title: A free-response evaluation determining value in the computed tomography attenuation correction image for revealing pulmonary incidental findings: a phantom study.
abstract: OBJECTIVE
  The purpose of this study was to compare lesion-detection performance when interpreting computed tomography (CT) images that are acquired for attenuation correction when performing single photon emission computed tomography/computed tomography (SPECT/CT) myocardial perfusion studies. In the United Kingdom, there is a requirement that these images be interpreted; thus, it is necessary to understand observer performance on these images.
  
  
  METHODS
  An anthropomorphic chest phantom with inserted spherical lesions of different sizes and contrasts was scanned on five different SPECT/CT systems using site-specific CT protocols for SPECT/CT myocardial perfusion imaging. Twenty-one observers (0-4 years of CT experience) searched 26 image slices (17 abnormal, containing 1-3 lesions, and 9 normal, containing no lesions) for each CT acquisition. The observers marked and rated perceived lesions under the free-response paradigm. Four analyses were conducted using jackknife alternative free-response receiver operating characteristic (JAFROC) analysis: (1) 20-pixel acceptance radius (AR) with all 21 readers, abbreviated to 20/ALL analysis, (2) 40-pixel AR with 21 readers (40/ALL), (3) 20-pixel AR with 14 readers experienced in CT (20/EXP), and (4) 20-pixel AR with 7 readers with no CT experience (20/NOT). The significance level of the test was set so as to conservatively control the overall probability of a type I error to <0.05.
  
  
  RESULTS
  The mean JAFROC figure of merit (FOM) for the five CT acquisitions for the 20/ALL study were 0.602, 0.639, 0.372, 0.475, and 0.719 with a significant difference in lesion-detection performance evident between all individual treatment pairs (P < .0001) with the exception of the 1-2 pairing, which was not significant (these differed only in milliamp seconds). System 5, which had the highest performance, had the smallest slice thickness and the largest matrix size. For the other analyses, the system orderings remained unchanged, and the significance of FOM difference findings remained identical to those for 20/ALL, with one exception: for 20/EXP analysis the 1-2 difference became significant with the higher milliamp seconds superior. Improved detection performance was associated with a smaller slice thickness, increased matrix size, and, to a lesser extent, increased tube charge.
  
  
  CONCLUSIONS
  Protocol variations for CT-based attenuation correction (AC) in SPECT/CT imaging have a measurable impact on lesion-detection performance. The results imply that z-axis resolution and matrix size had the greatest impact on lesion detection, with a weaker but detectable dependence on the product of milliamp and seconds.
authors.affiliation: University of Salford, Directorate of Radiography, 6th Floor Allerton Building, Frederick Road Campus, Greater Manchester, M6 6PU, UK; University Hospitals of Morecambe Bay NHS Foundation Trust, Nuclear Medicine, Furness General Hospital, Dalton Lane, Barrow-in-Furness, Cumbria, LA14 4LF, UK. Electronic address: john.thompson@mbht.nhs.uk.
authors.forename: John D
authors.initials: JD
authors.lastname: Thompson
authors.affiliation: University of Salford, Directorate of Radiography, 6th Floor Allerton Building, Frederick Road Campus, Greater Manchester, M6 6PU, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Hogg
authors.affiliation: Lancaster Medical School, Faculty of Health & Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Manning
authors.affiliation: University of Salford, Directorate of Radiography, 6th Floor Allerton Building, Frederick Road Campus, Greater Manchester, M6 6PU, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Szczepura
authors.affiliation: Medical Image Interpretation Assessment Laboratory, University of Pittsburgh, Presby South Tower, Room 4771, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Dev P
authors.initials: DP
authors.lastname: Chakraborty
mesh_terms: D000465:Algorithms; D016477:Artifacts; D002983:Clinical Competence; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D015588:Observer Variation; D019047:Phantoms, Imaging; 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; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT acquisition parameters; CT attenuation correction image; JAFROC; anthropomorphic chest phantom; lesion detection