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Lim RS, Rosenberg J, Willemink MJ, Cheng SN, Guo HH, Hollett PD, Lin MC, Madani MH, Martin L, Pogatchnik BP, Pohlen M, Shen J, Tsai EB, Berry GJ, Scott G, Leung AN. Volumetric Analysis: Effect on Diagnosis and Management of Indeterminate Solid Pulmonary Nodules in Routine Clinical Practice. J Comput Assist Tomogr 2024:00004728-990000000-00335. [PMID: 38968327 DOI: 10.1097/rct.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To evaluate the effect of volumetric analysis on the diagnosis and management of indeterminate solid pulmonary nodules in routine clinical practice. METHODS This was a retrospective study with 107 computed tomography (CT) cases of solid pulmonary nodules (range, 6-15 mm), 57 pathology-proven malignancies (lung cancer, n = 34; metastasis, n = 23), and 50 benign nodules. Nodules were evaluated on a total of 309 CT scans (average number of CTs/nodule, 2.9 [range, 2-7]). CT scans were from multiple institutions with variable technique. Nine radiologists (attendings, n = 3; fellows, n = 3; residents, n = 3) were asked their level of suspicion for malignancy (low/moderate or high) and management recommendation (no follow-up, CT follow-up, or care escalation) for baseline and follow-up studies first without and then with volumetric analysis data. Effect of volumetry on diagnosis and management was assessed by generalized linear and logistic regression models. RESULTS Volumetric analysis improved sensitivity (P = 0.009) and allowed earlier recognition (P < 0.05) of malignant nodules. Attending radiologists showed higher sensitivity in recognition of malignant nodules (P = 0.03) and recommendation of care escalation (P < 0.001) compared with trainees. Volumetric analysis altered management of high suspicion nodules only in the fellow group (P = 0.008). κ Statistics for suspicion for malignancy and recommended management were fair to substantial (0.38-0.66) and fair to moderate (0.33-0.50). Volumetric analysis improved interobserver variability for identification of nodule malignancy from 0.52 to 0.66 (P = 0.004) only on the second follow-up study. CONCLUSIONS Volumetric analysis of indeterminate solid pulmonary nodules in routine clinical practice can result in improved sensitivity and earlier identification of malignant nodules. The effect of volumetric analysis on management recommendations is variable and influenced by reader experience.
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Affiliation(s)
| | - Jarrett Rosenberg
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Martin J Willemink
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Sarah N Cheng
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Henry H Guo
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Philip D Hollett
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Margaret C Lin
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | | | - Lynne Martin
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Brian P Pogatchnik
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Michael Pohlen
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Jody Shen
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Emily B Tsai
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | | | - Ann N Leung
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
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Wu FZ, Wu YJ, Tang EK. An integrated nomogram combined semantic-radiomic features to predict invasive pulmonary adenocarcinomas in subjects with persistent subsolid nodules. Quant Imaging Med Surg 2023; 13:654-668. [PMID: 36819273 PMCID: PMC9929384 DOI: 10.21037/qims-22-308] [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: 04/04/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022]
Abstract
Background Patients with persistent pulmonary subsolid nodules have a relatively high incidence of lung adenocarcinoma. Preoperative early diagnosis of invasive pulmonary adenocarcinoma spectrum lesions could help avoid extensive advanced cancer management and overdiagnosis in lung cancer screening programs. Methods In total, 260 consecutive patients with persistent subsolid nodules ≤30 mm (n=260) confirmed by surgical pathology were retrospectively investigated from February 2016 to August 2020 at the Kaohsiung Veterans General Hospital. All patients underwent surgical resection within 3 months of the chest CT exam. The study subjects were divided into a training cohort (N=195) and a validation cohort (N=65) at a ratio of 3:1. The purpose of our study was to develop and validate a least absolute shrinkage and selection operator-derived nomogram integrating semantic-radiomic features in differentiating preinvasive and invasive pulmonary adenocarcinoma lesions, and compare its predictive value with clinical-semantic, semantic, and radiologist's performance. Results In the training cohort of 195 subsolid nodules, 106 invasive lesions and 89 preinvasive lesions were identified. We developed a least absolute shrinkage and selection operator-derived combined nomogram prediction model based on six predictors (nodular size, CTR, roundness, GLCM_Entropy_log10, HISTO_Entropy_log10, and CONVENTIONAL_Humean) to predict the invasive pulmonary adenocarcinoma lesions. Compared with other predictive models, the least absolute shrinkage and selection operator-derived model showed better diagnostic performance with an area under the curve of 0.957 (95% CI: 0.918 to 0.981) for detecting invasive pulmonary adenocarcinoma lesions with balanced sensitivity (92.45%) and specificity (88.64%). The results of Hosmer-Lemeshow test showed P values of 0.394 and 0.787 in the training and validation cohorts, respectively, indicating good calibration power. Conclusions We developed a least absolute shrinkage and selection operator-derived model integrating semantic-radiomic features with good calibration. This nomogram may help physicians to identify invasive pulmonary adenocarcinoma lesions for guidance in personalized medicine and make more informed decisions on managing subsolid nodules.
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Affiliation(s)
- Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung;,Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei;,School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung
| | - Yun-Ju Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung;,Department of Software Engineering and Management, National Kaohsiung Normal University, Kaohsiung
| | - En-Kuei Tang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
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Characterization of different reconstruction techniques on computer-aided system for detection of pulmonary nodules in lung from low-dose CT protocol. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lung Cancer Screening: New Perspective and Challenges in Europe. Cancers (Basel) 2022; 14:cancers14092343. [PMID: 35565472 PMCID: PMC9099920 DOI: 10.3390/cancers14092343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Screening for lung cancer in a high-risk population has been shown to be beneficial, with reduced mortality in large randomised trials. However, the general implementation of screening is not evident and many factors have to be considered. In this paper, we will review the current status of screening for lung cancer in Europe and the many hurdles that have to be overcome. Multidisciplinary cooperation between all specialists dealing with lung cancer is required to obtain the best outcome. Hopefully, Europe’s Beating Cancer Plan will incorporate screening for lung cancer to allow general implementation by similar programmes in every European Member State. This will also provide an opportunity for further, large-scale studies to refine the inclusion of specific risk populations, diagnosis and management of screen-detected nodules. Abstract Randomized-controlled trials have shown clear evidence that lung cancer screening with low-dose CT in a high-risk population of current or former smokers can significantly reduce lung-cancer-specific mortality by an inversion of stage distribution at diagnosis. This paper will review areas in which there is good or emerging evidence and areas which still require investment, research or represent implementation challenges. The implementation of population-based lung cancer screening in Europe is variable and fragmented. A number of European countries seem be on the verge of implementing lung cancer screening, mainly through the implementation of studies or trials. The cost and capacity of CT scanners and radiologists are considered to be the main hurdles for future implementation. Actions by the European Commission, related to its published Europe’s Beating Cancer Plan and the proposal to update recommendations on cancer screening, could be an incentive to help speed up its implementation.
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Murchison JT, Ritchie G, Senyszak D, Nijwening JH, van Veenendaal G, Wakkie J, van Beek EJR. Validation of a deep learning computer aided system for CT based lung nodule detection, classification, and growth rate estimation in a routine clinical population. PLoS One 2022; 17:e0266799. [PMID: 35511758 PMCID: PMC9070877 DOI: 10.1371/journal.pone.0266799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/28/2022] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE In this study, we evaluated a commercially available computer assisted diagnosis system (CAD). The deep learning algorithm of the CAD was trained with a lung cancer screening cohort and developed for detection, classification, quantification, and growth of actionable pulmonary nodules on chest CT scans. Here, we evaluated the CAD in a retrospective cohort of a routine clinical population. MATERIALS AND METHODS In total, a number of 337 scans of 314 different subjects with reported nodules of 3-30 mm in size were included into the evaluation. Two independent thoracic radiologists alternately reviewed scans with or without CAD assistance to detect, classify, segment, and register pulmonary nodules. A third, more experienced, radiologist served as an adjudicator. In addition, the cohort was analyzed by the CAD alone. The study cohort was divided into five different groups: 1) 178 CT studies without reported pulmonary nodules, 2) 95 studies with 1-10 pulmonary nodules, 23 studies from the same patients with 3) baseline and 4) follow-up studies, and 5) 18 CT studies with subsolid nodules. A reference standard for nodules was based on majority consensus with the third thoracic radiologist as required. Sensitivity, false positive (FP) rate and Dice inter-reader coefficient were calculated. RESULTS After analysis of 470 pulmonary nodules, the sensitivity readings for radiologists without CAD and radiologist with CAD, were 71.9% (95% CI: 66.0%, 77.0%) and 80.3% (95% CI: 75.2%, 85.0%) (p < 0.01), with average FP rate of 0.11 and 0.16 per CT scan, respectively. Accuracy and kappa of CAD for classifying solid vs sub-solid nodules was 94.2% and 0.77, respectively. Average inter-reader Dice coefficient for nodule segmentation was 0.83 (95% CI: 0.39, 0.96) and 0.86 (95% CI: 0.51, 0.95) for CAD versus readers. Mean growth percentage discrepancy of readers and CAD alone was 1.30 (95% CI: 1.02, 2.21) and 1.35 (95% CI: 1.01, 4.99), respectively. CONCLUSION The applied CAD significantly increased radiologist's detection of actionable nodules yet also minimally increasing the false positive rate. The CAD can automatically classify and quantify nodules and calculate nodule growth rate in a cohort of a routine clinical population. Results suggest this Deep Learning software has the potential to assist chest radiologists in the tasks of pulmonary nodule detection and management within their routine clinical practice.
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Affiliation(s)
- John T. Murchison
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- * E-mail: (JTM); (JHN)
| | - Gillian Ritchie
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - David Senyszak
- Edinburgh Imaging facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Edwin J. R. van Beek
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
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Hu Q, Liu Y, Chen C, Kang S, Sun Z, Wang Y, Xiang M, Guan H, Xia L. Application of computer-aided detection (CAD) software to automatically detect nodules under SDCT and LDCT scans with different parameters. Comput Biol Med 2022; 146:105538. [DOI: 10.1016/j.compbiomed.2022.105538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/26/2022] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
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Au C, Reeves R, Li Z, Gingold E, Halpern E, Sundaram B. Impact of multidetector computed tomography scan parameters, novel reconstruction settings, and lung nodule characteristics on nodule diameter measurements: A Phantom Study. Med Phys 2022; 49:3936-3943. [PMID: 35358333 DOI: 10.1002/mp.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Novel CT reconstruction techniques strive to maintain image quality and processing efficiency. The purpose of this study is to investigate the impact of a newer hybrid iterative reconstruction technique, Adaptive Statistical Iterative Reconstruction-V (ASIR-V) in combination with various CT scan parameters on the semi-automated quantification using various lung nodules. METHODS A chest phantom embedded with eight spherical objects was scanned using varying CT parameters such as tube current and ASIR-V levels. We calculated absolute percentage error (APE) and mean APE (MAPE) using differences between the semi-automated measured diameters and known dimensions. Predictive variables were assessed using a multivariable general linear model. The linear regression slope coefficients (β) were reported to demonstrate effect size and directionality. RESULTS The APE of the semi-automated measured diameters was higher in ground-glass than solid nodules (β = 9.000, p<0.001). APE had an inverse relationship with nodule diameter (mm; β = -3.499, p<0.001) and tube current (mA; β = -0.006, p<0.001). MAPE did not vary based on the ASIR-V level (range: 5.7-13.1%). CONCLUSION Error is dominated by nodule characteristics with a small effect of tube current. Regardless of phantom size, nodule size accuracy is not affected by tube voltage or ASIR-V level, maintaining accuracy while maximizing radiation dose reduction. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cherry Au
- Department of Internal Medicine, Rush University Medical Center, 1620 W Harrison St, Chicago, IL, 60612
| | - Russell Reeves
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA, 19107
| | - Zhenteng Li
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA, 19107.,The Vascular Center, St. Luke's Anderson Campus - Medical Office Building, 1700 St. Luke's Boulevard, Suite 301, Easton, PA
| | - Eric Gingold
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA, 19107
| | - Ethan Halpern
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA, 19107
| | - Baskaran Sundaram
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA, 19107
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Ziegelmayer S, Graf M, Makowski M, Gawlitza J, Gassert F. Cost-Effectiveness of Artificial Intelligence Support in Computed Tomography-Based Lung Cancer Screening. Cancers (Basel) 2022; 14:cancers14071729. [PMID: 35406501 PMCID: PMC8997030 DOI: 10.3390/cancers14071729] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lung cancer screening is already implemented in the USA and strongly recommended by European Radiological and Thoracic societies as well. Upon implementation, the total number of thoracic computed tomographies (CT) is likely to rise significantly. As shown in previous studies, modern artificial intelligence-based algorithms are on-par or even exceed radiologist's performance in lung nodule detection and classification. Therefore, the aim of this study was to evaluate the cost-effectiveness of an AI-based system in the context of baseline lung cancer screening. METHODS In this retrospective study, a decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Literature research was performed to determine model input parameters. Model uncertainty and possible costs of the AI-system were assessed using deterministic and probabilistic sensitivity analysis. RESULTS In the base case scenario CT + AI resulted in a negative incremental cost-effectiveness ratio (ICER) as compared to CT only, showing lower costs and higher effectiveness. Threshold analysis showed that the ICER remained negative up to a threshold of USD 68 for the AI support. The willingness-to-pay of USD 100,000 was crossed at a value of USD 1240. Deterministic and probabilistic sensitivity analysis showed model robustness for varying input parameters. CONCLUSION Based on our results, the use of an AI-based system in the initial low-dose CT scan of lung cancer screening is a feasible diagnostic strategy from a cost-effectiveness perspective.
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Retson TA, Hasenstab KA, Kligerman SJ, Jacobs KE, Yen AC, Brouha SS, Hahn LD, Hsiao A. Reader Perceptions and Impact of AI on CT Assessment of Air Trapping. Radiol Artif Intell 2022; 4:e210160. [PMID: 35391767 DOI: 10.1148/ryai.2021210160] [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] [Received: 06/15/2021] [Revised: 09/22/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022]
Abstract
Quantitative imaging measurements can be facilitated by artificial intelligence (AI) algorithms, but how they might impact decision-making and be perceived by radiologists remains uncertain. After creation of a dedicated inspiratory-expiratory CT examination and concurrent deployment of a quantitative AI algorithm for assessing air trapping, five cardiothoracic radiologists retrospectively evaluated severity of air trapping on 17 examination studies. Air trapping severity of each lobe was evaluated in three stages: qualitatively (visually); semiquantitatively, allowing manual region-of-interest measurements; and quantitatively, using results from an AI algorithm. Readers were surveyed on each case for their perceptions of the AI algorithm. The algorithm improved interreader agreement (intraclass correlation coefficients: visual, 0.28; semiquantitative, 0.40; quantitative, 0.84; P < .001) and improved correlation with pulmonary function testing (forced expiratory volume in 1 second-to-forced vital capacity ratio) (visual r = -0.26, semiquantitative r = -0.32, quantitative r = -0.44). Readers perceived moderate agreement with the AI algorithm (Likert scale average, 3.7 of 5), a mild impact on their final assessment (average, 2.6), and a neutral perception of overall utility (average, 3.5). Though the AI algorithm objectively improved interreader consistency and correlation with pulmonary function testing, individual readers did not immediately perceive this benefit, revealing a potential barrier to clinical adoption. Keywords: Technology Assessment, Quantification © RSNA, 2021.
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Affiliation(s)
- Tara A Retson
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
| | - Kyle A Hasenstab
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
| | - Seth J Kligerman
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
| | - Kathleen E Jacobs
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
| | - Andrew C Yen
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
| | - Sharon S Brouha
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
| | - Lewis D Hahn
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
| | - Albert Hsiao
- Department of Radiology, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., S.J.K., K.E.J., A.C.Y., S.S.B., L.D.H., A.H.); and Department of Mathematics and Statistics, San Diego State University, San Diego, Calif (K.A.H.)
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Wang D, Cao L, Li B. Computer-aided diagnosis system versus conventional reading system in low-dose (< 2 mSv) computed tomography: comparative study for patients at risk of lung cancer. SAO PAULO MED J 2022; 141:89-97. [PMID: 36472867 PMCID: PMC10005467 DOI: 10.1590/1516-3180.2022.0130.r1.29042022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/29/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Computer-aided diagnosis in low-dose (≤ 3 mSv) computed tomography (CT) is a potential screening tool for lung nodules, with quality interpretation and less inter-observer variability among readers. Therefore, we aimed to determine the screening potential of CT using a radiation dose that does not exceed 2 mSv. OBJECTIVE We aimed to compare the diagnostic parameters of low-dose (< 2 mSv) CT interpretation results using a computer-aided diagnosis system for lung cancer screening with those of a conventional reading system used by radiologists. DESIGN AND SETTING We conducted a comparative study of chest CT images for lung cancer screening at three private institutions. METHODS A database of low-dose (< 2 mSv) chest CT images of patients at risk of lung cancer was viewed with the conventional reading system (301 patients and 226 nodules) or computer-aided diagnosis system without any subsequent radiologist review (944 patients and 1,048 nodules). RESULTS The numbers of detected and solid nodules per patient (both P < 0.0001) were higher using the computer-aided diagnosis system than those using the conventional reading system. The nodule size was reported as the maximum size in any plane in the computer-aided diagnosis system. Higher numbers of patients (102 [11%] versus 20 [7%], P = 0.0345) and nodules (154 [15%] versus 17 [8%], P = 0.0035) were diagnosed with cancer using the computer-aided diagnosis system. CONCLUSIONS The computer-aided diagnosis system facilitates the diagnosis of cancerous nodules, especially solid nodules, in low-dose (< 2 mSv) CT among patients at risk for lung cancer.
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Affiliation(s)
- Dong Wang
- MD. Physician, Department of Medical Imaging, Xianyang Cai-Hong Hospital, Xianyang, Shaanxi, China
| | - Lina Cao
- MD. Physician, Department of Medical Imaging, Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Boya Li
- MD. Physician, Department of Medical Imaging, Jiangxi provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Cui X, Zheng S, Heuvelmans MA, Du Y, Sidorenkov G, Fan S, Li Y, Xie Y, Zhu Z, Dorrius MD, Zhao Y, Veldhuis RNJ, de Bock GH, Oudkerk M, van Ooijen PMA, Vliegenthart R, Ye Z. Performance of a deep learning-based lung nodule detection system as an alternative reader in a Chinese lung cancer screening program. Eur J Radiol 2021; 146:110068. [PMID: 34871936 DOI: 10.1016/j.ejrad.2021.110068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/03/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the performance of a deep learning-based computer-aided detection (DL-CAD) system in a Chinese low-dose CT (LDCT) lung cancer screening program. MATERIALS AND METHODS One-hundred-and-eighty individuals with a lung nodule on their baseline LDCT lung cancer screening scan were randomly mixed with screenees without nodules in a 1:1 ratio (total: 360 individuals). All scans were assessed by double reading and subsequently processed by an academic DL-CAD system. The findings of double reading and the DL-CAD system were then evaluated by two senior radiologists to derive the reference standard. The detection performance was evaluated by the Free Response Operating Characteristic curve, sensitivity and false-positive (FP) rate. The senior radiologists categorized nodules according to nodule diameter, type (solid, part-solid, non-solid) and Lung-RADS. RESULTS The reference standard consisted of 262 nodules ≥ 4 mm in 196 individuals; 359 findings were considered false positives. The DL-CAD system achieved a sensitivity of 90.1% with 1.0 FP/scan for detection of lung nodules regardless of size or type, whereas double reading had a sensitivity of 76.0% with 0.04 FP/scan (P = 0.001). The sensitivity for detection of nodules ≥ 4 - ≤ 6 mm was significantly higher with DL-CAD than with double reading (86.3% vs. 58.9% respectively; P = 0.001). Sixty-three nodules were only identified by the DL-CAD system, and 27 nodules only found by double reading. The DL-CAD system reached similar performance compared to double reading in Lung-RADS 3 (94.3% vs. 90.0%, P = 0.549) and Lung-RADS 4 nodules (100.0% vs. 97.0%, P = 1.000), but showed a higher sensitivity in Lung-RADS 2 (86.2% vs. 65.4%, P < 0.001). CONCLUSIONS The DL-CAD system can accurately detect pulmonary nodules on LDCT, with an acceptable false-positive rate of 1 nodule per scan and has higher detection performance than double reading. This DL-CAD system may assist radiologists in nodule detection in LDCT lung cancer screening.
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Affiliation(s)
- Xiaonan Cui
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Sunyi Zheng
- Westlake University, Artificial Intelligence and Biomedical Image Analysis Lab, School of Engineering, Hangzhou, People's Republic of China; Institute of Advanced Technology, Westlake Institute for Advanced Study, Hangzhou, People's Republic of China; University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Marjolein A Heuvelmans
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Yihui Du
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Shuxuan Fan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Yanju Li
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Yongsheng Xie
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Zhongyuan Zhu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Yingru Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Raymond N J Veldhuis
- University of Twente, Faculty of Electrical Engineering Mathematics and Computer Science, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Matthijs Oudkerk
- University of Groningen, Faculty of Medical Sciences, the Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Machine Learning Lab, Data Science Center in Health, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Zhaoxiang Ye
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China.
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12
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Fast fully automatic detection, classification and 3D reconstruction of pulmonary nodules in CT images by local image feature analysis. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Xiao Y, Wang X, Li Q, Fan R, Chen R, Shao Y, Chen Y, Gao Y, Liu A, Chen L, Liu S. A cascade and heterogeneous neural network for CT pulmonary nodule detection and its evaluation on both phantom and patient data. Comput Med Imaging Graph 2021; 90:101889. [PMID: 33848755 DOI: 10.1016/j.compmedimag.2021.101889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Screening of pulmonary nodules in computed tomography (CT) is crucial for early diagnosis and treatment of lung cancer. Although computer-aided diagnosis (CAD) systems have been designed to assist radiologists to detect nodules, fully automated detection is still challenging due to variations in nodule size, shape, and density. In this paper, we first propose a fully automated nodule detection method using a cascade and heterogeneous neural network trained on chest CT images of 12155 patients, then evaluate the performance by using phantom (828 CT images) and clinical datasets (2640 CT images) scanned with different imaging parameters. The nodule detection network employs two feature pyramid networks (FPNs) and a classification network (BasicNet). The first FPN is trained to achieve high sensitivity for nodule detection, and the second FPN refines the candidates for false positive reduction (FPR). Then, a BasicNet is combined with the second FPR to classify the candidates into either nodules or non-nodules for the final refinement. This study investigates the performance of nodule detection of solid and ground-glass nodules in phantom and patient data scanned with different imaging parameters. The results show that the detection of the solid nodules is robust to imaging parameters, and for GGO detection, reconstruction methods "iDose4-YA" and "STD-YA" achieve better performance. For thin-slice images, higher performance is achieved across different nodule sizes with reconstruction method "iDose4-STD". For 5 mm slice thickness, the best choice is the reconstruction method "iDose4-YA" for larger nodules (>5 mm). Overall, the reconstruction method "iDose4-YA" is suggested to achieve the best balanced results for both solid and GGO nodules.
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Affiliation(s)
- Yi Xiao
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiang Wang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qingchu Li
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rongrong Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rutan Chen
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ying Shao
- Shanghai United Imaging Intelligence Co., Ltd., China
| | - Yanbo Chen
- Shanghai United Imaging Intelligence Co., Ltd., China
| | - Yaozong Gao
- Shanghai United Imaging Intelligence Co., Ltd., China
| | - Aie Liu
- Shanghai United Imaging Intelligence Co., Ltd., China
| | - Lei Chen
- Shanghai United Imaging Intelligence Co., Ltd., China.
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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A comparative study to evaluate CT-based semantic and radiomic features in preoperative diagnosis of invasive pulmonary adenocarcinomas manifesting as subsolid nodules. Sci Rep 2021; 11:66. [PMID: 33462251 PMCID: PMC7814025 DOI: 10.1038/s41598-020-79690-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022] Open
Abstract
This study aims to predict the histological invasiveness of pulmonary adenocarcinoma spectrum manifesting with subsolid nodules ≦ 3 cm using the preoperative CT-based radiomic approach. A total of 186 patients with 203 SSNs confirmed with surgically pathologic proof were retrospectively reviewed from February 2016 to March 2020 for training cohort modeling. The validation cohort included 50 subjects with 57 SSNs confirmed with surgically pathologic proof from April 2020 to August 2020. CT-based radiomic features were extracted using an open-source software with 3D nodular volume segmentation manually. The association between CT-based conventional features/selected radiomic features and histological invasiveness of pulmonary adenocarcinoma status were analyzed. Diagnostic models were built using conventional CT features, selected radiomic CT features and experienced radiologists. In addition, we compared diagnostic performance between radiomic CT feature, conventional CT features and experienced radiologists. In the training cohort of 203 SSNs, there were 106 invasive lesions and 97 pre-invasive lesions. Logistic analysis identified that a selected radiomic feature named GLCM_Entropy_log10 was the predictor for histological invasiveness of pulmonary adenocarcinoma spectrum (OR: 38.081, 95% CI 2.735–530.309, p = 0.007). The sensitivity and specificity for predicting histological invasiveness of pulmonary adenocarcinoma spectrum using the cutoff value of CT-based radiomic parameter (GLCM_Entropy_log10) were 84.8% and 79.2% respectively (area under curve, 0.878). The diagnostic model of CT-based radiomic feature was compared to those of conventional CT feature (morphologic and quantitative) and three experienced radiologists. The diagnostic performance of radiomic feature was similar to those of the quantitative CT feature (nodular size and solid component, both lung and mediastinal window) in prediction invasive pulmonary adenocarcinoma (IPA). The AUC value of CT radiomic feature was higher than those of conventional CT morphologic feature and three experienced radiologists. The c-statistic of the training cohort model was 0.878 (95% CI 0.831–0.925) and 0.923 (0.854–0.991) in the validation cohort. Calibration was good in both cohorts. The diagnostic performance of CT-based radiomic feature is not inferior to solid component (lung and mediastinal window) and nodular size for predicting invasiveness. CT-based radiomic feature and nomogram could help to differentiate IPA lesions from preinvasive lesions in the both independent training and validation cohorts. The nomogram may help clinicians with decision making in the management of subsolid nodules.
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Gierada DS, Rydzak CE, Zei M, Rhea L. Improved Interobserver Agreement on Lung-RADS Classification of Solid Nodules Using Semiautomated CT Volumetry. Radiology 2020; 297:675-684. [PMID: 32930652 PMCID: PMC7706890 DOI: 10.1148/radiol.2020200302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/05/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022]
Abstract
Background Classification of lung cancer screening CT scans depends on measurement of lung nodule size. Information about interobserver agreement is limited. Purpose To assess interobserver agreement in the measurements and American College of Radiology Lung CT Screening Reporting and Data System (Lung-RADS) classifications of solid lung nodules detected at lung cancer screening using manual measurements of average diameter and computer-aided semiautomated measurements of average diameter and volume (CT volumetry). Materials and Methods Two radiologists and one radiology resident retrospectively measured lung nodules from screening CT scans obtained between September 2016 and June 2018 with a Lung-RADS (version 1.0) classification of 2, 3, 4A, or 4B in the clinical setting. Average manual diameter and semiautomated computer-aided diameter and volume measurements were converted to the corresponding Lung-RADS categories. Interobserver agreement in raw measurements was assessed using intraclass correlation and Bland-Altman indexes, and interobserver agreement in Lung-RADS classification was assessed using bi-rater κ. Results One hundred twenty patients (mean age, 63 years ± 6 [standard deviation]; 67 women) were evaluated. All manual, semiautomated diameter, and semiautomated volume measurements were obtained by all three readers in 120 of 147 nodules (82%). Intraclass correlation coefficients were greater than or equal to 0.95 for all reader pairs using all measurement methods and were highest using volumetry. Bias and 95% limits of agreement for average diameter were smaller with semiautomated measurements than with manual measurements. κ values across all Lung-RADS classifications were greater than or equal to 0.81, with the lowest being for manual measurements and the highest being for volumetric measurements. Forty-three of 120 (36%) of the nodules were classified into a lower Lung-RADS category on the basis of volumetry compared with using manual diameter measurements by at least one reader, whereas the reverse occurred for four of 120 (3%) of the nodules. Conclusion Interobserver agreement was high with manual diameter measurements and increased with semiautomated CT volumetric measurements. Semiautomated CT volumetry enabled classification of more nodules into lower Lung CT Screening Reporting and Data System categories than manual or semiautomated diameter measurements. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Nishino in this issue.
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Affiliation(s)
- David S. Gierada
- From the Mallinckrodt Institute of Radiology (D.S.G., C.E.R., M.Z.) and Department of Biostatistics (L.R.), School of Medicine, Washington University, 510 S Kingshighway Blvd, St Louis, MO 63110
| | | | - Markus Zei
- From the Mallinckrodt Institute of Radiology (D.S.G., C.E.R., M.Z.) and Department of Biostatistics (L.R.), School of Medicine, Washington University, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Lee Rhea
- From the Mallinckrodt Institute of Radiology (D.S.G., C.E.R., M.Z.) and Department of Biostatistics (L.R.), School of Medicine, Washington University, 510 S Kingshighway Blvd, St Louis, MO 63110
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Hwang EJ, Goo JM, Kim HY, Yoon SH, Jin GY, Yi J, Kim Y. Variability in interpretation of low-dose chest CT using computerized assessment in a nationwide lung cancer screening program: comparison of prospective reading at individual institutions and retrospective central reading. Eur Radiol 2020; 31:2845-2855. [PMID: 33123794 DOI: 10.1007/s00330-020-07424-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the degree of variability in computer-assisted interpretation of low-dose chest CTs (LDCTs) among radiologists in a nationwide lung cancer screening (LCS) program, through comparison with a retrospective interpretation from a central laboratory. MATERIALS AND METHODS Consecutive baseline LDCTs (n = 3353) from a nationwide LCS program were investigated. In the institutional reading, 20 radiologists in 14 institutions interpreted LDCTs using computer-aided detection and semi-automated segmentation systems for lung nodules. In the retrospective central review, a single radiologist re-interpreted all LDCTs using the same system, recording any non-calcified nodules ≥ 3 mm without arbitrary rejection of semi-automated segmentation to minimize the intervention of radiologist's discretion. Positive results (requiring additional follow-up LDCTs or diagnostic procedures) were initially classified by the lung CT screening reporting and data system (Lung-RADS) during the interpretation, while the classifications based on the volumetric criteria from the Dutch-Belgian lung cancer screening trial (NELSON) were retrospectively applied. Variabilities in positive rates were assessed with coefficients of variation (CVs). RESULTS In the institutional reading, positive rates by the Lung-RADS ranged from 7.5 to 43.3%, and those by the NELSON ranged from 11.4 to 45.0% across radiologists. The central review exhibited higher positive rates by Lung-RADS (20.0% vs. 27.3%; p < .001) and the NELSON (23.1% vs. 37.0%; p < .001), and lower inter-institution variability (CV, 0.30 vs. 0.12, p = .003 by Lung-RADS; CV, 0.25 vs. 0.12, p = .014 by the NELSON) compared to the institutional reading. CONCLUSION Considerable inter-institution variability in the interpretation of LCS results is caused by different usage of the computer-assisted system. KEY POINTS • Considerable variability existed in the interpretation of screening LDCT among radiologists partly from the different usage of the computerized system. • A retrospective reading of low-dose chest CTs in the central laboratory resulted in reduced variability but an increased positive rate.
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Affiliation(s)
- Eui Jin Hwang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jin Mo Goo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, South Korea
| | - Soon Ho Yoon
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Gong Yong Jin
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, South Korea
| | | | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
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Implementation of the cloud-based computerized interpretation system in a nationwide lung cancer screening with low-dose CT: comparison with the conventional reading system. Eur Radiol 2020; 31:475-485. [PMID: 32797309 DOI: 10.1007/s00330-020-07151-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/10/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to compare the CT interpretation before and after the implementation of a computerized system for lung nodule detection and measurements in a nationwide lung cancer screening program. METHODS Our screening program started in April 2017, with 14 participating institutions. Initially, all CTs were interpreted using interpretation systems in each institution and manual nodule measurement (conventional system). A cloud-based CT interpretation system, equipped with semi-automated measurement and CAD (computer-aided detection) for lung nodules (cloud-based system), was implemented during the project. Positive rates and performances for lung cancer diagnosis based on the Lung-RADS version 1.0 were compared between the conventional and cloud-based systems. RESULTS A total of 1821 (M:F = 1782:39, mean age 62.7 years, 16 confirmed lung cancers) and 4666 participants (M:F = 4560:106, mean age 62.8 years, 31 confirmed lung cancers) were included in the conventional and cloud-based systems, respectively. Significantly more nodules were detected in the cloud-based system (0.76 vs. 1.07 nodule/participant, p < .001). Positive rate did not differ significantly between the two systems (9.9% vs. 11.0%, p = .211), while their variability across institutions was significantly lower in the cloud-based system (coefficients of variability, 0.519 vs. 0.311, p = .018). The Lung-RADS-based sensitivity (93.8% vs. 93.5%, p = .979) and specificity (90.9% vs. 89.6%, p = .132) did not differ significantly between the two systems. CONCLUSION Implementation of CAD and semi-automated measurement for lung nodules in a nationwide lung cancer screening program resulted in increased number of detected nodules and reduced variability in positive rates across institutions. KEY POINTS • Computer-aided CT reading detected more lung nodules than radiologists alone in lung cancer screening. • Positive rate in lung cancer screening did not change with computer-aided reading. • Computer-aided CT reading reduced inter-institutional variability in lung cancer screening.
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Gierada DS, Black WC, Chiles C, Pinsky PF, Yankelevitz DF. Low-Dose CT Screening for Lung Cancer: Evidence from 2 Decades of Study. Radiol Imaging Cancer 2020; 2:e190058. [PMID: 32300760 PMCID: PMC7135238 DOI: 10.1148/rycan.2020190058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/15/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the overwhelmingly greatest cause of cancer death in the United States, accounting for more annual deaths than breast, prostate, and colon cancer combined. Accumulated evidence since the mid to late 1990s, however, indicates that low-dose CT screening of high-risk patients enables detection of lung cancer at an early stage and can reduce the risk of dying from lung cancer. CT screening is now a recommended clinical service in the United States, subject to guidelines and reimbursement requirements intended to standardize practice and optimize the balance of benefits and risks. In this review, the evidence on the effectiveness of CT screening will be summarized and the current guidelines and standards will be described in the context of knowledge gained from lung cancer screening studies. In addition, an overview of the potential advances that may improve CT screening will be presented, and the need to better understand the performance in clinical practice outside of the research trial setting will be discussed. © RSNA, 2020.
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Affiliation(s)
- David S. Gierada
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - William C. Black
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Caroline Chiles
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Paul F. Pinsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - David F. Yankelevitz
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
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Li Q, Li QC, Cao RT, Wang X, Chen RT, Liu K, Fan L, Xiao Y, Zhang ZT, Fu CC, Song Q, Liu W, Fang Q, Liu SY. Detectability of pulmonary nodules by deep learning: results from a phantom study. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42058-019-00015-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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The Added Value of Computer-aided Detection of Small Pulmonary Nodules and Missed Lung Cancers. J Thorac Imaging 2019; 33:390-395. [PMID: 30239461 DOI: 10.1097/rti.0000000000000362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer at its earliest stage is typically manifested on computed tomography as a pulmonary nodule, which could be detected by low-dose multidetector computed tomography technology and the use of thinner collimation. Within the last 2 decades, computer-aided detection (CAD) of pulmonary nodules has been developed to meet the increasing demand for lung cancer screening computed tomography with a larger set of images per scan. This review introduced the basic techniques and then summarized the up-to-date applications of CAD systems in clinical and research programs and in the low-dose lung cancer screening trials, especially in the detection of small pulmonary nodules and missed lung cancers. Many studies have already shown that the CAD systems could increase the sensitivity and reduce the false-positive rate in the diagnosis of pulmonary nodules, especially for the small and isolated nodules. Further improvements to the current CAD schemes are needed to detect nodules accurately, particularly for subsolid nodules.
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Nair A, Bartlett EC, Walsh SLF, Wells AU, Navani N, Hardavella G, Bhalla S, Calandriello L, Devaraj A, Goo JM, Klein JS, MacMahon H, Schaefer-Prokop CM, Seo JB, Sverzellati N, Desai SR. Variable radiological lung nodule evaluation leads to divergent management recommendations. Eur Respir J 2018; 52:13993003.01359-2018. [PMID: 30409817 DOI: 10.1183/13993003.01359-2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/07/2018] [Indexed: 12/18/2022]
Abstract
Radiological evaluation of incidentally detected lung nodules on computed tomography (CT) influences management. We assessed international radiological variation in 1) pulmonary nodule characterisation; 2) hypothetical guideline-derived management; and 3) radiologists' management recommendations.107 radiologists from 25 countries evaluated 69 CT-detected nodules, recording: 1) first-choice composition (solid, part-solid or ground-glass, with percentage confidence); 2) morphological features; 3) dimensions; 4) recommended management; and 5) decision-influencing factors. We modelled hypothetical management decisions on the 2005 and updated 2017 Fleischner Society, and both liberal and parsimonious interpretations of the British Thoracic Society 2015 guidelines.Overall agreement for first-choice nodule composition was good (Fleiss' κ=0.65), but poorest for part-solid nodules (weighted κ 0.62, interquartile range 0.50-0.71). Morphological variables, including spiculation (κ=0.35), showed poor-to-moderate agreement (κ=0.23-0.53). Variation in diameter was greatest at key thresholds (5 mm and 6 mm). Agreement for radiologists' recommendations was poor (κ=0.30); 21% disagreed with the majority. Although agreement within the four guideline-modelled management strategies was good (κ=0.63-0.73), 5-10% of radiologists would disagree with majority decisions if they applied guidelines strictly.Agreement was lowest for part-solid nodules, while significant measurement variation exists at important size thresholds. These variations resulted in generally good agreement for guideline-modelled management, but poor agreement for radiologists' actual recommendations.
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Affiliation(s)
- Arjun Nair
- Dept of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.,Both authors contributed equally
| | - Emily C Bartlett
- Dept of Radiology, King's College Hospital NHS Foundation Trust, London, UK.,Both authors contributed equally
| | - Simon L F Walsh
- Dept of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Athol U Wells
- Dept of Respiratory Medicine, The Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
| | - Neal Navani
- Dept of Thoracic Medicine, UCLH and Lungs for Living Centre, UCL Respiratory, University College London, London, UK
| | | | | | - Lucio Calandriello
- Radiologia Diagnostica e Interventistica Generale - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anand Devaraj
- Dept of Radiology, The Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
| | - Jin Mo Goo
- Seoul National University Hospital, Seoul, South Korea
| | - Jeffrey S Klein
- The University of Vermont Medical Center, Burlington, VT, USA
| | - Heber MacMahon
- Dept of Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Joon-Beom Seo
- Dept of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Nicola Sverzellati
- Dept of Clinical Sciences, Division of Radiology, University of Parma, Parma, Italy
| | - Sujal R Desai
- Dept of Radiology, King's College Hospital NHS Foundation Trust, London, UK.,Dept of Radiology, The Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Möller J, Steyn T, Combrinck N, Joubert G, Sherriff A, van Rensburg JJ. Inter-observer variability influences the Lugano classification when restaging lymphoma. SA J Radiol 2018; 22:1357. [PMID: 31754505 PMCID: PMC6837819 DOI: 10.4102/sajr.v22i1.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/20/2018] [Indexed: 11/28/2022] Open
Abstract
Background Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its robustness in the local setting should be determined. Objectives To determine the Inter-observer variability in response assignment when applying the LC in patients with lymphoma who were staged and restaged with computed tomography. In case of excessive discordance, specific mitigating measures will have to be taken before and during any proposed implementation of the LC. Method A total of 61 computed tomography scans in 21 patients were evaluated independently by four reviewers according to the LC, of which 21 scans were done at baseline, 21 at initial restaging and 19 at follow-up restaging. A retrospective comparative analysis was performed. Kappa values were calculated to determine agreement between observers. Results Only a moderate inter-observer agreement of 52% in the overall response classification was demonstrated. The most important sources of discrepancy were inconsistency in the assessment of target lesion regression to normal, determining the percentage change in the summed cross-sectional area of the target lesions and ascribing new lesions as either due to lymphoma or other causes. Conclusion Implementing the Lugano classification when restaging lymphoma is desirable to improve consistency and to conform to international guidelines. However, our study shows substantial inter-observer variability in response classification, potentially altering the treatment plan. Dedicated training and continuous quality control should, therefore, accompany the process.
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Affiliation(s)
- Jacobus Möller
- Department of Clinical Imaging Sciences, Universitas Academic Hospital and University of the Free State, South Africa
| | - Tiaan Steyn
- Department of Clinical Imaging Sciences, Universitas Academic Hospital and University of the Free State, South Africa
| | - Nantes Combrinck
- Department of Clinical Imaging Sciences, Universitas Academic Hospital and University of the Free State, South Africa
| | - Gina Joubert
- Department of Biostatistics, University of the Free State, South Africa
| | - Alicia Sherriff
- Department of Oncology, Universitas Academic Hospital and University of the Free State, South Africa
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A cloud-based computer-aided detection system improves identification of lung nodules on computed tomography scans of patients with extra-thoracic malignancies. Eur Radiol 2018; 29:144-152. [DOI: 10.1007/s00330-018-5528-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 01/04/2023]
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Kandathil A, Kay F, Batra K, Saboo SS, Rajiah P. Advances in Computed Tomography in Thoracic Imaging. Semin Roentgenol 2018; 53:157-170. [PMID: 29861007 DOI: 10.1053/j.ro.2018.02.006] [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]
Affiliation(s)
- Asha Kandathil
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Fernando Kay
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Kiran Batra
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Sachin S Saboo
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX.
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Vlahos I, Stefanidis K, Sheard S, Nair A, Sayer C, Moser J. Lung cancer screening: nodule identification and characterization. Transl Lung Cancer Res 2018; 7:288-303. [PMID: 30050767 DOI: 10.21037/tlcr.2018.05.02] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The accurate identification and characterization of small pulmonary nodules at low-dose CT is an essential requirement for the implementation of effective lung cancer screening. Individual reader detection performance is influenced by nodule characteristics and technical CT parameters but can be improved by training, the application of CT techniques, and by computer-aided techniques. However, the evaluation of nodule detection in lung cancer screening trials differs from the assessment of individual readers as it incorporates multiple readers, their inter-observer variability, reporting thresholds, and reflects the program accuracy in identifying lung cancer. Understanding detection and interpretation errors in screening trials aids in the implementation of lung cancer screening in clinical practice. Indeed, as CT screening moves to ever lower radiation doses, radiologists must be cognisant of new technical challenges in nodule assessment. Screen detected lung cancers demonstrate distinct morphological features from incidentally or symptomatically detected lung cancers. Hence characterization of screen detected nodules requires an awareness of emerging concepts in early lung cancer appearances and their impact on radiological assessment and malignancy prediction models. Ultimately many nodules remain indeterminate, but further imaging evaluation can be appropriate with judicious utilization of contrast enhanced CT or MRI techniques or functional evaluation by PET-CT.
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Affiliation(s)
- Ioannis Vlahos
- St George's NHS Foundation Hospitals Trust and School of Medicine, London, UK
| | | | | | - Arjun Nair
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Charles Sayer
- Brighton and Sussex University Hospitals Trust, Haywards Heath, UK
| | - Joanne Moser
- St George's NHS Foundation Hospitals Trust and School of Medicine, London, UK
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Jin S, Zhang B, Zhang L, Li S, Li S, Li P. Lung nodules assessment in ultra-low-dose CT with iterative reconstruction compared to conventional dose CT. Quant Imaging Med Surg 2018; 8:480-490. [PMID: 30050782 DOI: 10.21037/qims.2018.06.05] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background To retrospectively assess whether the low-voltage lung CT scan coupled with iterative reconstruction algorithms can be an optimal scanning method for measuring the size and density of lung nodules in cancer patients. Methods Eighty two cancer patients receiving both chest scan with low-voltage (80 kV) and abdomen CT scan with standard voltage (120 kV) were enrolled in this study. Lung nodules were measured manually and semi-automatically by two different computer-aided diagnosis (CAD) systems. The nodules were then divided into large-, medium- and small-size groups based on their largest diameter. Additionally, the nodules were categorized into three different groups according to their density: calcified, solid and partial-solid nodules. The 3D volumes, average diameter and CT value of lung nodules were measured using the two CAD semi-automated systems, and the CT values were compared with regards to the different tube voltages. Furthermore, the accuracy and reliability of CAD systems were validated in the large nodules. Results The scores of subjective evaluation indicated that the quality of lung nodule images yielded optimal clinical diagnostic value for both 80 kV (2.35±0.054) and 120 kV (2.51±0.053) scanning methods, with a strong inter-observer consistency (Kappa =0.848 and 0.829, respectively). Intraclass correlation coefficient (ICC) and Bland-Altman plot revealed that two CAD systems produced the consistent results. Mean CT values of large nodules (n=18) were significantly different between 80 and 120 kV (-28.11±47.39 vs. -39.61±43.32 HU, P<0.05). Notably, the CT value of 80 kV was 33.96% higher than that of 120 kV. Moreover, the volumes of 66 solid lung nodules demonstrated a statistically significant difference (1.68%) between 80 kV group (740.89±156.97 mm3) and 120 kV group (753.48±157.92 mm3, P<0.05). Furthermore, significant differences were observed in the CT values of large nodules between 80 and 120 kV groups (25.64±12.67 vs. 13.89±9.78 HU, P<0.05), but not the maximum diameters (12.08±1.56 vs. 12.13±1.56 mm, P>0.05). Conclusions Our study suggests that detection of lung nodules with ultra-low-dose CT can yield an excellent image quality and optimal diagnostic values as compared to the standard dose CT. Therefore, CT scan with low voltage of 80 kV CT scan can be leveraged to improve the diagnosis and surveillance of lung nodules measured less than 30 mm in diameter. Further investigation with a larger sample size is warranted to confirm our findings, particularly the increased CT values of large nodules and the greater volume of solid nodules after exposure to low-dose CT scan.
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Affiliation(s)
- Shiqi Jin
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Bo Zhang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Lina Zhang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Shu Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Songbai Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Peiling Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
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Kim H, Park CM. Current perspectives for the size measurement of screening-detected lung nodules. J Thorac Dis 2018; 10:1242-1244. [PMID: 29708162 DOI: 10.21037/jtd.2018.03.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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Garzelli L, Goo JM, Ahn SY, Chae KJ, Park CM, Jung J, Hong H. Improving the prediction of lung adenocarcinoma invasive component on CT: Value of a vessel removal algorithm during software segmentation of subsolid nodules. Eur J Radiol 2018; 100:58-65. [DOI: 10.1016/j.ejrad.2018.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 11/15/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
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Zia ur Rehman M, Javaid M, Shah SIA, Gilani SO, Jamil M, Butt SI. An appraisal of nodules detection techniques for lung cancer in CT images. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ohno Y, Aoyagi K, Chen Q, Sugihara N, Iwasawa T, Okada F, Aoki T. Comparison of computer-aided detection (CADe) capability for pulmonary nodules among standard-, reduced- and ultra-low-dose CTs with and without hybrid type iterative reconstruction technique. Eur J Radiol 2018; 100:49-57. [PMID: 29496079 DOI: 10.1016/j.ejrad.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/07/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To directly compare the effect of a reconstruction algorithm on nodule detection capability of the computer-aided detection (CADe) system using standard-dose, reduced-dose and ultra-low dose chest CTs with and without adaptive iterative dose reduction 3D (AIDR 3D). MATERIALS AND METHODS Our institutional review board approved this study, and written informed consent was obtained from each patient. Standard-, reduced- and ultra-low-dose chest CTs (250 mA, 50 mA and 10 mA) were used to examine 40 patients, 21 males (mean age ± standard deviation: 63.1 ± 11.0 years) and 19 females (mean age, 65.1 ± 12.7 years), and reconstructed as 1 mm-thick sections. Detection of nodule equal to more than 4 mm in dimeter was automatically performed by our proprietary CADe software. The utility of iterative reconstruction method for improving nodule detection capability, sensitivity and false positive rate (/case) of the CADe system using all protocols were compared by means of McNemar's test or signed rank test. RESULTS Sensitivity (SE: 0.43) and false-positive rate (FPR: 7.88) of ultra-low-dose CT without AIDR 3D was significantly inferior to those of standard-dose CTs (with AIDR 3D: SE, 0.78, p < .0001, FPR, 3.05, p < .0001; and without AIDR 3D: SE, 0.80, p < .0001, FPR: 2.63, p < .0001), reduced-dose CTs (with AIDR 3D: SE, 0.81, p < .0001, FPR, 3.05, p < .0001; and without AIDR 3D: SE, 0.62, p < .0001, FPR: 2.95, p < .0001) and ultra-low-dose CT with AIDR 3D (SE, 0.79, p < .0001, FPR, 4.88, p = .0001). CONCLUSION The AIDR 3D has a significant positive effect on nodule detection capability of the CADe system even when radiation dose is reduced.
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Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Kota Aoyagi
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Qi Chen
- Canon Medical Systems (China) Co., Ltd., Beijing, China
| | - Naoki Sugihara
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Fumito Okada
- Department of Radiology, Faculty of Medicine, University of Oita, Yufu, Oita, Japan
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Computer-Aided Diagnosis of Ground-Glass Opacity Nodules Using Open-Source Software for Quantifying Tumor Heterogeneity. AJR Am J Roentgenol 2017; 209:1216-1227. [PMID: 29045176 DOI: 10.2214/ajr.17.17857] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purposes of this study are to develop quantitative imaging biomarkers obtained from high-resolution CTs for classifying ground-glass nodules (GGNs) into atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC); to evaluate the utility of contrast enhancement for differential diagnosis; and to develop and validate a support vector machine (SVM) to predict the GGN type. MATERIALS AND METHODS The heterogeneity of 248 GGNs was quantified using custom software. Statistical analysis with a univariate Kruskal-Wallis test was performed to evaluate metrics for significant differences among the four GGN groups. The heterogeneity metrics were used to train a SVM to learn and predict the lesion type. RESULTS Fifty of 57 and 51 of 57 heterogeneity metrics showed statistically significant differences among the four GGN groups on unenhanced and contrast-enhanced CT scans, respectively. The SVM predicted lesion type with greater accuracy than did three expert radiologists. The accuracy of classifying the GGNs into the four groups on the basis of the SVM algorithm was 70.9%, whereas the accuracy of the radiologists was 39.6%. The accuracy of SVM in classifying the AIS and MIA nodules was 73.1%, and the accuracy of the radiologists was 35.7%. For indolent versus invasive lesions, the accuracy of the SVM was 88.1%, and the accuracy of the radiologists was 60.8%. We found that contrast enhancement does not significantly improve the differential diagnosis of GGNs. CONCLUSION Compared with the GGN classification done by the three radiologists, the SVM trained regarding all the heterogeneity metrics showed significantly higher accuracy in classifying the lesions into the four groups, differentiating between AIS and MIA and between indolent and invasive lesions. Contrast enhancement did not improve the differential diagnosis of GGNs.
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Devaraj A, van Ginneken B, Nair A, Baldwin D. Use of Volumetry for Lung Nodule Management: Theory and Practice. Radiology 2017; 284:630-644. [DOI: 10.1148/radiol.2017151022] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Anand Devaraj
- From the Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England (A.D.); Department of of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, the Netherlands (B.v.G.); Department of Radiology, Guy’s & St Thomas’ NHS Foundation Trust, London, England (A.N.); and Department of Respiratory Medicine, Nottingham University Hospitals and University of Nottingham, Nottingham, England
| | - Bram van Ginneken
- From the Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England (A.D.); Department of of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, the Netherlands (B.v.G.); Department of Radiology, Guy’s & St Thomas’ NHS Foundation Trust, London, England (A.N.); and Department of Respiratory Medicine, Nottingham University Hospitals and University of Nottingham, Nottingham, England
| | - Arjun Nair
- From the Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England (A.D.); Department of of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, the Netherlands (B.v.G.); Department of Radiology, Guy’s & St Thomas’ NHS Foundation Trust, London, England (A.N.); and Department of Respiratory Medicine, Nottingham University Hospitals and University of Nottingham, Nottingham, England
| | - David Baldwin
- From the Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England (A.D.); Department of of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, the Netherlands (B.v.G.); Department of Radiology, Guy’s & St Thomas’ NHS Foundation Trust, London, England (A.N.); and Department of Respiratory Medicine, Nottingham University Hospitals and University of Nottingham, Nottingham, England
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Fintelmann FJ. Elements of a Lung Cancer Screening Program. Semin Roentgenol 2017; 52:129-131. [PMID: 28734393 DOI: 10.1053/j.ro.2017.06.004] [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]
Affiliation(s)
- Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Thoracic Imaging and Intervention, Boston, MA.
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A review of lung cancer screening and the role of computer-aided detection. Clin Radiol 2017; 72:433-442. [DOI: 10.1016/j.crad.2017.01.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 12/26/2022]
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Horowitz TS. Prevalence in Visual Search: From the Clinic to the Lab and Back Again. JAPANESE PSYCHOLOGICAL RESEARCH 2017. [DOI: 10.1111/jpr.12153] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Setio AAA, Jacobs C, Gelderblom J, van Ginneken B. Automatic detection of large pulmonary solid nodules in thoracic CT images. Med Phys 2016; 42:5642-53. [PMID: 26429238 DOI: 10.1118/1.4929562] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Current computer-aided detection (CAD) systems for pulmonary nodules in computed tomography (CT) scans have a good performance for relatively small nodules, but often fail to detect the much rarer larger nodules, which are more likely to be cancerous. We present a novel CAD system specifically designed to detect solid nodules larger than 10 mm. METHODS The proposed detection pipeline is initiated by a three-dimensional lung segmentation algorithm optimized to include large nodules attached to the pleural wall via morphological processing. An additional preprocessing is used to mask out structures outside the pleural space to ensure that pleural and parenchymal nodules have a similar appearance. Next, nodule candidates are obtained via a multistage process of thresholding and morphological operations, to detect both larger and smaller candidates. After segmenting each candidate, a set of 24 features based on intensity, shape, blobness, and spatial context are computed. A radial basis support vector machine (SVM) classifier was used to classify nodule candidates, and performance was evaluated using ten-fold cross-validation on the full publicly available lung image database consortium database. RESULTS The proposed CAD system reaches a sensitivity of 98.3% (234/238) and 94.1% (224/238) large nodules at an average of 4.0 and 1.0 false positives/scan, respectively. CONCLUSIONS The authors conclude that the proposed dedicated CAD system for large pulmonary nodules can identify the vast majority of highly suspicious lesions in thoracic CT scans with a small number of false positives.
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Affiliation(s)
- Arnaud A A Setio
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Colin Jacobs
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Jaap Gelderblom
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands and Fraunhofer MEVIS, Bremen 28359, Germany
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Maximum-Intensity-Projection and Computer-Aided-Detection Algorithms as Stand-Alone Reader Devices in Lung Cancer Screening Using Different Dose Levels and Reconstruction Kernels. AJR Am J Roentgenol 2016; 207:282-8. [PMID: 27249174 DOI: 10.2214/ajr.15.15588] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate lung nodule detection rates on standard and microdose chest CT with two different computer-aided detection systems (SyngoCT-CAD, VA 20, Siemens Healthcare [CAD1]; Lung CAD, IntelliSpace Portal DX Server, Philips Healthcare [CAD2]) as well as maximum-intensity-projection (MIP) images. We also assessed the impact of different reconstruction kernels. MATERIALS AND METHODS Standard and microdose CT using three reconstruction kernels (i30, i50, i70) was performed with an anthropomorphic chest phantom. We placed 133 ground-glass and 133 solid nodules (diameters of 5 mm, 8 mm, 10 mm, and 12 mm) in 55 phantoms. Four blinded readers evaluated the MIP images; one recorded the results of CAD1 and CAD2. Sensitivities for CAD and MIP nodule detection on standard dose and microdose CT were calculated for each reconstruction kernel. RESULTS Dose for microdose CT was significantly less than that for standard-dose CT (0.1323 mSv vs 1.65 mSv; p < 0.0001). CAD1 delivered superior results compared with CAD2 for standard-dose and microdose CT (p < 0.0001). At microdose level, the best stand-alone sensitivity (97.6%) was comparable with CAD1 sensitivity (96.0%; p = 0.36; both with i30 reconstruction kernel). Pooled sensitivities for all nodules, doses, and reconstruction kernels on CAD1 ranged from 88.9% to 97.3% versus 49.6% to 73.9% for CAD2. The best sensitivity was achieved with standard-dose CT, i50 kernel, and CAD1 (97.3%) versus 96% with microdose CT, i30 or i50 kernel, and CAD1. MIP images and CAD1 had similar performance at both dose levels (p = 0.1313 and p = 0.48). CONCLUSION Submillisievert CT is feasible for detecting solid and ground-glass nodules that require soft-tissue kernels for MIP and CAD systems to achieve acceptable sensitivities. MIP reconstructions remain a valuable adjunct to the interpretation of chest CT for increasing sensitivity and have the advantage of significantly lower false-positive rates.
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Quantitative Computed Tomography Imaging Biomarkers in the Diagnosis and Management of Lung Cancer. Invest Radiol 2016; 50:571-83. [PMID: 25811833 DOI: 10.1097/rli.0000000000000152] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tumor diameter has traditionally been used as a standard metric in terms of diagnosis and prognosis prediction of lung cancer. However, recent advances in imaging techniques and data analyses have enabled novel quantitative imaging biomarkers that can characterize disease status more comprehensively and/or predict tumor behavior more precisely. The most widely used imaging modality for lung tumor assessment is computed tomography. Therefore, we focused on computed tomography imaging biomarkers such as tumor volume and mass, ground-glass opacities, perfusion parameters, as well as texture features in this review. Herein, we first appraised the conventional 1- or 2-dimensional measurement with brief discussion on their limits and then introduced the potential imaging biomarkers with emphasis on the current understanding of their clinical usefulness with respect to the malignancy differentiation, treatment response monitoring, and patient outcome prediction.
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Advanced imaging tools in pulmonary nodule detection and surveillance. Clin Imaging 2016; 40:296-301. [PMID: 26916752 DOI: 10.1016/j.clinimag.2016.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 11/23/2022]
Abstract
Lung cancer is a leading cause of death worldwide. The National Lung Screening Trial has demonstrated that lung cancer screening can reduce lung cancer specific and all cause mortality. With approval of national coverage for lung cancer screening, it is expected that an increase in exams related to pulmonary nodule detection and surveillance will ensue. Advanced imaging technologies for nodule detection and surveillance will be more important than ever. While computed tomography (CT) remains the modality of choice, other emerging modalities such as magnetic resonance imaging provides viable alternatives to CT.
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Effect of radiation dose reduction and iterative reconstruction on computer-aided detection of pulmonary nodules: Intra-individual comparison. Eur J Radiol 2015; 85:346-51. [PMID: 26781139 DOI: 10.1016/j.ejrad.2015.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/30/2015] [Accepted: 12/05/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of radiation dose reduction and iterative reconstruction (IR) on the performance of computer-aided detection (CAD) for pulmonary nodules. METHODS In this prospective study twenty-five patients were included who were scanned for pulmonary nodule follow-up. Image acquisition was performed at routine dose and three reduced dose levels in a single session by decreasing mAs-values with 45%, 60% and 75%. Tube voltage was fixed at 120 kVp for patients ≥ 80 kg and 100 kVp for patients < 80 kg. Data were reconstructed with filtered back projection (FBP), iDose(4) (levels 1,4,6) and IMR (levels 1-3). All noncalcified solid pulmonary nodules ≥ 4 mm identified by two radiologists in consensus served as the reference standard. Subsequently, nodule volume was measured with CAD software and compared to the reference consensus. The numbers of true-positives, false-positives and missed pulmonary nodules were evaluated as well as the sensitivity. RESULTS Median effective radiation dose was 2.2 mSv at routine dose and 1.2, 0.9 and 0.6 mSv at respectively 45%, 60% and 75% reduced dose. A total of 28 pulmonary nodules were included. With FBP at routine dose, 89% (25/28) of the nodules were correctly identified by CAD. This was similar at reduced dose levels with FBP, iDose(4) and IMR. CAD resulted in a median number of false-positives findings of 11 per scan with FBP at routine dose (93% of the CAD marks) increasing to 15 per scan with iDose(4) (95% of the CAD marks) and 26 per scan (96% of the CAD marks) with IMR at the lowest dose level. CONCLUSION CAD can identify pulmonary nodules at submillisievert dose levels with FBP, hybrid and model-based IR. However, the number of false-positive findings increased using hybrid and especially model-based IR at submillisievert dose while dose reduction did not affect the number of false-positives with FBP.
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Abstract
Fundamental to the diagnosis of lung cancer in computed tomography (CT) scans is the detection and interpretation of lung nodules. As the capabilities of CT scanners have advanced, higher levels of spatial resolution reveal tinier lung abnormalities. Not all detected lung nodules should be reported; however, radiologists strive to detect all nodules that might have relevance to cancer diagnosis. Although medium to large lung nodules are detected consistently, interreader agreement and reader sensitivity for lung nodule detection diminish substantially as the nodule size falls below 8 to 10 mm. The difficulty in establishing an absolute reference standard presents a challenge to the reliability of studies performed to evaluate lung nodule detection. In the interest of improving detection performance, investigators are using eye tracking to analyze the effectiveness with which radiologists search CT scans relative to their ability to recognize nodules within their search path in order to determine whether strategies might exist to improve performance across readers. Beyond the viewing of transverse CT reconstructions, image processing techniques such as thin-slab maximum-intensity projections are used to substantially improve reader performance. Finally, the development of computer-aided detection has continued to evolve with the expectation that one day it will serve routinely as a tireless partner to the radiologist to enhance detection performance without significant prolongation of the interpretive process. This review provides an introduction to the current understanding of these varied issues as we enter the era of widespread lung cancer screening.
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Fintelmann FJ, Bernheim A, Digumarthy SR, Lennes IT, Kalra MK, Gilman MD, Sharma A, Flores EJ, Muse VV, Shepard JAO. The 10 Pillars of Lung Cancer Screening: Rationale and Logistics of a Lung Cancer Screening Program. Radiographics 2015; 35:1893-908. [PMID: 26495797 DOI: 10.1148/rg.2015150079] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
On the basis of the National Lung Screening Trial data released in 2011, the U.S. Preventive Services Task Force made lung cancer screening (LCS) with low-dose computed tomography (CT) a public health recommendation in 2013. The Centers for Medicare and Medicaid Services (CMS) currently reimburse LCS for asymptomatic individuals aged 55-77 years who have a tobacco smoking history of at least 30 pack-years and who are either currently smoking or had quit less than 15 years earlier. Commercial insurers reimburse the cost of LCS for individuals aged 55-80 years with the same smoking history. Effective care for the millions of Americans who qualify for LCS requires an organized step-wise approach. The 10-pillar model reflects the elements required to support a successful LCS program: eligibility, education, examination ordering, image acquisition, image review, communication, referral network, quality improvement, reimbursement, and research frontiers. Examination ordering can be coupled with decision support to ensure that only eligible individuals undergo LCS. Communication of results revolves around the Lung Imaging Reporting and Data System (Lung-RADS) from the American College of Radiology. Lung-RADS is a structured decision-oriented reporting system designed to minimize the rate of false-positive screening examination results. With nodule size and morphology as discriminators, Lung-RADS links nodule management pathways to the variety of nodules present on LCS CT studies. Tracking of patient outcomes is facilitated by a CMS-approved national registry maintained by the American College of Radiology. Online supplemental material is available for this article.
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Affiliation(s)
- Florian J Fintelmann
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Adam Bernheim
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Subba R Digumarthy
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Inga T Lennes
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Mannudeep K Kalra
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Matthew D Gilman
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Amita Sharma
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Efren J Flores
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Victorine V Muse
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Jo-Anne O Shepard
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
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Solid, part-solid, or non-solid?: classification of pulmonary nodules in low-dose chest computed tomography by a computer-aided diagnosis system. Invest Radiol 2015; 50:168-73. [PMID: 25478740 DOI: 10.1097/rli.0000000000000121] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to develop and validate a computer-aided diagnosis (CAD) tool for automatic classification of pulmonary nodules seen on low-dose computed tomography into solid, part-solid, and non-solid. MATERIALS AND METHODS Study lesions were randomly selected from 2 sites participating in the Dutch-Belgian NELSON lung cancer screening trial. On the basis of the annotations made by the screening radiologists, 50 part-solid and 50 non-solid pulmonary nodules with a diameter between 5 and 30 mm were randomly selected from the 2 sites. For each unique nodule, 1 low-dose chest computed tomographic scan was randomly selected, in which the nodule was visible. In addition, 50 solid nodules in the same size range were randomly selected. A completely automatic 3-dimensional segmentation-based classification system was developed, which analyzes the pulmonary nodule, extracting intensity-, texture-, and segmentation-based features to perform a statistical classification. In addition to the nodule classification by the screening radiologists, an independent rating of all nodules by 3 experienced thoracic radiologists was performed. Performance of CAD was evaluated by comparing the agreement between CAD and human experts and among human experts using the Cohen κ statistics. RESULTS Pairwise agreement for the differentiation between solid, part-solid, and non-solid nodules between CAD and each of the human experts had a κ range between 0.54 and 0.72. The interobserver agreement among the human experts was in the same range (κ range, 0.56-0.81). CONCLUSIONS A novel automated classification tool for pulmonary nodules achieved good agreement with the human experts, yielding κ values in the same range as the interobserver agreement. Computer-aided diagnosis may aid radiologists in selecting the appropriate workup for pulmonary nodules.
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Penn A, Ma M, Chou BB, Tseng JR, Phan P. Inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. Acta Radiol 2015; 56:1180-6. [PMID: 25293951 DOI: 10.1177/0284185114551975] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/27/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2013, the Fleischner Society published recommendations for managing subsolid pulmonary nodules. Inter-reader variability has not yet been defined and has potential implications for the ease and reproducibility of applying the guidelines to clinical practice. PURPOSE To evaluate inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. MATERIAL AND METHODS Potential nodules were identified through a systematic retrospective review of CT studies that reported a ground-glass lesion. Three radiologists decided whether these lesions fit criteria of a subsolid nodule and thus merit application of the Fleischner Society guidelines, determined if a solid component was present, and measured each component in two dimensions. Final management recommendations were based on these intermediate decisions. Inter-reader variability for management was calculated and Fleiss' kappa was used to determine significance. Logistic regression and Fisher's exact test determined whether management was contingent on each intermediate decision. RESULTS Forty-four nodules with mean diameter of 9.4 mm were evaluated by three radiologists. Final management recommendations were in agreement for 93 out of 132 cases (70.4%, kappa = 0.56). Inter-reader variability in management recommendation was contingent on disagreement over whether a pulmonary lesion fit criteria of a subsolid nodule for 24 cases (P < 0.01), whether there was a solid component for 10 cases (P = 0.01), and whether the measurement met the threshold of 5 mm for five cases (P = 0.12). CONCLUSION There is moderate inter-reader variability when applying the 2013 Fleischner Society management recommendations. Significant contributors of variability include whether the potential lesions fit subsolid nodule criteria and whether a solid component is present. Measurement variability does not significantly affect the final management decisions.
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Affiliation(s)
- Alex Penn
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Mingming Ma
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Benjamin B Chou
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jeffrey R Tseng
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Peter Phan
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
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Wielpütz MO, Wroblewski J, Lederlin M, Dinkel J, Eichinger M, Koenigkam-Santos M, Biederer J, Kauczor HU, Puderbach MU, Jobst BJ. Computer-aided detection of artificial pulmonary nodules using an ex vivo lung phantom: Influence of exposure parameters and iterative reconstruction. Eur J Radiol 2015; 84:1005-11. [DOI: 10.1016/j.ejrad.2015.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/28/2015] [Accepted: 01/31/2015] [Indexed: 11/26/2022]
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Nayate AP, Dubroff JG, Schmitt JE, Nasrallah I, Kishore R, Mankoff D, Pryma DA. Use of Standardized Uptake Value Ratios Decreases Interreader Variability of [18F] Florbetapir PET Brain Scan Interpretation. AJNR Am J Neuroradiol 2015; 36:1237-44. [PMID: 25767185 DOI: 10.3174/ajnr.a4281] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 01/12/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Fluorine-18 florbetapir is a recently developed β-amyloid plaque positron-emission tomography imaging agent with high sensitivity, specificity, and accuracy in the detection of moderate-to-frequent cerebral cortical β-amyloid plaque. However, the FDA has expressed concerns about the consistency of interpretation of [(18)F] florbetapir PET brain scans. We hypothesized that incorporating automated cerebral-to-whole-cerebellar standardized uptake value ratios into [(18)F] florbetapir PET brain scan interpretation would reduce this interreader variability. MATERIALS AND METHODS This randomized, blinded-reader study used previously acquired [(18)F] florbetapir scans from 30 anonymized patients who were enrolled in the Alzheimer's Disease Neuroimaging Initiative 2. In 4 separate, blinded-reading sessions, 5 readers classified 30 cases as positive or negative for significant β-amyloid deposition either qualitatively alone or qualitatively with additional adjunct software that determined standardized uptake value ratios. A κ coefficient was used to calculate interreader agreement with and without the use of standardized uptake value ratios. RESULTS There was complete interreader agreement on 20/30 cases of [(18)F] florbetapir PET brain scans by using qualitative interpretation and on 27/30 scans interpreted with the adjunct use of standardized uptake value ratios. The κ coefficient for the studies read with standardized uptake value ratios (0.92) was significantly higher compared with the qualitatively read studies (0.69, P = .006). CONCLUSIONS Use of standardized uptake value ratios improves interreader agreement in the interpretation of [(18)F] florbetapir images.
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Affiliation(s)
- A P Nayate
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J G Dubroff
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J E Schmitt
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - I Nasrallah
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R Kishore
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D Mankoff
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D A Pryma
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Pulmonary Nodule Characterization, Including Computer Analysis and Quantitative Features. J Thorac Imaging 2015; 30:139-56. [DOI: 10.1097/rti.0000000000000137] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nordholm-Carstensen A, Jorgensen LN, Wille-Jørgensen PA, Hansen H, Harling H. Indeterminate Pulmonary Nodules in Colorectal-Cancer: Do Radiologists Agree? Ann Surg Oncol 2014; 22:543-9. [DOI: 10.1245/s10434-014-4063-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Indexed: 12/21/2022]
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Wang YXJ, Gong JS, Suzuki K, Morcos SK. Evidence based imaging strategies for solitary pulmonary nodule. J Thorac Dis 2014; 6:872-87. [PMID: 25093083 DOI: 10.3978/j.issn.2072-1439.2014.07.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/29/2014] [Indexed: 12/21/2022]
Abstract
Solitary pulmonary nodule (SPN) is defined as a rounded opacity ≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.
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Affiliation(s)
- Yi-Xiang J Wang
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Jing-Shan Gong
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Kenji Suzuki
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Sameh K Morcos
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
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