Improved detection of small lung cancers with dual-energy subtraction chest radiography.
OBJECTIVE
The objective of our study was to retrospectively evaluate whether the use of dual-energy subtraction chest radiographs can improve radiologists' performance for the detection of small previously missed lung cancers.


METHODS
Dual-energy subtraction chest radiographs of 19 patients with previously missed nodular cancers, in which the radiology report did not mention a nodule that was visible in retrospect, were selected. Dual-energy subtraction radiographs of 19 patients with cancer and 16 patients without cancer were used for an observer study. Six radiologists indicated their confidence level regarding the presence of a lung cancer and, if they thought a cancer was present, also marked the most likely position for each lung, first using standard posteroanterior and lateral chest radiographs and then using both soft-tissue and bone dual-energy subtraction images along with standard radiographs. Receiver operating characteristic (ROC) curves were used to evaluate the observers' performance. The indicated locations of cancers and false-positives were also analyzed.


RESULTS
The average area under the ROC curve (A(z)) value for the six radiologists was improved from 0.718 to 0.816, a statistically significant amount (p = 0.004), and the average sensitivity (correct localizations) for 19 previously missed cancers was also significantly improved from 40% to 59% (p = 0.008) with the aid of dual-energy subtraction images. The average number of false-positive (incorrect) localizations on 70 lungs was 10 without and nine with dual-energy subtraction images (p = 0.785).


CONCLUSIONS
Dual-energy subtraction chest radiography has the potential to improve radiologists' performance for the detection of small missed lung cancers.
Li
Feng
F
Kurt Rossmann Laboratories for Radiologic Image Research and the Department of Radiology, The University of Chicago, 5841 S Maryland Ave., MC-2026, Chicago, IL 60637, USA. feng@uchicago.edu
Engelmann
Roger
R
Doi
Kunio
K
MacMahon
Heber
H
D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D013902:Radiography, Thoracic / Q000379:methods*; D012042:Registries; D013382:Subtraction Technique