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Surveillance of small, solid pulmonary nodules at digital chest tomosynthesis: data from a cohort of the pilot Swedish CArdioPulmonary bioImage Study (SCAPIS)

Journal article
Authors Carin Meltzer
Erika Fagman
Jenny Vikgren
David Molnar
Eivind Borna
Maral Mirzai
John Brandberg
Bengt Bergman
Magnus Båth
Åse (Allansdotter) Johnsson
Published in Acta Radiologica
Pages 12
ISSN 0284-1851
Publication year 2020
Published at Institute of Clinical Sciences, Department of Radiation Physics
Krefting Research Centre
Institute of Medicine
Institute of Clinical Sciences, Department of Radiology
Pages 12
Language en
Keywords Lung, computer applications - detection, diagnosis, radiation safety, digital radiography, computed-tomography, lung nodules, ct, software, observer, optimization, performance, volumetry, statement, viewdex, Radiology, Nuclear Medicine & Medical Imaging
Subject categories Clinical Medicine


Background Digital tomosynthesis (DTS) might be a low-dose/low-cost alternative to computed tomography (CT). Purpose To investigate DTS relative to CT for surveillance of incidental, solid pulmonary nodules. Material and Methods Recruited from a population study, 106 participants with indeterminate solid pulmonary nodules on CT underwent surveillance with concurrently performed CT and DTS. Nodule size on DTS was assessed by manual diameter measurements and semi-automatic nodule segmentations were independently performed on CT. Measurement agreement was analyzed according to Bland-Altman with 95% limits of agreement (LoA). Detection of nodule volume change > 25% by DTS in comparison to CT was evaluated with receiver operating characteristics (ROC). Results A total of 81 nodules (76%) were assessed as measurable on DTS by two independent observers. Inter- and intra-observer LoA regarding change in average diameter were +/- 2 mm. Calculation of relative volume change on DTS resulted in wide inter- and intra-observer LoA in the order of +/- 100% and +/- 50%. Comparing relative volume change between DTS and CT resulted in LoA of -58% to 67%. The area under the ROC curve regarding the ability of DTS to detect volumetric changes > 25% on CT was 0.58 (95% confidence interval [CI] = 0.40-0.76) and 0.50 (95% CI = 0.35-0.66) for the two observers. Conclusion The results of the present study show that measurement variability limits the agreement between DTS and CT regarding nodule size change for small solid nodules.

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