Korean J Radiol.  2015 Apr;16(2):430-439. 10.3348/kjr.2015.16.2.430.

Digital Tomosynthesis for Evaluating Metastatic Lung Nodules: Nodule Visibility, Learning Curves, and Reading Times

• Lee KH
• Goo JM
• Lee SM
• Park CM
• Bahn YE
• Kim H
• Song YS
• Hwang EJ

• KMID: 2070187
• DOI: http://doi.org/10.3348/kjr.2015.16.2.430

Abstract

OBJECTIVE
To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT).
MATERIALS AND METHODS
We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined.
RESULTS
Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, < or = 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed.
CONCLUSION
Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

Keyword

Pulmonary nodules; Tomography; X-ray; Learning curve

MeSH Terms

Adult
Aged
Aged, 80 and over
Area Under Curve
Female
Humans
Learning Curve
Lung Neoplasms/*diagnosis/*radiography/secondary
Male
Middle Aged
ROC Curve
Reading
Retrospective Studies
Software
Tomography, X-Ray Computed/*methods
Young Adult

Figure

• 

  Fig. 1 Number and proportion of computed tomography (CT)- and digital tomosynthesis (DT)-visible nodules and reasons for invisibility on DT. Of 414 nodules identified on CT, 53.3% (221/414) were visible on DT. Note that proportion of malignant to visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Chief reason for invisibility of nodule on DT was small size (≤ 5 mm). Reasons for invisibility of nodules > 5 mm were far anterior or posterior location (n = 3), apical or juxta-diaphragmatic location (n = 3), central location (n = 2), ground-glass opacity (n = 1), and non-attributable (n = 4). GGN = ground-glass nodule

• 

  Fig. 2 Example of nodule visible on digital tomosynthesis (DT) in 53-year-old man with underlying papillary thyroid cancer. A. Chest X-ray shows no definite nodule in right lower lung field. B. DT depicts tiny nodule (arrow) in right lower lung field. C. Coronal reconstructed chest computed tomography image reveals 3 mm nodule (arrow) in right lower lobe, which was confirmed to be lung metastasis. Among six readers, four did not detect this nodule, whereas two readers recognized nodule.

• 

  Fig. 3 Example of invisible nodule on digital tomosynthesis (DT) in 55-year-old woman with underlying sigmoid colon cancer. There is 7 mm ground-glass nodule (arrow) in right upper lobe on coronal reconstructed computed tomography image (B) that is not visible on DT image (A). This nodule was confirmed as atypical adenomatous hyperplasia.

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