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Jungblut L, Euler A, Landsmann A, Englmaier V, Mergen V, Sefirovic M, Frauenfelder T. Pulmonary nodule visualization and evaluation of AI-based detection at various ultra-low-dose levels using photon-counting detector CT. Acta Radiol 2024; 65:1238-1245. [PMID: 39279297 DOI: 10.1177/02841851241275289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
BACKGROUND Radiation dose should be as low as reasonably achievable. With the invention of photon-counting detector computed tomography (PCD-CT), the radiation dose may be considerably reduced. PURPOSE To evaluate the potential of PCD-CT for dose reduction in pulmonary nodule visualization for human readers as well as for computer-aided detection (CAD) studies. MATERIAL AND METHODS A chest phantom containing pulmonary nodules of different sizes/densities (range 3-12 mm and -800-100 HU) was scanned on a PCD-CT with standard low-dose protocol as well as with half, quarter, and 1/40 dose (CTDIvol 0.4-0.03 mGy). Dose-matched scans were performed on a third-generation energy-integrating detector CT (EID-CT). Evaluation of nodule visualization and detectability was performed by two blinded radiologists. Subjective image quality was rated on a 5-point Likert scale. Artificial intelligence (AI)-based nodule detection was performed using commercially available software. RESULTS Highest image noise was found at the lowest dose setting of 1/40 radiation dose (eff. dose = 0.01mSv) with 166.1 ± 18.5 HU for PCD-CT and 351.8 ± 53.0 HU for EID-CT. Overall sensitivity was 100% versus 93% at standard low-dose protocol (eff. dose = 0.2 mSv) for PCD-CT and EID-CT, respectively. At the half radiation dose, sensitivity remained 100% for human reader and CAD studies in PCD-CT. At the quarter radiation dose, PCD-CT achieved the same results as EID-CT at the standard radiation dose setting (93%, P = 1.00) in human reading studies. The AI-CAD system delivered a sensitivity of 93% at the lowest radiation dose level in PCD-CT. CONCLUSION At half dose, PCD CT showed pulmonary nodules similar to full-dose PCD, and at quarter dose, PCD CT performed comparably to standard low-dose EID CT. The CAD algorithm is effective even at ultra-low doses.
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Affiliation(s)
- Lisa Jungblut
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - André Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Landsmann
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vanessa Englmaier
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor Mergen
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Medina Sefirovic
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Digital Tomosynthesis as a Problem-Solving Technique to Confirm or Exclude Pulmonary Lesions in Hidden Areas of the Chest. Diagnostics (Basel) 2023; 13:diagnostics13061010. [PMID: 36980318 PMCID: PMC10046899 DOI: 10.3390/diagnostics13061010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Objectives: To evaluate the capability of digital tomosynthesis (DTS) to characterize suspected pulmonary lesions in the so-called hidden areas at chest X-ray (CXR). Materials and Methods: Among 726 patients with suspected pulmonary lesions at CXR who underwent DTS, 353 patients (201 males, 152 females; age 71.5 ± 10.4 years) revealed suspected pulmonary lesions in the apical, hilar, retrocardiac, or paradiaphragmatic lung zones and were retrospectively included. Two readers analyzed CXR and DTS images and provided a confidence score: 1 or 2 = definitely or probably benign pulmonary or extra-pulmonary lesion, or pulmonary pseudo-lesion deserving no further diagnostic work-up; 3 = indeterminate lesion; 4 or 5 = probably or definitely pulmonary lesion deserving further diagnostic work-up by CT. The nature of DTS findings was proven by CT (n = 108) or CXR during follow-up (n = 245). Results: In 62/353 patients the suspected lung lesions were located in the lung apex, in 92/353 in the hilar region, in 59/353 in the retrocardiac region, and in 140/353 in the paradiaphragmatic region. DTS correctly characterized the CXR findings as benign pulmonary or extrapulmonary lesion (score 1 or 2) in 43/62 patients (69%) in the lung apex region, in 56/92 (61%) in the pulmonary hilar region, in 40/59 (67%) in the retrocardiac region, and in 106/140 (76%) in the paradiaphragmatic region, while correctly recommending CT in the remaining cases due to the presence of true solid pulmonary lesion, with the exception of 22 false negative findings (60 false positive findings). DTS showed a significantly (p < 0.05) increased sensitivity, specificity, and overall diagnostic accuracy and area under ROC curve compared to CXR alone. Conclusions: DTS allowed confirmation or exclusion of the presence of true pulmonary lesions in the hidden areas of the chest.
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Burgos D, Blumenkopf B, Afshari A, Snodderly K, Pfefer TJ. Biomimetic tissue phantoms for neurosurgical near-infrared fluorescence imaging. NEUROPHOTONICS 2023; 10:015007. [PMID: 36936998 PMCID: PMC10015182 DOI: 10.1117/1.nph.10.1.015007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
SIGNIFICANCE Neurosurgical fluorescence imaging is a well-established clinical approach with a growing range of indications for use. However, this technology lacks effective phantom-based tools for development, performance testing, and clinician training. AIM Our primary aim was to develop and evaluate 3D-printed phantoms capable of optically and morphologically simulating neurovasculature under fluorescence angiography. APPROACH Volumetric digital maps of the circle of Willis with basilar and posterior communicator artery aneurysms, along with surrounding cerebral tissue, were generated. Phantoms were fabricated with a stereolithography printer using custom photopolymer composites, then visualized under white light and near-infrared fluorescence imaging. RESULTS Feature sizes of printed components were found to be within 13% of digital models. Phantoms exhibited realistic optical properties and convincingly recapitulated fluorescence angiography scenes. CONCLUSIONS Methods identified in this study can facilitate the development of realistic phantoms as powerful new tools for fluorescence imaging.
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Affiliation(s)
- David Burgos
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland, United States
| | - Bennett Blumenkopf
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland, United States
| | - Ali Afshari
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland, United States
| | - Kirstie Snodderly
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland, United States
| | - T. Joshua Pfefer
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, Maryland, United States
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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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Detection of lung carcinoma arising from ground glass opacities (GGO) after 5 years - A retrospective review. Respir Med 2022; 196:106803. [DOI: 10.1016/j.rmed.2022.106803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
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Werner S, Gast R, Grimmer R, Wimmer A, Horger M. Accuracy and Reproducibility of a Software Prototype for Semi-Automated Computer-Aided Volumetry of the solid and subsolid Components of part-solid Pulmonary Nodules. ROFO-FORTSCHR RONTG 2021; 194:296-305. [PMID: 34674215 DOI: 10.1055/a-1656-9834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To test the accuracy and reproducibility of a software prototype for semi-automated computer-aided volumetry (CAV) of part-solid pulmonary nodules (PSN) with separate segmentation of the solid part. MATERIALS AND METHODS 66 PSNs were retrospectively identified in 34 thin-slice unenhanced chest CTs of 19 patients. CAV was performed by two medical students. Manual volumetry (MV) was carried out by two radiology residents. The reference standard was determined by an experienced radiologist in consensus with one of the residents. Visual assessment of CAV accuracy was performed. Measurement variability between CAV/MV and the reference standard as a measure of accuracy, CAV inter- and intra-rater variability as well as CAV intrascan variability between two recontruction kernels was determined via the Bland-Altman method and intraclass correlation coefficients (ICC). RESULTS Subjectively assessed accuracy of CAV/MV was 77 %/79 %-80 % for the solid part and 67 %/73 %-76 % for the entire nodule. Measurement variability between CAV and the reference standard ranged from -151-117 % for the solid part and -106-54 % for the entire nodule. Interrater variability was -16-16 % for the solid part (ICC 0.998) and -102-65 % for the entire nodule (ICC 0.880). Intra-rater variability was -70-49 % for the solid part (ICC 0.992) and -111-31 % for the entire nodule (ICC 0.929). Intrascan variability between the smooth and the sharp reconstruction kernel was -45-39 % for the solid part and -21-46 % for the entire nodule. CONCLUSION Although the software prototype delivered satisfactory results when segmentation is evaluated subjectively, quantitative statistical analysis revealed room for improvement especially regarding the segmentation accuracy of the solid part and the reproducibility of measurements of the nodule's subsolid margins. KEY POINTS · Assessed visually CAV delivers similar accuracy compared to manual volumetry. · Accuracy of CAV was higher for the entire nodule. · Reproducibility was better for the solid part. · Variability between the kernels was higher for the solid part.
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Affiliation(s)
| | - Regina Gast
- Radiology, University Hospitals Tübingen, Tübingen, Germany
| | - Rainer Grimmer
- Medical Imaging, Siemens Healthineers AG, Erlangen, Germany
| | | | - Marius Horger
- Radiology, University Hospitals Tübingen, Tübingen, Germany
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Wu M, Li Y, Fu B, Wang G, Chu Z, Deng D. Evaluate the performance of four artificial intelligence-aided diagnostic systems in identifying and measuring four types of pulmonary nodules. J Appl Clin Med Phys 2021; 22:318-326. [PMID: 33369008 PMCID: PMC7856495 DOI: 10.1002/acm2.13142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/19/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study aims to evaluate the performance of four artificial intelligence-aided diagnostic systems in identifying and measuring four types of pulmonary nodules. METHODS Four types of nodules were implanted in a commercial lung phantom. The phantom was scanned with multislice spiral computed tomography, after which four systems (A, B, C, D) were used to identify the nodules and measure their volumes. RESULTS The relative volume error (RVE) of system A was the lowest for all nodules, except for small ground glass nodules (SGGNs). System C had the smallest RVE for SGGNs, -0.13 (-0.56, 0.00). In the Bland-Altman test, only systems A and C passed the consistency test, P = 0.40. In terms of precision, the miss rate (MR) of system C was 0.00% for small solid nodules (SSNs), ground glass nodules (GGNs), and solid nodules (SNs) but 4.17% for SGGNs. The comparable system D MRs for SGGNs, SSNs, and GGNs were 71.30%, 25.93%, and 47.22%, respectively, the highest among all the systems. Receiver operating characteristic curve analysis indicated that system A had the best performance in recognizing SSNs and GGNs, with areas under the curve of 0.91 and 0.68. System C had the best performance for SGGNs (AUC = 0.91). CONCLUSION Among four types nodules, SGGNs are the most difficult to recognize, indicating the need to improve higher accuracy and precision of artificial systems. System A most accurately measured nodule volume. System C was most precise in recognizing all four types of nodules, especially SGGN.
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Affiliation(s)
- Ming‐yue Wu
- School of Public Health and ManagementChongqing Medical UniversityChongqingChina
| | - Yong Li
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Bin‐jie Fu
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Guo‐shu Wang
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zhi‐gang Chu
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Dan Deng
- School of Public Health and ManagementChongqing Medical UniversityChongqingChina
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Fu B, Wang G, Wu M, Li W, Zheng Y, Chu Z, Lv F. Influence of CT effective dose and convolution kernel on the detection of pulmonary nodules in different artificial intelligence software systems: A phantom study. Eur J Radiol 2020; 126:108928. [DOI: 10.1016/j.ejrad.2020.108928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/05/2020] [Accepted: 02/28/2020] [Indexed: 12/29/2022]
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9
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Gavrielides MA, Li Q, Zeng R, Berman BP, Sahiner B, Gong Q, Myers KJ, DeFilippo G, Petrick N. Discrimination of Pulmonary Nodule Volume Change for Low- and High-contrast Tasks in a Phantom CT Study with Low-dose Protocols. Acad Radiol 2019; 26:937-948. [PMID: 30292564 DOI: 10.1016/j.acra.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/30/2018] [Accepted: 09/09/2018] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The quantitative assessment of volumetric CT for discriminating small changes in nodule size has been under-examined. This phantom study examined the effect of imaging protocol, nodule size, and measurement method on volume-based change discrimination across low and high object to background contrast tasks. MATERIALS AND METHODS Eight spherical objects ranging in diameter from 5.0 mm to 5.75 mm and 8.0 mm to 8.75 mm with 0.25 mm increments were scanned within an anthropomorphic phantom with either foam-background (high-contrast task, ∼1000 HU object to background difference)) or gelatin-background (low-contrast task, ∼50 to 100 HU difference). Ten repeat acquisitions were collected for each protocol with varying exposures, reconstructed slice thicknesses and reconstruction kernels. Volume measurements were obtained using a matched-filter approach (MF) and a publicly available 3D segmentation-based tool (SB). Discrimination of nodule sizes was assessed using the area under the ROC curve (AUC). RESULTS Using a low-dose (1.3 mGy), thin-slice (≤1.5 mm) protocol, changes of 0.25 mm in diameter were detected with AU = 1.0 for all baseline sizes for the high-contrast task regardless of measurement method. For the more challenging low-contrast task and same protocol, MF detected changes of 0.25 mm from baseline sizes ≥5.25 mm and volume changes ≥9.4% with AUC≥0.81 whereas corresponding results for SB were poor (AUC within 0.49-0.60). Performance for SB was improved, but still inconsistent, when exposure was increased to 4.4 mGy. CONCLUSION The reliable discrimination of small changes in pulmonary nodule size with low-dose, thin-slice CT protocols suitable for lung cancer screening was dependent on the inter-related effects of nodule to background contrast and measurement method.
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Effect of Reconstruction Parameters on the Quantitative Analysis of Chest Computed Tomography. J Thorac Imaging 2019; 34:92-102. [DOI: 10.1097/rti.0000000000000389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effect of CT Reconstruction Algorithm on the Diagnostic Performance of Radiomics Models: A Task-Based Approach for Pulmonary Subsolid Nodules. AJR Am J Roentgenol 2019; 212:505-512. [DOI: 10.2214/ajr.18.20018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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12
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Ohno Y, Koyama H, Seki S, Kishida Y, Yoshikawa T. Radiation dose reduction techniques for chest CT: Principles and clinical results. Eur J Radiol 2018; 111:93-103. [PMID: 30691672 DOI: 10.1016/j.ejrad.2018.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/06/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022]
Abstract
Computer tomography plays a major role in the evaluation of thoracic diseases, especially since the advent of the multidetector-row CT (MDCT) technology. However, the increase use of this technique has raised some concerns about the resulting radiation dose. In this review, we will present the various methods allowing limiting the radiation dose exposure resulting from chest CT acquisitions, including the options of image filtering and iterative reconstruction (IR) algorithms. The clinical applications of reduced dose protocols will be reviewed, especially for lung nodule detection and diagnosis of pulmonary thromboembolism. The performance of reduced dose protocols for infiltrative lung disease assessment will also be discussed. Lastly, the influence of using IR algorithms on computer-aided detection and volumetry of lung nodules, as well as on quantitative and functional assessment of chest diseases will be presented and discussed.
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Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Japan.
| | | | - Shinichiro Seki
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Japan
| | - Yuji Kishida
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Japan
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Ahn H, Lee KH, Kim J, Kim J, Kim J, Lee KW. Diameter of the Solid Component in Subsolid Nodules on Low-Dose Unenhanced Chest Computed Tomography: Measurement Accuracy for the Prediction of Invasive Component in Lung Adenocarcinoma. Korean J Radiol 2018; 19:508-515. [PMID: 29713229 PMCID: PMC5904478 DOI: 10.3348/kjr.2018.19.3.508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/24/2017] [Indexed: 01/15/2023] Open
Abstract
Objective To determine if measurement of the diameter of the solid component in subsolid nodules (SSNs) on low-dose unenhanced chest computed tomography (CT) is as accurate as on standard-dose enhanced CT in prediction of pathological size of invasive component of lung adenocarcinoma. Materials and Methods From February 2012 to October 2015, 114 SSNs were identified in 105 patients that underwent low-dose unenhanced and standard-dose enhanced CT pre-operatively. Three radiologists independently measured the largest diameter of the solid component. Intraclass correlation coefficients (ICCs) were used to assess inter-reader agreement. We estimated measurement differences between the size of solid component and that of invasive component. We measured diagnostic accuracy of the prediction of invasive adenocarcinoma using a size criterion of a solid component ≥ 6 mm, and compared them using a generalized linear mixed model. Results Inter-reader agreement was excellent (ICC, 0.84.0.89). The mean ± standard deviation of absolute measurement differences between the solid component and invasive component was 4 ± 4 mm in low-dose unenhanced CT and 5 ± 4 mm in standard-dose enhanced CT. Diagnostic accuracy was 81.3% (95% confidence interval, 76.7.85.3%) in low-dose unenhanced CT and 76.6% (71.8.81.0%) in standard-dose enhanced CT, with no statistically significant difference (p = 0.130). Conclusion Measurement of the diameter of the solid component of SSNs on low-dose unenhanced chest CT was as accurate as on standard-dose enhanced CT for predicting the invasive component. Thus, low-dose unenhanced CT may be used safely in the evaluation of patients with SSNs.
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Affiliation(s)
- Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jeongjae Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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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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Larici AR, Farchione A, Franchi P, Ciliberto M, Cicchetti G, Calandriello L, del Ciello A, Bonomo L. Lung nodules: size still matters. Eur Respir Rev 2017; 26:26/146/170025. [DOI: 10.1183/16000617.0025-2017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/28/2017] [Indexed: 12/18/2022] Open
Abstract
The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.
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Gavrielides MA, Berman BP, Supanich M, Schultz K, Li Q, Petrick N, Zeng R, Siegelman J. Quantitative assessment of nonsolid pulmonary nodule volume with computed tomography in a phantom study. Quant Imaging Med Surg 2017; 7:623-635. [PMID: 29312867 DOI: 10.21037/qims.2017.12.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background To assess the volumetric measurement of small (≤1 cm) nonsolid nodules with computed tomography (CT), focusing on the interaction of state of the art iterative reconstruction (IR) methods and dose with nodule densities, sizes, and shapes. Methods Twelve synthetic nodules [5 and 10 mm in diameter, densities of -800, -630 and -10 Hounsfield units (HU), spherical and spiculated shapes] were scanned within an anthropomorphic phantom. Dose [computed tomography scan dose index (CTDIvol)] ranged from standard (4.1 mGy) to below screening levels (0.3 mGy). Data was reconstructed using filtered back-projection and two state-of-the-art IR methods (adaptive and model-based). Measurements were extracted with a previously validated matched filter-based estimator. Analysis of accuracy and precision was based on evaluation of percent bias (PB) and the repeatability coefficient (RC) respectively. Results Density had the most important effect on measurement error followed by the interaction of density with nodule size. The nonsolid -630 HU nodules had high accuracy and precision at levels comparable to solid (-10 HU) nonsolid, regardless of reconstruction method and with CTDIvol as low as 0.6 mGy. PB was <5% and <11% for the 10- and 5-mm in nominal diameter -630 HU nodules respectively, and RC was <5% and <12% for the same nodules. For nonsolid -800 HU nodules, PB increased to <11% and <30% for the 10- and 5-mm nodules respectively, whereas RC increased slightly overall but varied widely across dose and reconstruction algorithms for the 5-mm nodules. Model-based IR improved measurement accuracy for the 5-mm, low-density (-800, -630 HU) nodules. For other nodules the effect of reconstruction method was small. Dose did not affect volumetric accuracy and only affected slightly the precision of 5-mm nonsolid nodules. Conclusions Reasonable values of both accuracy and precision were achieved for volumetric measurements of all 10-mm nonsolid nodules, and for the 5-mm nodules with -630 HU or higher density, when derived from scans acquired with below screening dose levels as low as 0.6 mGy and regardless of reconstruction algorithm.
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Affiliation(s)
- Marios A Gavrielides
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Benjamin P Berman
- Division of Radiological Health, Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mark Supanich
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kurt Schultz
- Toshiba Medical Research Institute USA, Inc., Center for Medical Research and Development, Illinois, USA
| | - Qin Li
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nicholas Petrick
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rongping Zeng
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jenifer Siegelman
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussetts, USA
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CT Screening for Lung Cancer: Part-Solid Nodules in Baseline and Annual Repeat Rounds. AJR Am J Roentgenol 2016; 207:1176-1184. [PMID: 27726410 DOI: 10.2214/ajr.16.16043] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the frequencies of identifying participants with part-solid nodules, of diagnostic pursuit, of diagnoses of lung cancer, and long-term lung cancer survival in baseline and annual repeat rounds of CT screening in the International Early Lung Cancer Action Project. MATERIALS AND METHODS Screenings were performed under a common protocol. Participants with solid, nonsolid, and part-solid nodules and the diagnoses of lung cancer were documented. RESULTS Part-solid nodules were identified in 2892 of 57,496 (5.0%) baseline screening studies; 567 (19.6%) of these nodules resolved or decreased in size. Diagnostic pursuit led to the diagnosis of adenocarcinoma in 79 cases, all clinical stage I. At resection, one nodule (12-mm solid component) had a single N2 metastasis. A new part-solid nodule was identified in 541 of 64,677 (0.8%) annual repeat screenings; 377 (69.7%) of these nodules resolved or decreased in size. In eight cases among the 541, the diagnosis of adenocarcinoma manifesting as a part solid nodule was made; on retrospective review the nodule originally had been a nonsolid nodule. In another 20 cases, the cancer originally had manifested as a nonsolid nodule but had progressed to become part-solid at annual repeat screening before any diagnosis was pursued. These 28 annual repeat cases of lung cancer were all pathologic stage IA. Of the 107 cases of lung cancer (79 baseline cases and 28 annual repeat cases), 106 were surgically resected, and one baseline case was followed up with imaging for 4 years. The lung cancer survival rate was 100% with a median follow-up period from diagnosis of 89 months (interquartile range, 52-134 months). CONCLUSION Lung cancers manifesting as part-solid nodules at repeat screening studies all started as nonsolid nodules. Among 107 cases of adenocarcinoma manifesting as a part-solid nodule, a single lymph node metastasis was found in a single case (solid component, 12 mm).
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Rampinelli C, Calloni SF, Minotti M, Bellomi M. Spectrum of early lung cancer presentation in low-dose screening CT: a pictorial review. Insights Imaging 2016; 7:449-59. [PMID: 27188380 PMCID: PMC4877352 DOI: 10.1007/s13244-016-0487-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
The typical presentation of early stage lung cancers on low-dose CT screening are non-calcified pulmonary nodules. However, there is a wide spectrum of unusual focal abnormalities that can be early presentations of lung cancer. These abnormalities include, for example, cancers associated with 'cystic airspaces' or scar-like cancers. The detection of lung cancer with low-dose CT can be affected by the absence of intravenous contrast medium. As a consequence, endobronchial and central lesions can be difficult to recognize, raising the potential for missed cancers. Focal lesions arising within pre-existing lung disease, such as lung fibrosis or apical scars, can also be early lung cancer manifestations and deserve particular consideration as recognition of these lesions may be hindered by the underlying disease. Furthermore, the unpredictable growth rate of lung cancer, which ranges from indolent to aggressive cancers, necessitates attention to the wide spectrum of progression in lung cancer appearance on serial low-dose CT scans. In this pictorial review we discuss the spectrum of early lung cancer presentation in low-dose CT screening, highlighting typical as well as unusual radiological features and the varied growth rates of early lung cancer. Teaching Points • There is a wide spectrum of early presentations of lung cancer on LDCT. • Low radiation dose and the absence of contrast medium injection can affect lung cancer detection. • Lung cancer growth shows various behaviours, ranging from indolent to aggressive cancers. • Familiarity with LDCT technique can improve CT screening effectiveness and avoid missed diagnosis.
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Affiliation(s)
- Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy.
| | | | - Marta Minotti
- School of Medicine, University of Milan, Milan, Italy
| | - Massimo Bellomi
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy
- School of Medicine, University of Milan, Milan, Italy
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19
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Gavrielides MA, Li Q, Zeng R, Myers KJ, Sahiner B, Petrick N. Volume estimation of multidensity nodules with thoracic computed tomography. J Med Imaging (Bellingham) 2016; 3:013504. [PMID: 26844235 DOI: 10.1117/1.jmi.3.1.013504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/18/2015] [Indexed: 11/14/2022] Open
Abstract
This work focuses on volume estimation of "multidensity" lung nodules in a phantom computed tomography study. Eight objects were manufactured by enclosing spherical cores within larger spheres of double the diameter but with a different density. Different combinations of outer-shell/inner-core diameters and densities were created. The nodules were placed within an anthropomorphic phantom and scanned with various acquisition and reconstruction parameters. The volumes of the entire multidensity object as well as the inner core of the object were estimated using a model-based volume estimator. Results showed percent volume bias across all nodules and imaging protocols with slice thicknesses [Formula: see text] ranging from [Formula: see text] to 6.6% for the entire object (standard deviation ranged from 1.5% to 7.6%), and within [Formula: see text] to 5.7% for the inner-core measurement (standard deviation ranged from 2.0% to 17.7%). Overall, the estimation error was larger for the inner-core measurements, which was expected due to the smaller size of the core. Reconstructed slice thickness was found to substantially affect volumetric error for both tasks; exposure and reconstruction kernel were not. These findings provide information for understanding uncertainty in volumetry of nodules that include multiple densities such as ground glass opacities with a solid component.
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Affiliation(s)
- Marios A Gavrielides
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Qin Li
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Rongping Zeng
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Kyle J Myers
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Berkman Sahiner
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Nicholas Petrick
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
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Diagnostic impact of digital tomosynthesis in oncologic patients with suspected pulmonary lesions on chest radiography. Eur Radiol 2015; 26:2837-44. [PMID: 26628064 DOI: 10.1007/s00330-015-4104-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 10/30/2015] [Accepted: 11/10/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the actual diagnostic impact of digital tomosynthesis (DTS) in oncologic patients with suspected pulmonary lesions on chest radiography (CXR). METHODS A total of 237 patients (135 male, 102 female; age, 70.8 ± 10.4 years) with a known primary malignancy and suspected pulmonary lesion(s) on CXR and who underwent DTS were retrospectively identified. Two radiologists (experience, 10 and 15 years) analysed in consensus CXR and DTS images and proposed a diagnosis according to a confidence score: 1 or 2 = definitely or probably benign pulmonary or extrapulmonary lesion, or pseudolesion; 3 = indeterminate; 4 or 5 = probably or definitely pulmonary lesion. DTS findings were proven by CT (n = 114 patients), CXR during follow-up (n = 105) or histology (n = 18). RESULTS Final diagnoses included 77 pulmonary opacities, 26 pulmonary scars, 12 pleural lesions and 122 pulmonary pseudolesions. DTS vs CXR presented a higher (P < 0.05) sensitivity (92 vs 15 %), specificity (91 vs 9 %), overall accuracy (92 vs 12 %), and diagnostic confidence (area under ROC, 0.997 vs 0.619). Mean effective dose of CXR vs DTS was 0.06 vs 0.107 mSv (P < 0.05). CONCLUSIONS DTS improved diagnostic accuracy and confidence in comparison to CXR alone in oncologic patients with suspected pulmonary lesions on CXR with only a slight, though significant, increase in radiation dose. KEY POINTS • Digital tomosynthesis (DTS) improves accuracy of chest radiography (CXR) in oncologic patients. • DTS improves confidence of CXR in oncologic patients. • DTS allowed avoidance of CT in about 50 % of oncologic patients.
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21
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Martini K, Higashigaito K, Barth BK, Baumueller S, Alkadhi H, Frauenfelder T. Ultralow-dose CT with tin filtration for detection of solid and sub solid pulmonary nodules: a phantom study. Br J Radiol 2015; 88:20150389. [PMID: 26492317 DOI: 10.1259/bjr.20150389] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To investigate the diagnostic performance of advanced modelled iterative reconstruction (ADMIRE) to filtered back projection (FBP) when using an ultralow-dose protocol for the detection of solid and subsolid pulmonary nodules. METHODS Single-energy CT was performed at 100 kVp with tin filtration in an anthropomorphic chest phantom with solid and subsolid pulmonary nodules (2-10 mm, attenuation, 20 to -800 HU at 120 kVp). The mean volume CT dose index (CTDIvol) of the standard chest protocol was 2.2 mGy. Subsequent scans were obtained at 1/8 (0.28 mGy), 1/20 (0.10 mGy) and 1/70 (0.03 mGy) dose levels by lowering tube voltage and tube current. Images were reconstructed with FBP and ADMIRE. One reader measured image noise; two readers determined image quality and assessed nodule localization. RESULTS Image noise was significantly reduced using ADMIRE compared with FBP (ADMIRE at a strength level of 5 : 70.4% for 1/20; 71.6% for 1/8; p < 0.001). Interobserver agreement for image quality was excellent (k = 0.88). Image quality was considered diagnostic for all images at 1/20 dose using ADMIRE. Sensitivity of nodule detection was 97.1% (100% for solid, 93.8% for subsolid nodules) at 1/20 dose and 100% for both nodule entities at 1/8 dose using ADMIRE 5. Images obtained with 1/70 dose had moderate sensitivity (overall 85.7%; solid 95%; subsolid 73.3%). CONCLUSION Our study suggests that with a combination of tin filtration and ADMIRE, the CTDIvol of chest CT can be lowered considerably, while sensitivity for nodule detection remains high. For solid nodules, CTDIvol was 0.10 mGy, while subsolid nodules required a slightly higher CTDIvol of 0.28 mGy. ADVANCES IN KNOWLEDGE Detection of subsolid nodules is feasible with ultralow-dose protocols.
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Affiliation(s)
- Katharina Martini
- University Hospital Zurich, Department of Diagnostic and Interventional Radiology/University of Zurich, Zurich, Switzerland
| | - Kai Higashigaito
- University Hospital Zurich, Department of Diagnostic and Interventional Radiology/University of Zurich, Zurich, Switzerland
| | - Borna K Barth
- University Hospital Zurich, Department of Diagnostic and Interventional Radiology/University of Zurich, Zurich, Switzerland
| | - Stephan Baumueller
- University Hospital Zurich, Department of Diagnostic and Interventional Radiology/University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- University Hospital Zurich, Department of Diagnostic and Interventional Radiology/University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- University Hospital Zurich, Department of Diagnostic and Interventional Radiology/University of Zurich, Zurich, Switzerland
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