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.
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McAdams HP, Samei E, Dobbins J, 3rd, Tourassi GD, Ravin CE (2006) Recent advances in chest radiography. Radiology 241:663–683
Stewart BK, Huang HK (1990) Single-exposure dual-energy computed radiography. Medical Physics 17:866–875
Samei E, Flynn MJ (2002) An experimental comparison of detector performance for computed radiography systems. Medical physics 29:447–459
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 44:616–621
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 16:1544–1550
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 160:595–601
Ho JT, Kruger RA (1989) Comparison of dual-energy and conventional chest radiography for nodule detection. Investigative Radiology 24:861–868
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 24:517–521
Samei E, Flynn MJ, Eyler WR (1997) Simulation of subtle lung nodules in projection chest radiography. Radiology 202:117–124
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 44:205–209
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 13:2577–2582
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 23:391–397
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 194:407–412
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 181:1519–1524
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 33:290–296
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 33:411–420
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 33:3637–3639
Eng J ROC analysis: web-based calculator for ROC curves http://www.jrocfit.org. Last updated:2006 May 17
Chakraborty DP, Winter LH (1990) Free-response methodology: alternate analysis and a new observer-performance experiment. Radiology 174:873–881
Samei E, Flynn MJ, Eyler WR (1999) Detection of subtle lung nodules: relative influence of quantum and anatomic noise on chest radiographs. Radiology 213:727–734
Samei E, Flynn MJ, Peterson E, Eyler WR (2003) Subtle lung nodules: influence of local anatomic variations on detection. Radiology 228:76–84
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 231:164–168
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 16:65–68
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Szucs-Farkas, Z., Patak, M.A., Yuksel-Hatz, S. et al. Single-exposure dual-energy subtraction chest radiography: Detection of pulmonary nodules and masses in clinical practice. Eur Radiol 18, 24–31 (2008). https://doi.org/10.1007/s00330-007-0758-z
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DOI: https://doi.org/10.1007/s00330-007-0758-z