Added Value of Bone Suppression Image in the Detection of Subtle Lung Lesions on Chest Radiographs with Regard to Reader's Expertise
10.3346/jkms.2019.34.e250
- Author:
Gil Sun HONG
1
;
Kyung Hyun DO
;
Choong Wook LEE
Author Information
1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. dokh@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Radiography;
Computer-Assisted Image Processing;
Diagnosis
- MeSH:
Area Under Curve;
Diagnosis;
Emergency Service, Hospital;
Humans;
Image Processing, Computer-Assisted;
Lung;
Radiography;
Radiography, Thoracic;
Retrospective Studies;
Thorax
- From:Journal of Korean Medical Science
2019;34(38):e250-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Chest radiographs (CXR) are the most commonly used imaging techniques by various clinicians and radiologists. However, detecting lung lesions on CXR depends largely on the reader's experience level, so there have been several trials to overcome this problem using post-processing of CXR. We investigated the added value of bone suppression image (BSI) in detecting various subtle lung lesions on CXR with regard to reader's expertise. METHODS: We applied a software program to generate BSI in 1,600 patients in the emergency department. Of them, 80 patients with subtle lung lesions and 80 patients with negative finding on CXR were retrospectively selected based on the subtlety scores on CXR and CT findings. Ten readers independently rated their confidence in deciding the presence or absence of a lung lesion at each of 960 lung regions on the two separated imaging sessions: CXR alone vs. CXR with BSI. RESULTS: The additional use of BSI for all readers significantly increased the mean area under the curve (AUC) in detecting subtle lung lesions (0.663 vs. 0.706; P < 0.001). The less experienced readers were, the more AUC differences increased: 0.067 (P < 0.001) for junior radiology residents; 0.064 (P < 0.001) for non-radiology clinicians; 0.044 (P < 0.001) for senior radiology residents; and 0.019 (P = 0.041) for chest radiologists. The additional use of BSI significantly increased the mean confidence regarding the presence or absence of lung lesions for 213 positive lung regions (2.083 vs. 2.357; P < 0.001) and for 747 negative regions (1.217 vs. 1.195; P = 0.008). CONCLUSION: The use of BSI increases diagnostic performance and confidence, regardless of reader's expertise, reduces the impact of reader's expertise and can be helpful for less experienced clinicians and residents in the detection of subtle lung lesions.
