Abstract
PurposeTo retrospectively evaluate diagnostic performance of dual-energy subtraction radiography (DESR) for interpretation of chest radiographs compared to conventional radiography (CR) using computed tomography (CT) as standard of reference.Material and methodsA total of 199 patients (75 female, median age 67) were included in this institutional review board (IRB)-approved clinical trial. All patients were scanned in posteroanterior and lateral direction with dual-shot DE-technique. Chest CT was performed within ±72 hours. The system provides three types of images: bone weighted-image, soft tissue weighted-image, herein termed as DESR-images, and a standard image, termed CR-image (marked as CR-image). Images were evaluated by two radiologists for presence of inserted life support lines, pneumothorax, pleural effusion, infectious consolidation, interstitial lung changes, tumor, skeletal alterations, soft tissue alterations, aortic or tracheal calcification and pleural thickening. Inter-observer agreement between readers and diagnostic performance were calculated. McNemar’s test was used to test for significant differences.ResultsMean inter-observer agreement throughout the investigated parameters was higher in DESR images compared to CR-images (kDESR = 0.935 vs. kCR = 0.858). DESR images provided significantly increased sensitivity compared to CR-images for the detection of infectious consolidations (42% vs. 62%), tumor (46% vs. 57%), interstitial lung changes (69% vs. 87%) and aortic or tracheal calcification (25 vs. 73%) (p<0.05). There were no significant differences in sensitivity for the detection of inserted life support lines, pneumothorax, pleural effusion, skeletal alterations, soft tissue alterations or pleural thickening (p>0.05).ConclusionDESR increases significantly the sensibility without affecting the specificity evaluating chest radiographs, with emphasis on the detection of interstitial lung diseases.
Highlights
Conventional radiography (CR) of the chest is one of the oldest radiological examinations, conventional radiography (CR) holds its position in the daily clinical practice due to its broad availability, fast examination time, low cost, and last but not least low radiation dose delivered to the patient [1,2,3,4].it is known that CR has limited diagnostic accuracy in many clinical situations: Previous studies documented lower sensitivity in the detection of pathologic lung changes compared to computed tomography (CT) [5,6]
dual-energy subtraction radiography (DESR) images provided significantly increased sensitivity compared to CR-images for the detection of infectious consolidations (42% vs. 62%), tumor (46% vs. 57%), interstitial lung changes (69% vs. 87%) and aortic or tracheal calcification (25 vs. 73%) (p
Conventional radiography (CR) of the chest is one of the oldest radiological examinations, CR holds its position in the daily clinical practice due to its broad availability, fast examination time, low cost, and last but not least low radiation dose delivered to the patient [1,2,3,4]
Summary
Conventional radiography (CR) of the chest is one of the oldest radiological examinations, CR holds its position in the daily clinical practice due to its broad availability, fast examination time, low cost, and last but not least low radiation dose delivered to the patient [1,2,3,4].it is known that CR has limited diagnostic accuracy in many clinical situations: Previous studies documented lower sensitivity in the detection of pathologic lung changes compared to computed tomography (CT) [5,6]. Thoracic imaging has made significant progress in the last years due to the transition from filmbased systems to digital radiography allowing the development of more refined modalities such as dual-energy subtraction radiography (DESR) [7]. This new technique might be able to improve the diagnostic accuracy of CR while maintaining its advantages such as fast examination time, low cost and low radiation dose. Regardless of the used system images are subtracted by a post processing algorithm to produce tissue selective and bone selective images resulting in three different images: 1- bone image, 2soft tissue image (both marked as DESR images) and 3- standard image (marked as CRimage)
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