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Subtle Lung Nodules: Influence of Local Anatomic Variations on Detection¹

¹ From the Departments of Radiology, Physics, and Biomedical Engineering, Duke University Medical Center, DUMC 3302, Durham, NC 27710 (E.S.); and Departments of Radiology (E.S., M.J.F., W.R.E.) and Biostatistics and Research Epidemiology (E.P.), Henry Ford Health System, Detroit, Mich. Received May 15, 2002; revision requested July 12; revision received August 7; accepted September 26. Supported in part by a small project grant from the Henry Ford Health Sciences Center, Detroit, Mich, and by the NIH, R21 CA91806. Address correspondence to E.S. (e-mail: samei@duke.edu).

PURPOSE: To assess the influence of local anatomic noise on the detection of subtle lung nodules depicted on chest radiographs.

MATERIALS AND METHODS: Six 8 x 8-cm lung regions were extracted from digital chest radiographs obtained in healthy subjects. Simulated nodules emulating the radiographic characteristics of subtle tissue-equivalent lesions 3.2–6.4 mm in diameter (equivalent to 0.1–0.4 mm in contrast-diameter product [CD]) were added to the images. On multiple renditions of each image, nodules were inserted at slightly different locations within 6 mm of the center; this process allowed different local background patterns to overlie the nodules. An observer detection study involving 15 experienced radiologists was performed. The authors performed analysis of variance and pairwise t test analyses to determine variations in nodule detectability related to nodule location and size on each image.

RESULTS: Results indicated a strong correlation between nodule size and observer detection score and significant variation in nodule detectability as a function of location. Changes in nodule position caused observer score variations that were equivalent to the variation caused by an up to 185% change in nodule CD (78% average over all six images), an up to 68% change in diameter (32% average), and an up to 28% change in area under the receiver operating characteristic curve (A_z) (14% average).

CONCLUSION: Local anatomic variations surrounding and overlying a subtle lung nodule on a chest radiograph that are created by the projection of anatomic features in the thorax, such as ribs and pulmonary vessels, can greatly influence the detection of nodules, altering the A_z by as much as 28%.

© RSNA, 2003

Index terms: Diagnostic radiology, observer performance • Lung, nodule, 60.1215, 60.281 • Lung neoplasms, diagnosis, 60.1215, 60.31 • Radiography, digital, 60.1215 • Thorax, radiography, 60.1215

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