title: Detection of simulated nodules on clinical radiographs: dose reduction at digital posteroanterior chest radiography.
abstract: OBJECTIVE
  To determine to what extent dose reduction results in decreased detection of simulated nodules on patient digital posteroanterior (PA) chest radiographs.
  
  
  METHODS
  Raw data from 20 clinical digital PA chest images that were reported as having normal findings and that were obtained with a slot-scan charge-coupled device system were used. For research protocol that concerns data with patient identities concealed, institutional review board approval is not required. One hundred twenty nodules varying in size and signal intensity were digitally simulated and added to the chest images. Hard copies were printed to represent a 100% dose and, by adding noise, to represent simulated patient doses of 50%, 25%, and 12%. Four radiologists reviewed images. Each lesion was registered as "detected" or "not detected." A semiparametric logistic regression model was used for statistical analysis.
  
  
  RESULTS
  The decrease in radiation dose from 100% to 50%, 25%, or 12% had no effect on lesion detection in the lungs. The decrease in radiation dose had an effect on lesion detection in the mediastinum, as probabilities deteriorated from the 100% dose to the 50%, 25%, and 12% dose with each step. Probabilities of smaller detection rates when compared with that of the reference category (100% dose) were 0.97 (95% confidence interval [CI]: -0.86, 0.012) for the 50% dose, 1 (CI: -0.59, -0.61) for the 25% dose, and 1 (CI: -2.41, -1.22) for the 12% dose. CIs for the effects were on the log(odds). Detection probability decreased with smaller and lower signal intensity lesions.
  
  
  CONCLUSIONS
  At clinical digital radiography, dose reduction resulted in decreased observer detection of simulated nodules in the mediastinum but not in the lungs.
authors.affiliation: Department of Radiology , C2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. l.j.m.kroft@lumc.nl
authors.forename: Lucia J M
authors.initials: LJ
authors.lastname: Kroft
authors.forename: Wouter J H
authors.initials: WJ
authors.lastname: Veldkamp
authors.forename: Bart J A
authors.initials: BJ
authors.lastname: Mertens
authors.forename: Jan Pieter A
authors.initials: JP
authors.lastname: van Delft
authors.forename: Jacob
authors.initials: J
authors.lastname: Geleijns
mesh_terms: D001499:Bayes Theorem; D002983:Clinical Competence; D003951:Diagnostic Errors; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D011871:Radiology / Q000193:education