title: Comparison of dual energy subtraction chest radiography and traditional chest X-rays in the detection of pulmonary nodules.
abstract: BACKGROUND
  Dual energy subtraction (DES) radiography is a powerful but underutilized technique which aims to improve the diagnostic value of an X-ray by separating soft tissue from bones, producing two different images. Compared to traditional chest X-rays, DES requires exposure to higher doses of radiation but may achieve higher accuracy. The objective of this study was to assess the clinical benefits of DES radiography by comparing the speed and accuracy of diagnosis of pulmonary nodules with DES versus traditional chest X-rays.
  
  
  METHODS
  Five radiologists and five radiology residents read the DES and traditional chest X-rays of 51 patients, 34 with pulmonary nodules and 17 without. Their accuracy and speed in the detection of nodules were measured using specialized image display software.
  
  
  RESULTS
  DES radiography reduced reading time from 13 to 10 sec (P<0.0001) in staff and from 21 to 15 sec in residents (P<0.0001). There was also a small increase in sensitivity 0.58 to 0.67 overall (P<0.10) with no change in specificity (0.85 overall).
  
  
  CONCLUSIONS
  By eliminating rib shadows in soft tissue images, DES improved the speed and accuracy of radiologists in the diagnosis of pulmonary nodules.
authors.affiliation: 1 Department of Diagnostic Imaging, McMaster University, Hamilton, ON, Canada ; 2 University of Waterloo, Waterloo, ON, Canada.
authors.forename: Farheen
authors.initials: F
authors.lastname: Manji
authors.affiliation: 1 Department of Diagnostic Imaging, McMaster University, Hamilton, ON, Canada ; 2 University of Waterloo, Waterloo, ON, Canada.
authors.forename: Jiheng
authors.initials: J
authors.lastname: Wang
authors.affiliation: 1 Department of Diagnostic Imaging, McMaster University, Hamilton, ON, Canada ; 2 University of Waterloo, Waterloo, ON, Canada.
authors.forename: Geoff
authors.initials: G
authors.lastname: Norman
authors.affiliation: 1 Department of Diagnostic Imaging, McMaster University, Hamilton, ON, Canada ; 2 University of Waterloo, Waterloo, ON, Canada.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Wang
authors.affiliation: 1 Department of Diagnostic Imaging, McMaster University, Hamilton, ON, Canada ; 2 University of Waterloo, Waterloo, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Koff
keywords: Dual energy subtraction (DES); chest X-ray; chest imaging; pulmonary nodules