title: A computerized scheme for lung nodule detection in multiprojection chest radiography.
abstract: OBJECTIVE
  Our previous study indicated that multiprojection chest radiography could significantly improve radiologists' performance for lung nodule detection in clinical practice. In this study, the authors further verify that multiprojection chest radiography can greatly improve the performance of a computer-aided diagnostic (CAD) scheme.
  
  
  METHODS
  Our database consisted of 59 subjects, including 43 subjects with 45 nodules and 16 subjects without nodules. The 45 nodules included 7 real and 38 simulated ones. The authors developed a conventional CAD scheme and a new fusion CAD scheme to detect lung nodules. The conventional CAD scheme consisted of four steps for (1) identification of initial nodule candidates inside lungs, (2) nodule candidate segmentation based on dynamic programming, (3) extraction of 33 features from nodule candidates, and (4) false positive reduction using a piecewise linear classifier. The conventional CAD scheme processed each of the three projection images of a subject independently and discarded the correlation information between the three images. The fusion CAD scheme included the four steps in the conventional CAD scheme and two additional steps for (5) registration of all candidates in the three images of a subject, and (6) integration of correlation information between the registered candidates in the three images. The integration step retained all candidates detected at least twice in the three images of a subject and removed those detected only once in the three images as false positives. A leave-one-subject-out testing method was used for evaluation of the performance levels of the two CAD schemes.
  
  
  RESULTS
  At the sensitivities of 70%, 65%, and 60%, our conventional CAD scheme reported 14.7, 11.3, and 8.6 false positives per image, respectively, whereas our fusion CAD scheme reported 3.9, 1.9, and 1.2 false positives per image, and 5.5, 2.8, and 1.7 false positives per patient, respectively. The low performance of the conventional CAD scheme may be attributed to the high noise level in chest radiography, and the small size and low contrast of most nodules.
  
  
  CONCLUSIONS
  This study indicated that the fusion of correlation information in multiprojection chest radiography can markedly improve the performance of CAD scheme for lung nodule detection.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Boyce
authors.forename: H Page
authors.initials: HP
authors.lastname: McAdams
authors.forename: Junji
authors.initials: J
authors.lastname: Shiraishi
authors.forename: Kunio
authors.initials: K
authors.lastname: Doi
authors.forename: Ehsan
authors.initials: E
authors.lastname: Samei
mesh_terms: D000465:Algorithms; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D010363:Pattern Recognition, Automated / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D013382:Subtraction Technique