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Evaluation of chest tomosynthesis for the detection of pulmonary nodules: Effect of clinical experience and comparison with chest radiography

Magazine article
Authors Sara Zachrisson
Jenny Vikgren
Angelica Svalkvist
Åse (Allansdotter) Johnsson
Marianne Boijsen
Agneta Flinck
Lars Gunnar Månsson
Susanne Kheddache
Magnus Båth
Published in Progress in Biomedical Optics and Imaging - Proceedings of SPIE
Volume 7263
Pages 72630Z
ISSN 1605-7422
Publication year 2009
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Radiology
Pages 72630Z
Language en
Keywords Chest radiography , Chest tomosynthesis , Observer performance evaluation , Technology assessment
Subject categories Radiological physics, Radiology


Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary nodules examined with both chest tomosynthesis and chest radiography. Multidetector computed tomography (MDCT) was used as reference and the total number of nodules found using MDCT was 131. In order to investigate the effect of additional clinical experience of chest tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability from the additional clinical experience of tomosynthesis.

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