European Radiology

, Volume 23, Issue 8, pp 2118–2126

Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

  • Yoshitake Yamada
  • Masahiro Jinzaki
  • Masahiro Hashimoto
  • Eisuke Shiomi
  • Takayuki Abe
  • Sachio Kuribayashi
  • Kenji Ogawa



To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference.


Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of −950 HU or lower (LAA−950) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used.


ROC analysis revealed significantly better performance (P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA−950.


The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA−950.

Key Points

Tomosynthesis showed significantly better diagnostic performance for pulmonary emphysema than radiography.

Interobserver agreement for tomosynthesis was significantly higher than that for radiography.

Sensitivity increased with increasing LAA950in both tomosynthesis and radiography.

Tomosynthesis imparts a similar radiation dose to two projection chest radiography.

Radiation dose and cost of tomosynthesis are lower than those of MDCT.


Tomosynthesis Thorax Pulmonary emphysema Multidetector computed tomography Radiography 



Low-attenuation area with attenuation values of −950 HU or lower


Generalised estimating equations


  1. 1.
    Litmanovich D, Boiselle PM, Bankier AA (2009) CT of pulmonary emphysema—current status, challenges, and future directions. Eur Radiol 19:537–551PubMedCrossRefGoogle Scholar
  2. 2.
    Geitung JT, Skjaerstad LM, Gothlin JH (1999) Clinical utility of chest roentgenograms. Eur Radiol 9:721–723PubMedCrossRefGoogle Scholar
  3. 3.
    Speets AM, van der Graaf Y, Hoes AW et al (2006) Chest radiography in general practice: indications, diagnostic yield and consequences for patient management. Br J Gen Pract 56:574–578PubMedGoogle Scholar
  4. 4.
    Washko GR (2010) Diagnostic imaging in COPD. Semin Respir Crit Care Med 31:276–285PubMedCrossRefGoogle Scholar
  5. 5.
    Coxson HO, Rogers RM (2005) Quantitative computed tomography of chronic obstructive pulmonary disease. Acad Radiol 12:1457–1463PubMedCrossRefGoogle Scholar
  6. 6.
    Mets OM, de Jong PA, van Ginneken B, Gietema HA, Lammers JW (2012) Quantitative computed tomography in COPD: possibilities and limitations. Lung 190:133–145PubMedCrossRefGoogle Scholar
  7. 7.
    Mayo JR, Aldrich J, Muller NL (2003) Radiation exposure at chest CT: a statement of the Fleischner Society. Radiology 228:15–21PubMedCrossRefGoogle Scholar
  8. 8.
    Payne JT (2005) CT radiation dose and image quality. Radiol Clin North Am 43:953–962, viiPubMedCrossRefGoogle Scholar
  9. 9.
    Grant DG (1972) Tomosynthesis: a three-dimensional radiographic imaging technique. IEEE Trans Biomed Eng 19:20–28PubMedCrossRefGoogle Scholar
  10. 10.
    McAdams HP, Samei E, Dobbins J III, Tourassi GD, Ravin CE (2006) Recent advances in chest radiography. Radiology 241:663–683PubMedCrossRefGoogle Scholar
  11. 11.
    Sone S, Kasuga T, Sakai F et al (1991) Development of a high-resolution digital tomosynthesis system and its clinical application. Radiographics 11:807–822PubMedGoogle Scholar
  12. 12.
    Dobbins JT III, Godfrey DJ (2003) Digital x-ray tomosynthesis: current state of the art and clinical potential. Phys Med Biol 48:R65–R106PubMedCrossRefGoogle Scholar
  13. 13.
    Dobbins JT III, McAdams HP, Godfrey DJ, Li CM (2008) Digital tomosynthesis of the chest. J Thorac Imaging 23:86–92PubMedCrossRefGoogle Scholar
  14. 14.
    Dobbins JT, McAdams HP, Song JW et al (2008) Digital tomosynthesis of the chest for lung nodule detection: interim sensitivity results from an ongoing NIH-sponsored trial. Med Phys 35:2554–2557CrossRefGoogle Scholar
  15. 15.
    Johnsson AA, Vikgren J, Svalkvist A et al (2010) Overview of two years of clinical experience of chest tomosynthesis at Sahlgrenska University Hospital. Radiat Prot Dosim 139:124–129CrossRefGoogle Scholar
  16. 16.
    Vikgren J, Zachrisson S, Svalkvist A et al (2008) Comparison of chest tomosynthesis and chest radiography for detection of pulmonary nodules: human observer study of clinical cases. Radiology 249:1034–1041PubMedCrossRefGoogle Scholar
  17. 17.
    Dobbins JT 3rd, McAdams HP (2009) Chest tomosynthesis: technical principles and clinical update. Eur J Radiol 72:244–251PubMedCrossRefGoogle Scholar
  18. 18.
    Kim EY, Chung MJ, Lee HY, Koh WJ, Jung HN, Lee KS (2010) Pulmonary mycobacterial disease: diagnostic performance of low-dose digital tomosynthesis as compared with chest radiography. Radiology 257:269–277PubMedCrossRefGoogle Scholar
  19. 19.
    Quaia E, Baratella E, Cioffi V et al (2010) The value of digital tomosynthesis in the diagnosis of suspected pulmonary lesions on chest radiography: analysis of diagnostic accuracy and confidence. Acad Radiol 17:1267–1274PubMedCrossRefGoogle Scholar
  20. 20.
    Yamada Y, Jinzaki M, Hasegawa I et al (2011) Fast scanning tomosynthesis for the detection of pulmonary nodules: diagnostic performance compared with chest radiography, using multidetector-row computed tomography as the reference. Invest Radiol 46:471–477PubMedCrossRefGoogle Scholar
  21. 21.
    Servomaa A, Tapiovaara M (1998) Organ dose calculation in medical X ray examinations by the program PCXMC. Radiat Prot Dosim 80:213–219CrossRefGoogle Scholar
  22. 22.
    (2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37:1–332Google Scholar
  23. 23.
    European Guidelines on Quality Criteria for Computed Tomography (1999) Report EUR 16262. European Commission, Brussels. Available at: Accessed 18 Aug 2012
  24. 24.
    Sutinen S, Christoforidis AJ, Klugh GA, Pratt PC (1965) Roentgenologic criteria for the recognition of nonsymptomatic pulmonary emphysema. Correlation between roentgenologic findings and pulmonary pathology. Am Rev Respir Dis 91:69–76PubMedGoogle Scholar
  25. 25.
    Nicklaus TM, Stowell DW, Christiansen WR, Renzetti AD Jr (1966) The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema. Am Rev Respir Dis 93:889–899PubMedGoogle Scholar
  26. 26.
    Washko GR, Hunninghake GM, Fernandez IE et al (2011) Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 364:897–906PubMedCrossRefGoogle Scholar
  27. 27.
    Kim WJ, Silverman EK, Hoffman E et al (2009) CT metrics of airway disease and emphysema in severe COPD. Chest 136:396–404PubMedCrossRefGoogle Scholar
  28. 28.
    Gierada DS, Guniganti P, Newman BJ et al (2011) Quantitative CT assessment of emphysema and airways in relation to lung cancer risk. Radiology 261:950–959PubMedCrossRefGoogle Scholar
  29. 29.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  30. 30.
    Quaia E, Baratella E, Cernic S et al (2012) Analysis of the impact of digital tomosynthesis on the radiological investigation of patients with suspected pulmonary lesions on chest radiography. Eur Radiol 22:1912–1922PubMedCrossRefGoogle Scholar
  31. 31.
    Friedman PJ (2008) Imaging studies in emphysema. Proc Am Thorac Soc 5:494–500PubMedCrossRefGoogle Scholar
  32. 32.
    Gurney JW (1998) Pathophysiology of obstructive airways disease. Radiol Clin North Am 36:15–27PubMedCrossRefGoogle Scholar
  33. 33.
    Uppaluri R, Mitsa T, Sonka M, Hoffman EA, McLennan G (1997) Quantification of pulmonary emphysema from lung computed tomography images. Am J Respir Crit Care Med 156:248–254PubMedCrossRefGoogle Scholar
  34. 34.
    Sanders C, Nath PH, Bailey WC (1988) Detection of emphysema with computed tomography. Correlation with pulmonary function tests and chest radiography. Invest Radiol 23:262–266PubMedCrossRefGoogle Scholar
  35. 35.
    Price D, Freeman D, Cleland J, Kaplan A, Cerasoli F (2011) Earlier diagnosis and earlier treatment of COPD in primary care. Prim Care Respir J 20:15–22PubMedCrossRefGoogle Scholar
  36. 36.
    O’Donnell DE, Hernandez P, Kaplan A et al (2008) Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2008 update—highlights for primary care. Can Respir J 15:1A–8APubMedGoogle Scholar
  37. 37.
    Yamada Y, Jinzaki M, Tanami Y et al (2012) Model-based iterative reconstruction technique for ultralow-dose computed tomography of the lung: a pilot study. Invest Radiol 47:482–489PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Yoshitake Yamada
    • 1
    • 2
  • Masahiro Jinzaki
    • 1
  • Masahiro Hashimoto
    • 1
  • Eisuke Shiomi
    • 1
  • Takayuki Abe
    • 3
  • Sachio Kuribayashi
    • 1
  • Kenji Ogawa
    • 2
  1. 1.Department of Diagnostic RadiologyKeio University School of MedicineTokyoJapan
  2. 2.Department of RadiologyNippon Koukan HospitalKawasaki-shiJapan
  3. 3.Center for Clinical ResearchKeio University School of MedicineTokyoJapan

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