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Gange C, Ku J, Gosangi B, Liu J, Maolinbay M. Next-generation digital chest tomosynthesis. J Clin Imaging Sci 2024; 14:22. [PMID: 38975057 PMCID: PMC11225395 DOI: 10.25259/jcis_4_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/17/2024] [Indexed: 07/09/2024] Open
Abstract
The objective of this study was to demonstrate the performance characteristics and potential utility of a novel tomosynthesis device as applied to imaging the chest, specifically relating to lung nodules. The imaging characteristics and quality of a novel digital tomosynthesis prototype system was assessed by scanning, a healthy volunteer, and an andromorphic lung phantom with different configurations of simulated pulmonary nodules. The adequacy of nodule detection on the phantoms was rated by chest radiologists using a standardized scale. Results from using this tomosynthesis device demonstrate in plane resolution of 16lp/cm, with estimated effective radiation doses of 90% less than low dose CT. Nodule detection was adequate across various anatomic locations on a phantom. These proof-of-concept tests showed this novel tomosynthesis device can detect lung nodules with low radiation dose to the patient. This technique has potential as an alternative to low dose chest CT for lung nodule screening and tracking.
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Affiliation(s)
- Christopher Gange
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States
| | - Jamie Ku
- Product Development, Aixscan Inc., Sunnyvale, California, United States
| | - Babina Gosangi
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States
| | - Jianqiang Liu
- Product Development, Aixscan Inc., Sunnyvale, California, United States
| | - Manat Maolinbay
- Product Development, Aixscan Inc., Sunnyvale, California, United States
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Kim K, Lee JH, Je Oh S, Chung MJ. AI-based computer-aided diagnostic system of chest digital tomography synthesis: Demonstrating comparative advantage with X-ray-based AI systems. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107643. [PMID: 37348439 DOI: 10.1016/j.cmpb.2023.107643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Compared with chest X-ray (CXR) imaging, which is a single image projected from the front of the patient, chest digital tomosynthesis (CDTS) imaging can be more advantageous for lung lesion detection because it acquires multiple images projected from multiple angles of the patient. Various clinical comparative analysis and verification studies have been reported to demonstrate this, but there is no artificial intelligence (AI)-based comparative analysis studies. Existing AI-based computer-aided detection (CAD) systems for lung lesion diagnosis have been developed mainly based on CXR images; however, CAD-based on CDTS, which uses multi-angle images of patients in various directions, has not been proposed and verified for its usefulness compared to CXR-based counterparts. BACKGROUND AND OBJECTIVE This study develops and tests a CDTS-based AI CAD system to detect lung lesions to demonstrate performance improvements compared to CXR-based AI CAD. METHODS We used multiple (e.g., five) projection images as input for the CDTS-based AI model and a single-projection image as input for the CXR-based AI model to compare and evaluate the performance between models. Multiple/single projection input images were obtained by virtual projection on the three-dimensional (3D) stack of computed tomography (CT) slices of each patient's lungs from which the bed area was removed. These multiple images result from shooting from the front and left and right 30/60∘. The projected image captured from the front was used as the input for the CXR-based AI model. The CDTS-based AI model used all five projected images. The proposed CDTS-based AI model consisted of five AI models that received images in each of the five directions, and obtained the final prediction result through an ensemble of five models. Each model used WideResNet-50. To train and evaluate CXR- and CDTS-based AI models, 500 healthy data, 206 tuberculosis data, and 242 pneumonia data were used, and three three-fold cross-validation was applied. RESULTS The proposed CDTS-based AI CAD system yielded sensitivities of 0.782 and 0.785 and accuracies of 0.895 and 0.837 for the (binary classification) performance of detecting tuberculosis and pneumonia, respectively, against normal subjects. These results show higher performance than the sensitivity of 0.728 and 0.698 and accuracies of 0.874 and 0.826 for detecting tuberculosis and pneumonia through the CXR-based AI CAD, which only uses a single projection image in the frontal direction. We found that CDTS-based AI CAD improved the sensitivity of tuberculosis and pneumonia by 5.4% and 8.7% respectively, compared to CXR-based AI CAD without loss of accuracy. CONCLUSIONS This study comparatively proves that CDTS-based AI CAD technology can improve performance more than CXR. These results suggest that we can enhance the clinical application of CDTS. Our code is available at https://github.com/kskim-phd/CDTS-CAD-P.
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Affiliation(s)
- Kyungsu Kim
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
| | - Ju Hwan Lee
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Seong Je Oh
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
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Mok J, Yeom JA, Nam SW, Yoo JM, Lee JW, Lee G, Kim KI, Jeong YJ. Role of digital tomosynthesis in the context of tuberculosis contact investigation: comparisons with digital radiography. Acta Radiol 2022; 63:901-908. [PMID: 34082579 DOI: 10.1177/02841851211022498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chest radiography value as a screening tool in those exposed to pulmonary tuberculosis (TB) is reduced by its lower sensitivity to detect small intrapulmonary lesions. PURPOSE To evaluate the efficacy of digital tomosynthesis (DTS) screening of individuals that had contacted persons with active TB using low-dose computed tomography (CT) as the reference standard methods. MATERIAL AND METHODS This retrospective, community-based screening study of 90 adults who had been in close contact with a TB case was undertaken at our institution. All individuals underwent clinical evaluation, digital radiography (DR), DTS, and low-dose chest CT. Observers assessed and classified DR and DTS images using CT as the reference-standard method. Based on clinical and imaging findings, TB status was classified as normal, latent, minimal, subclinical, and active. Diagnostic performances of DTS and DR for the interpretation of correct diagnosis were calculated. RESULTS The estimated effective doses for DR, DTS, and low-dose CT were 0.01 mSv, 0.1 mSv, and 0.33 mSv, respectively. TB statuses of the 90 individuals were as follows: 62 latent (68.9%); two subclinical (2.2%); and one minimal (1.1%). The sensitivities, specificities, and accuracies of DTS and DR in the interpretation of correct diagnosis were 75.8%, 100%, 91.1% and 48.5%, 96.5%, 78.9%, respectively. CONCLUSION DTS appears to be superior to DR for the detection of lung lesions in individuals with TB contacts. DTS can offer a reasonable option for TB contact investigation.
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Affiliation(s)
- Jeongha Mok
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Won Nam
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul, Republic of Korea
| | - Jun Mi Yoo
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ji Won Lee
- Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Geewon Lee
- Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kun-Il Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yeon Joo Jeong
- Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Li Q, Liu J, Mo Y, Yu J, Zhang K, Zhang H. [Extraction of respiratory signals from chest tomosynthesis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:916-922. [PMID: 34238745 DOI: 10.12122/j.issn.1673-4254.2021.06.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the respiratory motion of the scanned object during acquisition of digital chest tomosynthesis (CTS) using a linear model. OBJECTIVE Respiratory signals were generated by extracting the motion of the diaphragm from the projection radiographs. The diaphragm trajectory obtained by dynamic programming (DP) was modeled and fitted, and according to the fitting of the data, the base motion curve and respiratory signal curve of the diaphragm were separated. Multipurpose chest phantom data, simulated digital Xcat phantom data and the datasets of 3 clinical patients were used to validate the performance of the proposed method. OBJECTIVE The motion trajectory of the diaphragm extracted from multipurpose chest phantom simulation data was linear. The respiratory signals could be effectively extracted from the 3 datasets of clinical patients in different respiratory states. The correlation coefficient between the respiratory signal extracted in Xcat simulation experiment and the original design was 0.9797. OBJECTIVE The linear model can effectively obtain the respiratory motion information of patients in real time, thus enabling the physicians to make clinical decisions on a rescan.
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Affiliation(s)
- Q Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510000 China
| | - J Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510000 China
| | - Y Mo
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510000 China
| | - J Yu
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510000 China
| | - K Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510000 China
| | - H Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510000 China
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Accuracy of Digital Tomosynthesis of the Chest in Detection of Interstitial Lung Disease Comparison With Digital Chest Radiography. J Comput Assist Tomogr 2019; 43:109-114. [PMID: 30119061 DOI: 10.1097/rct.0000000000000780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to assess the ability of chest digital tomosynthesis (DTS) for detection of interstitial lung disease (ILD) compared with conventional chest radiography. MATERIALS AND METHODS We retrospectively reviewed 78 patients (60 males, 18 females, mean age = 53.05 years, range, 19-83 years) who underwent chest DTS for a 5-year interval (January 1, 2009-December 31, 2014). Of the 78 patients, 33 (42.3%) carried a diagnosis of ILD and 45 (57.7%) were not ILD. All computed tomography reports and medical records were reviewed. The conventional chest radiography and DTS were separately reviewed by 2 radiologists for the presence of ILD and the confidence in diagnosis. RESULTS The diagnostic accuracy of DTS for the detection of ILD was better than conventional chest radiography (P < 0.05). Digital tomosynthesis had a sensitivity of 83.3% and negative predictive value of 89.0% that were statistically significantly better than conventional chest radiography (43.9% and 70.9%, respectively). Confidence in diagnosing ILD at DTS was higher than conventional chest radiography (P < 0.001) and had higher interobserver agreement than conventional chest radiography (P < 0.01). CONCLUSIONS Digital tomosynthesis improves diagnostic performance and confidence in diagnosing ILD compared with conventional chest radiography. Digital tomosynthesis can be suggested as the initial diagnostic technique for patients with suspected ILD.
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Mazzei MA, Sartorelli P, Bagnacci G, Gentili F, Sisinni AG, Fausto A, Mazzei FG, Volterrani L. Occupational Lung Diseases: Underreported Diagnosis in Radiological Practice. Semin Ultrasound CT MR 2018; 40:36-50. [PMID: 30686366 DOI: 10.1053/j.sult.2018.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Underreporting of occupational lung diseases is a widespread problem in clinical practice. In Europe there is not a common regulation even for the recognition of occupational cancers. Furthermore epidemiologic data on occupational interstitial lung diseases, in general, is limited by no standardized diagnostic criteria, varied physician awareness and training, limitations inherent to the various data sources, and the long latency period. Therefore, to optimize the management of the patient with occupational pathology, the collaboration and skills of the multidisciplinary at the service of the patient, play a fundamental role. In particular, radiologists should give substance to a clinical suspicion on an anamnestic basis and at the same time should recognize patterns of illness that can lead to the emergence of stories of misunderstood exposures. This article aims to provide an overview of the main occupational lung diseases with attention to diagnostic possibilities of the different imaging techniques. The issue of the radiological error is investigated, providing tools to minimize it in the daily practice.
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Affiliation(s)
- Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy
| | - Pietro Sartorelli
- Unit of Occupational Medicine, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy; Department of Medical Biotechnology, Unit of Occupational Medicine, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy
| | - Giulio Bagnacci
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy.
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy
| | | | - Alfonso Fausto
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy
| | | | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy
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Jadidi M, Båth M, Nyrén S. Dependency of image quality on acquisition protocol and image processing in chest tomosynthesis-a visual grading study based on clinical data. Br J Radiol 2018; 91:20170683. [PMID: 29565673 DOI: 10.1259/bjr.20170683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To compare the quality of images obtained with two different protocols with different acquisition time and the influence from image post processing in a chest digital tomosynthesis (DTS) system. METHODS 20 patients with suspected lung cancer were imaged with a chest X-ray equipment with tomosynthesis option. Two examination protocols with different acquisition times (6.3 and 12 s) were performed on each patient. Both protocols were presented with two different image post-processing (standard DTS processing and more advanced processing optimised for chest radiography). Thus, 4 series from each patient, altogether 80 series, were presented anonymously and in a random order. Five observers rated the quality of the reconstructed section images according to predefined quality criteria in three different classes. Visual grading characteristics (VGC) was used to analyse the data and the area under the VGC curve (AUCVGC) was used as figure-of-merit. The 12 s protocol and the standard DTS processing were used as references in the analyses. RESULTS The protocol with 6.3 s acquisition time had a statistically significant advantage over the vendor-recommended protocol with 12 s acquisition time for the classes of criteria, Demarcation (AUCVGC = 0.56, p = 0.009) and Disturbance (AUCVGC = 0.58, p < 0.001). A similar value of AUCVGC was found also for the class Structure (definition of bone structures in the spine) (0.56) but it could not be statistically separated from 0.5 (p = 0.21). For the image processing, the VGC analysis showed a small but statistically significant advantage for the standard DTS processing over the more advanced processing for the classes of criteria Demarcation (AUCVGC = 0.45, p = 0.017) and Disturbance (AUCVGC = 0.43, p = 0.005). A similar value of AUCVGC was found also for the class Structure (0.46), but it could not be statistically separated from 0.5 (p = 0.31). CONCLUSION The study indicates that the protocol with 6.3 s acquisition time yields slightly better image quality than the vender-recommended protocol with acquisition time 12 s for several anatomical structures. Furthermore, the standard gradation processing (the vendor-recommended post-processing for DTS), yields to some extent advantage over the gradation processing/multiobjective frequency processing/flexible noise control processing in terms of image quality for all classes of criteria. Advances in knowledge: The study proves that the image quality may be strongly affected by the selection of DTS protocol and that the vendor-recommended protocol may not always be the optimal choice.
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Affiliation(s)
- Masoud Jadidi
- 1 Departments of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm , Sweden
| | - Magnus Båth
- 2 Department of Radiation Physics, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.,3 Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Sven Nyrén
- 4 Molecular medicine and surgery, Karolinska intitutet , Stockholm , Sweden.,5 Department of Thoracic radiology, Karolinska University Hospital , Stockholm , Sweden
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Schikowsky C, Felten MK, Eisenhawer C, Das M, Kraus T. Response to Baur et al. (2017). Am J Ind Med 2018. [PMID: 29542199 DOI: 10.1002/ajim.22812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Michael K Felten
- Institute for Occupational Medicine, RWTH Aachen University, Aachen, Germany
| | | | - Marco Das
- Department of Diagnostic Radiology, RWTH Aachen University, Aachen, Germany
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Thomas Kraus
- Institute for Occupational Medicine, RWTH Aachen University, Aachen, Germany
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Tao X, Zhang H, Qin G, Ma J, Feng Q, Chen W. Sin-quadratic model for chest tomosynthesis respiratory signal analysis and its application in four dimensional chest tomosynthesis reconstruction. Med Eng Phys 2018; 52:59-68. [PMID: 29336877 DOI: 10.1016/j.medengphy.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 11/23/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022]
Abstract
Chest tomosynthesis (CTS) is a newly developed imaging technique which provides pseudo-3D volume anatomical information of thorax from limited-angle projections and contains much less of superimposed anatomy than the chest X-ray radiography. One of the relatively common problems in CTS is the patient respiratory motion during image acquisition, which negatively impacts the detectability. In this work, we propose a sin-quadratic model to analyze the respiratory motion during CTS scan, which is a real time method where the respiratory signal is generated by extracting the motion of diaphragm from projection radiographs. According to the estimated respiratory signal, the CTS projections were then amplitude-based sorted into four to eight phases, and an iterative reconstruction strategy with total variation regularization was adopted to reconstruct the CTS images at each phase. Simulated digital XCAT phantom data and three sets of patient data were adopted for the experiments to validate the performance of the sin-quadratic model and its application in four dimensional (4D) CTS reconstruction. Results of the XCAT phantom simulation study show that the correlation coefficient between the extracted respiratory signal and the originally designed respiratory signal is 0.9964, which suggests that the proposed model could exactly extract the respiratory signal from CTS projections. The 4D CTS reconstructions of both the phantom data and the patient data show clear reduction of motion-induced blur.
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Affiliation(s)
- Xi Tao
- School of Biomedical Engineering, and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China
| | - Hua Zhang
- School of Biomedical Engineering, and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China.
| | - Genggeng Qin
- Department of Radiology, Nanfang Hospital, Southern Medical University Guangzhou, 510515, China
| | - Jianhua Ma
- School of Biomedical Engineering, and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China
| | - Qianjin Feng
- School of Biomedical Engineering, and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China
| | - Wufan Chen
- School of Biomedical Engineering, and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China
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Cha YK, Kim JS, Kim Y, Kim YK. Radiologic Diagnosis of Asbestosis in Korea. Korean J Radiol 2016; 17:674-83. [PMID: 27587956 PMCID: PMC5007394 DOI: 10.3348/kjr.2016.17.5.674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/17/2016] [Indexed: 11/29/2022] Open
Abstract
Asbestosis is the most important change noted in the lung parenchyma after environmental and occupational exposure to asbestos fibers. It is characterized by diffuse interstitial pulmonary fibrosis. In Korea, the incidence of asbestosis will continue to increase for many years to come and the government enacted the Asbestos Damage Relief Law in 2011 to provide compensation to those suffering from asbestos-related diseases. Radiologic evaluation is necessary for diagnosis of asbestosis, and radiologists play a key role in this process. Therefore, it is important for radiologists to be aware of the various imaging features of asbestosis.
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Affiliation(s)
- Yoon Ki Cha
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Yookyung Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul 07985, Korea
| | - Yoon Kyung Kim
- Department of Radiology, Gachon University Gil Medical Center, Gachon University, Incheon 21565, Korea
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Dobbins JT, McAdams HP, Sabol JM, Chakraborty DP, Kazerooni EA, Reddy GP, Vikgren J, Båth M. Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules. Radiology 2016; 282:236-250. [PMID: 27439324 DOI: 10.1148/radiol.2016150497] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P < .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional chest radiography or tomosynthesis. Conclusion Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- James T Dobbins
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - H Page McAdams
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - John M Sabol
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Dev P Chakraborty
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Ella A Kazerooni
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Gautham P Reddy
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Jenny Vikgren
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Magnus Båth
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
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12
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Comparison of Digital Tomosynthesis and Chest Radiography for the Detection of Noncalcified Pulmonary and Hilar Lesions. J Thorac Imaging 2016; 30:328-35. [PMID: 25844978 DOI: 10.1097/rti.0000000000000144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to compare the sensitivity and specificity of chest digital tomosynthesis (DTS) with chest radiography (CXR) for the detection of noncalcified pulmonary nodules and hilar lesions using computed tomography (CT) as the reference standard. MATERIALS AND METHODS A total of 78 patients with suspected noncalcified pulmonary lesions on CXR were included in the study. Two radiologists, blinded to the history and CT, analyzed the CXR and the DTS images (separately), whereas a third radiologist analyzed the CXR and DTS images together. Noncalcified intrapulmonary nodules and hilar lesions were recorded for analysis. The interobserver agreement for CXR and DTS was assessed, and the time taken to report the images was recorded. RESULTS A total of 202 lesions were recorded in 78 patients. There were 111 true lesions confirmed on CT in 53 patients; in 25 patients subsequent CT excluded a lesion. The overall sensitivity was 32% for CXR and 49% for DTS. This improved to 54% when the posteroanterior CXR and DTS were reviewed together (CXR-DTS). The overall specificities for CXR, DTS, and CXR-DTS were 49%, 96%, and 98%, respectively. There were 56 suspected hilar lesions with subgroup sensitivities of 76% for CXR, 65% for DTS, and 76% for CXR-DTS. The specificity for hilar lesions was 59%, 92%, and 97% for CXR, DTS, and CXR-DTS, respectively. CONCLUSIONS DTS significantly improves the detectability of noncalcified nodules when compared with and when used in combination with CXR. The specificity and interobserver agreement of DTS in the diagnosis of suspected noncalcified pulmonary nodules and hilar lesions are significantly better than those of CXR and approaches those of CT.
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Petersson C, Båth M, Vikgren J, Johnsson ÅA. AN ANALYSIS OF THE POTENTIAL ROLE OF CHEST TOMOSYNTHESIS IN OPTIMISING IMAGING RESOURCES IN THORACIC RADIOLOGY. RADIATION PROTECTION DOSIMETRY 2016; 169:165-170. [PMID: 26979807 PMCID: PMC4911966 DOI: 10.1093/rpd/ncw040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of the study was to investigate the potential role of chest tomosynthesis (CTS) at a tertiary referral centre by exploring to what extent CTS could substitute chest radiography (CXR) and computed tomography (CT). The study comprised 1433 CXR, 523 CT and 216 CTS examinations performed 5 years after the introduction of CTS. For each examination, it was decided if CTS would have been appropriate instead of CXR (CXR cases), if CTS could have replaced the performed CT (CT cases) or if CT would have been performed had CTS not been available (CTS cases). It was judged that (a) CTS had been appropriate in 15 % of the CXR examinations, (b) CTS could have replaced additionally 7 % of the CT examinations and (c) CT would have been carried out in 63 % of the performed CTS examinations, had CTS not been available. In conclusion, the potential role for CTS to substitute other modalities during office hours at a tertiary referral centre may be in the order of 20 and 25 % of performed CXR and chest CT, respectively.
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Affiliation(s)
- Cecilia Petersson
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Åse Allansdotter Johnsson
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
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14
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Söderman C, Johnsson ÅA, Vikgren J, Norrlund RR, Molnar D, Svalkvist A, Månsson LG, Båth M. EFFECT OF RADIATION DOSE LEVEL ON ACCURACY AND PRECISION OF MANUAL SIZE MEASUREMENTS IN CHEST TOMOSYNTHESIS EVALUATED USING SIMULATED PULMONARY NODULES. RADIATION PROTECTION DOSIMETRY 2016; 169:188-198. [PMID: 26994093 PMCID: PMC4911967 DOI: 10.1093/rpd/ncw041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of the present study was to investigate the dependency of the accuracy and precision of nodule diameter measurements on the radiation dose level in chest tomosynthesis. Artificial ellipsoid-shaped nodules with known dimensions were inserted in clinical chest tomosynthesis images. Noise was added to the images in order to simulate radiation dose levels corresponding to effective doses for a standard-sized patient of 0.06 and 0.04 mSv. These levels were compared with the original dose level, corresponding to an effective dose of 0.12 mSv for a standard-sized patient. Four thoracic radiologists measured the longest diameter of the nodules. The study was restricted to nodules located in high-dose areas of the tomosynthesis projection radiographs. A significant decrease of the measurement accuracy and intraobserver variability was seen for the lowest dose level for a subset of the observers. No significant effect of dose level on the interobserver variability was found. The number of non-measurable small nodules (≤5 mm) was higher for the two lowest dose levels compared with the original dose level. In conclusion, for pulmonary nodules at positions in the lung corresponding to locations in high-dose areas of the projection radiographs, using a radiation dose level resulting in an effective dose of 0.06 mSv to a standard-sized patient may be possible in chest tomosynthesis without affecting the accuracy and precision of nodule diameter measurements to any large extent. However, an increasing number of non-measurable small nodules (≤5 mm) with decreasing radiation dose may raise some concerns regarding an applied general dose reduction for chest tomosynthesis examinations in the clinical praxis.
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Affiliation(s)
- Christina Söderman
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Åse Allansdotter Johnsson
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Jenny Vikgren
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Rauni Rossi Norrlund
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - David Molnar
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Angelica Svalkvist
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Lars Gunnar Månsson
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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15
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Ceder E, Danielson B, Kovàč P, Fogel H, Svalkvist A, Vikgren J, Båth M. THORACIC SPINE IMAGING: A COMPARISON BETWEEN RADIOGRAPHY AND TOMOSYNTHESIS USING VISUAL GRADING CHARACTERISTICS. RADIATION PROTECTION DOSIMETRY 2016; 169:204-210. [PMID: 26868012 DOI: 10.1093/rpd/ncv559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of the present study was to evaluate digital tomosynthesis (DTS) in thoracic spine imaging, comparing the reproduction of anatomical structures with that achieved using digital radiography (DR). In a prospective visual grading study, 23 patients referred in 2014 for elective radiographic examination of the thoracic spine were examined using lateral DR and DTS. The DR image and the DTS section images were read in random order by four radiologists, evaluating the ability of the modalities to present a clear reproduction of nine specific relevant structures of the thoracic vertebrae 3, 6 and 9 (T3, T6 and T9). The data were analysed using visual grading characteristics (VGC) analysis. The VGC analysis revealed a statistically significant difference in favour of DTS for all evaluated structures, except for the anterior vertebral edges and lower end plate surfaces of T6 and T9 and the cancellous bone of T9. The difference was most striking in T3 and for posterior structures. For no structure in any vertebra was the reproduction rated significantly better for DR. In conclusion, DTS of the thoracic spine appears to be a promising alternative to DR, especially in areas where the problem of overlaying anatomy is accentuated, such as posterior and upper thoracic structures.
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Affiliation(s)
- Erik Ceder
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Barbro Danielson
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Peter Kovàč
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Hanna Fogel
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Angelica Svalkvist
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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16
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Båth M, Söderman C, Svalkvist A. RETROSPECTIVE ESTIMATION OF PATIENT DOSE-AREA PRODUCT IN THORACIC SPINE TOMOSYNTHESIS PERFORMED USING VOLUMERAD. RADIATION PROTECTION DOSIMETRY 2016; 169:281-285. [PMID: 26590395 DOI: 10.1093/rpd/ncv475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the use of a recently developed method of retrospectively estimating the patient dose-area product (DAP) of a chest tomosynthesis examination, performed using VolumeRAD, in thoracic spine tomosynthesis and to determine the necessary field-size correction factor. Digital imaging and communications in medicine (DICOM) data for the projection radiographs acquired during a thoracic spine tomosynthesis examination were retrieved directly from the modality for 17 patients. Using the previously developed method, an estimated DAP for the tomosynthesis examination was determined from DICOM data in the scout image. By comparing the estimated DAP with the actual DAP registered for the projection radiographs, a field-size correction factor was determined. The field-size correction factor for thoracic spine tomosynthesis was determined to 0.92. Applying this factor to the DAP estimated retrospectively, the maximum difference between the estimated DAP and the actual DAP was <3 %. In conclusion, the previously developed method of retrospectively estimating the DAP in chest tomosynthesis can be applied to thoracic spine tomosynthesis.
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Affiliation(s)
- Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Christina Söderman
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Angelica Svalkvist
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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17
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Armstrong H, Jones B, Miften M. Characterization of image quality in digital tomosynthesis for radiotherapy applications. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/2/025013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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A comparison of digital tomosynthesis and chest radiography in evaluating airway lesions using computed tomography as a reference. Eur Radiol 2015; 26:3147-54. [DOI: 10.1007/s00330-015-4127-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 11/11/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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19
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Hayashi D, Xu L, Gusenburg J, Roemer FW, Hunter DJ, Li L, Guermazi A. Reliability of semiquantitative assessment of osteophytes and subchondral cysts on tomosynthesis images by radiologists with different levels of expertise. Diagn Interv Radiol 2015; 20:353-9. [PMID: 24834489 DOI: 10.5152/dir.2014.13283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess reliability of the evaluation of osteophytes and subchondral cysts on tomosynthesis images when read by radiologists with different levels of expertise. MATERIALS AND METHODS Forty subjects aged >40 years had both knees evaluated using tomosynthesis. Images were read by an "experienced" reader (musculoskeletal radiologist with prior experience) and an "inexperienced" reader (radiology resident with no prior experience). Readers graded osteophytes from 0 to 3 and noted the presence/absence of subchondral cysts in four locations of the tibiofemoral joint. Twenty knees were randomly selected and re-read. Inter- and intrareader reliabilities were calculated using overall exact percent agreement and weighted κ statistics. Diagnostic performance of the two readers was compared against magnetic resonance imaging readings by an expert reader (professor of musculoskeletal radiology). RESULTS The experienced reader showed substantial intrareader reliability for graded reading of osteophytes (90%, κ=0.93), osteophyte detection (95%, κ=0.86) and cyst detection (95%, κ=0.83). The inexperienced reader showed perfect intrareader reliability for cyst detection (100%, κ=1.00) but intrareader reliability for graded reading (75%, κ=0.79) and detection (80%, κ=0.61) of osteophytes was lower than the experienced reader. Inter-reader reliability was 61% (κ=0.72) for graded osteophyte reading, 91% (κ=0.82) for osteophyte detection, and 88% (κ=0.66) for cyst detection. Diagnostic performance of the experienced reader was higher than the inexperienced reader regarding osteophyte detection (sensitivity range 0.74-0.95 vs. 0.54-0.75 for all locations) but diagnostic performance was similar for subchondral cysts. CONCLUSION Tomosynthesis offers excellent intrareader reliability regardless of the reader experience, but experience is important for detection of osteophytes.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut, USA.
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20
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Jadidi M, Sundin A, Aspelin P, Båth M, Nyrén S. Evaluation of a new system for chest tomosynthesis: aspects of image quality of different protocols determined using an anthropomorphic phantom. Br J Radiol 2015; 88:20150057. [PMID: 26118300 DOI: 10.1259/bjr.20150057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the image quality obtained with the different protocols in a new chest digital tomosynthesis (DTS) system. METHODS A chest phantom was imaged with chest X-ray equipment with DTS. 10 protocols were used, and for each protocol, nine acquisitions were performed. Four observers visually rated the quality of the reconstructed section images according to pre-defined quality criteria in four different classes. The data were analysed with visual grading characteristics (VGC) analysis, using the vendor-recommended protocol [12-s acquisition time, source-to-image distance (SID) 180 cm] as reference, and the area under the VGC curve (AUCVGC) was determined for each protocol and class of criteria. RESULTS Protocols with a smaller swing angle resulted in a lower image quality for the classes of criteria "disturbance" and "homogeneity in nodule" but a higher image quality for the class "structure". The class "demarcation" showed little dependency on the swing angle. All protocols but one (6.3 s, SID 130 cm) obtained an AUCVGC significantly <0.5 (indicating lower quality than reference) for at least one class of criteria. CONCLUSION The study indicates that the DTS protocol with 6.3 s yields image quality similar to that obtained with the vendor-recommended protocol (12 s) but with the clinically important advantage for patients with respiratory impairment of a shorter acquisition time. ADVANCES IN KNOWLEDGE The study demonstrates that the image quality may be strongly affected by the choice of protocol and that the vendor-recommended protocol may not be optimal.
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Affiliation(s)
- M Jadidi
- 1 Departments of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - A Sundin
- 2 Radiology Department, Uppsala University Hospital, Uppsala, Sweden.,3 Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden
| | - P Aspelin
- 4 Departments of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden.,5 Radiology Department, Karolinska University Hospital, Stockholm, Sweden
| | - M Båth
- 6 Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,7 Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S Nyrén
- 8 Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,9 Radiology Department, Karolinska Institute, Stockholm, Sweden
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Lee KH, Goo JM, Lee SM, Park CM, Bahn YE, Kim H, Song YS, Hwang EJ. Digital tomosynthesis for evaluating metastatic lung nodules: nodule visibility, learning curves, and reading times. Korean J Radiol 2015; 16:430-9. [PMID: 25741205 PMCID: PMC4347279 DOI: 10.3348/kjr.2015.16.2.430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/30/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). MATERIALS AND METHODS We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. RESULTS Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, ≤ 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. CONCLUSION Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.
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Affiliation(s)
- Kyung Hee Lee
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Sang Min Lee
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Young Eun Bahn
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Yong Sub Song
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
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Galea A, Dubbins P, Riordan R, Adlan T, Roobottom C, Gay D. The value of digital tomosynthesis of the chest as a problem-solving tool for suspected pulmonary nodules and hilar lesions detected on chest radiography. Eur J Radiol 2015; 84:1012-8. [PMID: 25757629 DOI: 10.1016/j.ejrad.2015.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/28/2014] [Accepted: 02/09/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the capability of digital tomosynthesis (DTS) of the chest compared to a postero-anterior (PA) and lateral chest radiograph (CXR) in the diagnosis of suspected but unconfirmed pulmonary nodules and hilar lesions detected on a CXR. Computed tomography (CT) was used as the reference standard. MATERIALS AND METHOD 78 patients with suspected non-calcified pulmonary nodules or hilar lesions on their CXR were included in the study. Two radiologists, blinded to the history and CT, prospectively analysed the CXR (PA and lateral) and the DTS images using a picture archiving and communication workstation and were asked to designate one of two outcomes: true intrapulmonary lesion or false intrapulmonary lesion. A CT of the chest performed within 4 weeks of the CXR was used as the reference standard. Inter-observer agreement and time to report the modalities were calculated for CXR and DTS. RESULTS There were 34 true lesions confirmed on CT, 12 were hilar lesions and 22 were peripheral nodules. Of the 44 false lesions, 37 lesions were artefactual or due to composite shadow and 7 lesions were real but extrapulmonary simulating non-calcified intrapulmonary lesions. The PA and lateral CXR correctly classified 39/78 (50%) of the lesions, this improved to 75/78 (96%) with DTS. The sensitivity and specificity was 0.65 and 0.39 for CXR and 0.91 and 1 for DTS. Based on the DTS images, readers correctly classified all the false lesions but missed 3/34 true lesions. Two of the missed lesions were hilar in location and one was a peripheral nodule. All three missed lesions were incorrectly classified on DTS as composite shadow. CONCLUSIONS DTS improves diagnostic confidence when compared to a repeat PA and lateral CXR in the diagnosis of both suspected hilar lesions and pulmonary nodules detected on CXR. DTS is able to exclude most peripheral pulmonary nodules but caution and further studies are needed to assess its ability to exclude hilar lesions.
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Affiliation(s)
- Angela Galea
- Peninsula Radiology Academy, William Prance Road, Plymouth PL65WR, UK.
| | - Paul Dubbins
- Plymouth Hospital NHS Trust, Plymouth PL68DH, UK.
| | | | - Tarig Adlan
- Plymouth Hospital NHS Trust, Plymouth PL68DH, UK.
| | | | - David Gay
- Plymouth Hospital NHS Trust, Plymouth PL68DH, UK.
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Söderman C, Asplund S, Allansdotter Johnsson Å, Vikgren J, Rossi Norrlund R, Molnar D, Svalkvist A, Gunnar Månsson L, Båth M. Image quality dependency on system configuration and tube voltage in chest tomosynthesis-A visual grading study using an anthropomorphic chest phantom. Med Phys 2015; 42:1200-12. [DOI: 10.1118/1.4907963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chou SHS, Kicska GA, Pipavath SN, Reddy GP. Digital tomosynthesis of the chest: current and emerging applications. Radiographics 2015; 34:359-72. [PMID: 24617684 DOI: 10.1148/rg.342135057] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Digital tomosynthesis (DTS) of the chest is a technique whose basic components are similar to those of digital radiography, but that also provides some of the benefits of computed tomography (CT). The major advantages of DTS over conventional chest radiography are improved visibility of the pulmonary parenchyma and depiction of abnormalities such as pulmonary nodules. Calcifications, vessels, airways, and chest wall abnormalities are also much more readily visualized at DTS than at chest radiography. DTS could potentially be combined with chest radiography to follow up known nodules, confirm or rule out suspected nodules seen at radiography, or evaluate individuals who are at high risk for lung cancer or pulmonary metastases. DTS generates coronal "slices" through the chest whose resolution is superior to that of coronal reconstructed CT images, but it is limited by its suboptimal depth resolution and susceptibility to motion; consequently, potential pitfalls in recognizing lesions adjacent to the pleura, diaphragm, central vessels, and mediastinum can occur. However, the radiation dose and projected cost of chest DTS are lower than those of standard chest CT. Besides pulmonary nodule detection, specific applications of DTS that are under investigation include evaluation of pulmonary tuberculous and nontuberculous mycobacterial disease, cystic fibrosis, interstitial lung disease, and asbestos-related thoracic diseases. A basic understanding of chest DTS and of the emerging applications of this technique can prove useful to the radiologist. Online supplemental material is available for this article.
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Affiliation(s)
- Shinn-Huey S Chou
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195-7115
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Lacout A, Marcy PY. Insights into Digital Tomosynthesis of Interstitial Lung Disease. Radiographics 2014; 34:1871. [DOI: 10.1148/rg.347140199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Båth M, Söderman C, Svalkvist A. A simple method to retrospectively estimate patient dose-area product for chest tomosynthesis examinations performed using VolumeRAD. Med Phys 2014; 41:101905. [DOI: 10.1118/1.4895002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Doo KW, Kang EY, Yong HS, Ham SY, Lee KY, Choo JY. Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study. Eur Radiol 2014; 24:3269-76. [PMID: 25097138 DOI: 10.1007/s00330-014-3376-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 07/11/2014] [Accepted: 07/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kyung Won Doo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, Korea
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Effect of radiation dose level on the detectability of pulmonary nodules in chest tomosynthesis. Eur Radiol 2014; 24:1529-36. [DOI: 10.1007/s00330-014-3182-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 12/21/2022]
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Gomi T, Nakajima M, Umeda T. Wavelet denoising for quantum noise removal in chest digital tomosynthesis. Int J Comput Assist Radiol Surg 2014; 10:75-86. [PMID: 24748209 DOI: 10.1007/s11548-014-1003-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Quantum noise impairs image quality in chest digital tomosynthesis (DT). A wavelet denoising processing algorithm for selectively removing quantum noise was developed and tested. METHODS A wavelet denoising technique was implemented on a DT system and experimentally evaluated using chest phantom measurements including spatial resolution. Comparison was made with an existing post-reconstruction wavelet denoising processing algorithm reported by Badea et al. (Comput Med Imaging Graph 22:309-315, 1998). The potential DT quantum noise decrease was evaluated using different exposures with our technique (pre-reconstruction and post-reconstruction wavelet denoising processing via the balance sparsity-norm method) and the existing wavelet denoising processing algorithm. Wavelet denoising processing algorithms such as the contrast-to-noise ratio (CNR), root mean square error (RMSE) were compared with and without wavelet denoising processing. Modulation transfer functions (MTF) were evaluated for the in-focus plane. We performed a statistical analysis (multi-way analysis of variance) using the CNR and RMSE values. RESULTS Our wavelet denoising processing algorithm significantly decreased the quantum noise and improved the contrast resolution in the reconstructed images (CNR and RMSE: pre-balance sparsity-norm wavelet denoising processing versus existing wavelet denoising processing, P<0.05; post-balance sparsity-norm wavelet denoising processing versus existing wavelet denoising processing, P<0.05; CNR: with versus without wavelet denoising processing, P<0.05). The results showed that although MTF did not vary (thus preserving spatial resolution), the existing wavelet denoising processing algorithm caused MTF deterioration. CONCLUSIONS A balance sparsity-norm wavelet denoising processing algorithm for removing quantum noise in DT was demonstrated to be effective for certain classes of structures with high-frequency component features. This denoising approach may be useful for a variety of clinical applications for chest digital tomosynthesis when quantum noise is present.
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Affiliation(s)
- Tsutomu Gomi
- School of Allied Health Sciences, Kitasato University, Kitasato, 1-15-1 Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan,
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Galea A, Durran A, Adlan T, Gay D, Riordan R, Dubbins P, Williams MP. Practical applications of digital tomosynthesis of the chest. Clin Radiol 2013; 69:424-30. [PMID: 24333001 DOI: 10.1016/j.crad.2013.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 10/25/2022]
Abstract
Digital tomosynthesis is a radiographic technique that generates a number of coronal raw images of a patient from a single pass of the x-ray tube. Tomosynthesis provides some of the tomographic benefits of computed tomography (CT), but at a much lower dose of radiation and cost when compared to CT. This review illustrates the range of practical applications of digital tomosynthesis of the chest.
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Affiliation(s)
- A Galea
- Peninsula Radiology Academy, Plymouth, UK.
| | - A Durran
- Peninsula Radiology Academy, Plymouth, UK
| | - T Adlan
- Peninsula Radiology Academy, Plymouth, UK
| | - D Gay
- Derriford Hospital, Plymouth, UK
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Commentary on: Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease. Clin Radiol 2013; 68:336-7. [DOI: 10.1016/j.crad.2012.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/19/2012] [Accepted: 09/24/2012] [Indexed: 11/18/2022]
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