title: Detection of subtle lung nodules: relative influence of quantum and anatomic noise on chest radiographs.
abstract: OBJECTIVE
  To assess the relative influence of quantum mottle and structured lung patterns (anatomic noise) on the detection of subtle lung nodules on chest radiographs.
  
  
  METHODS
  Sixty 8 x 8-cm lung pattern images were extracted from digital chest radiographs in healthy individuals. Sixty quantum mottle images of the same size and quantum noise level were extracted from uniformly exposed digital radiographs. Simulated nodules with various peak contrast-diameter products (CD) that emulated subtle tissue-equivalent lung nodules were numerically superimposed at the center on three-fourths of the images. Printouts were independently viewed and scored by five experienced radiologists. The area under the receiver operating characteristic curve (Az) was estimated as a measure of the detectability of the nodules.
  
  
  RESULTS
  At a fixed observer performance level (e.g., Az = 0.8), much smaller and lower-contrast nodules were detected on quantum mottle images (1-mm diameter, CD = 0.01 mm), compared with those on anatomic images (4.5-mm diameter, CD = 0.20 mm). The findings generally agreed with the signal-to-noise ratio calculations based on statistical observer models.
  
  
  CONCLUSIONS
  The detection of subtle lung nodules on chest radiographs is limited by anatomic noise.
authors.affiliation: Department of Diagnostic Radiology, Henry Ford Health System, Detroit, MI 48202, USA.
authors.forename: E
authors.initials: E
authors.lastname: Samei
authors.forename: M J
authors.initials: MJ
authors.lastname: Flynn
authors.forename: W R
authors.initials: WR
authors.lastname: Eyler
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011789:Quantum Theory; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*