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Evaluation of an improved method of simulating lung nodules in chest tomosynthesis.

Journal article
Authors Angelica Svalkvist
Åse (Allansdotter) Johnsson
Jenny Vikgren
Markus Håkansson
Gustaf Ullman
Marianne Boijsen
Valeria A Fisichella
Agneta Flinck
David Molnar
Lars Gunnar Månsson
Magnus Båth
Published in Acta radiologica
Volume 53
Issue 8
Pages 874-884
ISSN 1600-0455
Publication year 2012
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Radiology
Pages 874-884
Language en
Keywords thorax, digital radiography, lung, adults, observer performance, technology assessments
Subject categories Radiology, Radiological physics


BackgroundSimulated pathology is a valuable complement to clinical images in studies aiming at evaluating an imaging technique. In order for a study using simulated pathology to be valid, it is important that the simulated pathology in a realistic way reflect the characteristics of real pathology.PurposeTo perform a thorough evaluation of a nodule simulation method for chest tomosynthesis, comparing the detection rate and appearance of the artificial nodules with those of real nodules in an observer performance experiment.Material and MethodsA cohort consisting of 64 patients, 38 patients with a total of 129 identified pulmonary nodules and 26 patients without identified pulmonary nodules, was used in the study. Simulated nodules, matching the real clinically found pulmonary nodules by size, attenuation, and location, were created and randomly inserted into the tomosynthesis section images of the patients. Three thoracic radiologists and one radiology resident reviewed the images in an observer performance study divided into two parts. The first part included nodule detection and the second part included rating of the visual appearance of the nodules. The results were evaluated using a modified receiver-operating characteristic (ROC) analysis.ResultsThe sensitivities for real and simulated nodules were comparable, as the area under the modified ROC curve (AUC) was close to 0.5 for all observers (range, 0.43-0.55). Even though the ratings of visual appearance for real and simulated nodules overlapped considerably, the statistical analysis revealed that the observers to were able to separate simulated nodules from real nodules (AUC values range 0.70-0.74).ConclusionThe simulation method can be used to create artificial lung nodules that have similar detectability as real nodules in chest tomosynthesis, although experienced thoracic radiologists may be able to distinguish them from real nodules.

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