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Thoracic Imaging |
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 (Az) (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 Az 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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