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Detection of Pulmonary Nodule Growth with Chest Tomosynthesis: A Human Observer Study Using Simulated Nodules

Journal article
Authors Christina Söderman
Åse (Allansdotter) Johnsson
Jenny Vikgren
Rauni Rossi-Norrlund
David Molnar
Maral Mirzai
Angelica Svalkvist
Lars Gunnar Månsson
Magnus Båth
Published in Academic Radiology
Volume 26
Issue 4
Pages 508-518
ISSN 10766332
Publication year 2019
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Radiology
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 508-518
Language en
Keywords Chest tomosynthesis, digital radiology, observer performance, parenchymal nodules
Subject categories Radiological physics, Radiology


Chest tomosynthesis has been suggested as a suitable alternative to CT for follow-up of pulmonary nodules. The aim of the present study was to investigate the possibility of detecting pulmonary nodule growth using chest tomosynthesis. Materials and Methods: Simulated nodules with volumes of approximately 100 mm 3 and 300 mm 3 as well as additional versions with increasing volumes were created. The nodules were inserted into images from pairs of chest tomosynthesis examinations, simulating cases where the nodule had either remained stable in size or increased in size between the two imaging occasions. Nodule volume growths ranging from 11% to 252% were included. A simulated dose reduction was applied to a subset of the cases. Cases differing in terms of nodule size, dose level, and nodule position relative to the plane of image reconstruction were included. Observers rated their confidence that the nodules were stable in size or not. The rating data for the nodules that were stable in size was compared to the rating data for the nodules simulated to have increased in size using ROC analysis. Results: Area under the curve values ranging from 0.65 to 1 were found. The lowest area under the curve values were found when there was a mismatch in nodule position relative to the reconstructed image plane between the two examinations. Nodule size and dose level affected the results. Conclusion: The study indicates that chest tomosynthesis can be used to detect pulmonary nodule growth. Nodule size, dose level, and mismatch in position relative to the image reconstruction plane in the baseline and follow-up examination may affect the precision.

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