energy computed radiography. Medical Physics 17:866–875PubMedCrossRefGoogle Scholar
  3. 3.
    Samei E, Flynn MJ (2002) An experimental comparison of detector performance for computed radiography systems. Medical physics 29:447–459PubMedCrossRefGoogle Scholar
  4. 4.
    Fischbach F, Freund T, Pech M, Werk M, Bassir C, Stoever B, Felix R, Ricke J (2003) Comparison of indirect CsI/a:Si and direct a:Se digital radiography. An assessment of contrast and detail visualization. Acta Radiol 44:616–621PubMedCrossRefGoogle Scholar
  5. 5.
    Gruber M, Uffmann M, Weber M, Prokop M, Balassy C, Schaefer-Prokop C (2006) Direct detector radiography versus dual reading computed radiography: feasibility of dose reduction in chest radiography. European Radiology 16:1544–1550PubMedCrossRefGoogle Scholar
  6. 6.
    Fraser RG, Hickey NM, Niklason LT, Sabbagh EA, Luna RF, Alexander CB, Robinson CA, Katzenstein AL, Barnes GT (1986) Calcification in pulmonary nodules: detection with dual-energy digital radiography. Radiology 160:595–601PubMedGoogle Scholar
  7. 7.
    Ho JT, Kruger RA (1989) Comparison of dual-energy and conventional chest radiography for nodule detection. Investigative Radiology 24:861–868PubMedCrossRefGoogle Scholar
  8. 8.
    Oestmann JW, Greene R, Rhea JT, Rosenthal H, Koenker RM, Tillotson CL, Pearsen KD, Hill JW, Velaj RH (1989) “Single-exposure” dual energy digital radiography in the detection of pulmonary nodules and calcifications. Investigative Radiology 24:517–521PubMedCrossRefGoogle Scholar
  9. 9.
    Samei E, Flynn MJ, Eyler WR (1997) Simulation of subtle lung nodules in projection chest radiography. Radiology 202:117–124PubMedGoogle Scholar
  10. 10.
    Kido S, Kuriyama K, Kuroda C, Nakamura H, Ito W, Shimura K, Kato H (2002) Detection of simulated pulmonary nodules by single-exposure dual-energy computed radiography of the chest: effect of a computer-aided diagnosis system (Part 2). European Journal of Radiology 44:205–209PubMedCrossRefGoogle Scholar
  11. 11.
    Ricke J, Fischbach F, Freund T, Teichgraber U, Hanninen EL, Rottgen R, Engert U, Eichstadt H, Felix R (2003) Clinical results of CsI-detector-based dual-exposure dual energy in chest radiography. Eur Radiol 13:2577–2582PubMedCrossRefGoogle Scholar
  12. 12.
    Uemura M, Miyagawa M, Yasuhara Y, Murakami T, Ikura H, Sakamoto K, Tagashira H, Arakawa K, Mochizuki T (2005) Clinical evaluation of pulmonary nodules with dual-exposure dual-energy subtraction chest radiography. Radiation Medicine 23:391–397PubMedGoogle Scholar
  13. 13.
    Kido S, Ikezoe J, Naito H, Arisawa J, Tamura S, Kozuka T, Ito W, Shimura K, Kato H (1995) Clinical evaluation of pulmonary nodules with single-exposure dual-energy subtraction chest radiography with an iterative noise-reduction algorithm. Radiology 194:407–412PubMedGoogle Scholar
  14. 14.
    Fischbach F, Freund T, Rottgen R, Engert U, Felix R, Ricke J (2003) Dual-energy chest radiography with a flat-panel digital detector: revealing calcified chest abnormalities. AJR 181:1519–1524PubMedGoogle Scholar
  15. 15.
    Fetterly KA, Schueler BA (2006) Performance evaluation of a computed radiography imaging device using a typical “front side” and novel “dual side” readout storage phosphors. Medical Physics 33:290–296PubMedCrossRefGoogle Scholar
  16. 16.
    Monnin P, Holzer Z, Wolf R, Neitzel U, Vock P, Gudinchet F, Verdun FR (2006) An image quality comparison of standard and dual-side read CR systems for pediatric radiology. Medical Physics 33:411–420PubMedCrossRefGoogle Scholar
  17. 17.
    Monnin P, Holzer Z, Wolf R, Neitzel U, Vock P, Gudinchet F, Verdun FR (2006) Influence of cassette type on the DQE of CR systems. Medical Physics 33:3637–3639PubMedCrossRefGoogle Scholar
  18. 18.
    Eng J ROC analysis: web-based calculator for ROC curves http://www.jrocfit.org. Last updated:2006 May 17
  19. 19.
    Chakraborty DP, Winter LH (1990) Free-response methodology: alternate analysis and a new observer-performance experiment. Radiology 174:873–881PubMedGoogle Scholar
  20. 20.
    Samei E, Flynn MJ, Eyler WR (1999) Detection of subtle lung nodules: relative influence of quantum and anatomic noise on chest radiographs. Radiology 213:727–734PubMedGoogle Scholar
  21. 21.
    Samei E, Flynn MJ, Peterson E, Eyler WR (2003) Subtle lung nodules: influence of local anatomic variations on detection. Radiology 228:76–84PubMedCrossRefGoogle Scholar
  22. 22.
    Henschke CI, Yankelevitz DF, Naidich DP, McCauley DI, McGuinness G, Libby DM, Smith JP, Pasmantier MW, Miettinen OS (2004) CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans. Radiology 231:164–168PubMedCrossRefGoogle Scholar
  23. 23.
    Aberle RD, Gamsu G, Henschke CI, Naidich DP, Swensen SJ (2001) Screening for Lung Cancer with Helical Computed Tomography: A Consensus Statement of the Society of Thoracic Radiology. J Thorac Imaging 16:65–68PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2007

Authors and Affiliations

  • Zsolt Szucs-Farkas
    • 1
  • Michael A. Patak
    • 1
  • Seyran Yuksel-Hatz
    • 1
  • Thomas Ruder
    • 1
  • Peter Vock
    • 1
  1. 1.Department of Interventional and Diagnostic RadiologyUniversity Hospital of BerneBerneSwitzerland

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