Magnus Båth

Comparison of Chest Tomosynthesis and Chest Radiography for Detection of Pulmonary Nodules: Human Observer Study of Clinical Cases

PURPOSEnTo compare chest tomosynthesis with chest radiography in the detection of pulmonary nodules by using multidetector computed tomography (CT) as the reference method.nnnMATERIALS AND METHODSnThe Regional Ethical Review Board approved this study, and all participants gave informed consent. Four thoracic radiologists acted as observers in a jackknife free-response receiver operating characteristic (JAFROC) study conducted in 42 patients with and 47 patients without pulmonary nodules examined with chest tomosynthesis and chest radiography. Multidetector CT served as reference method. The observers marked suspected nodules on the images by using a four-point rating scale for the confidence of presence. The JAFROC figure of merit was used as the measure of detectability. The number of lesion localizations relative to the total number of lesions (lesion localization fraction [LLF]) and the number of nonlesion localizations relative to the total number of cases (nonlesion localization fraction [NLF]) were determined.nnnRESULTSnPerformance of chest tomosynthesis was significantly better than that of chest radiography with regard to detectability (F statistic = 32.7, df = 1, 34.8, P < .0001). For tomosynthesis, the LLF for the smallest nodules (< or = 4 mm) was 0.39 and increased with an increase in size to an LLF for the largest nodules (> 8 mm) of 0.83. The LLF for radiography was small, except for the largest nodules, for which it was 0.52. In total, the LLF was three times higher for tomosynthesis. The NLF was approximately 50% higher for tomosynthesis.nnnCONCLUSIONnFor the detection of pulmonary nodules, the performance of chest tomosynthesis is better, with increased sensitivity especially for nodules smaller than 9 mm, than that of chest radiography.

Dose dependence of mass and microcalcification detection in digital mammography: free response human observer studies.

The purpose of this study was to evaluate the effect of dose reduction in digital mammography on the detection of two lesion types-malignant masses and clusters of microcalcifications. Two free-response observer studies were performed-one for each lesion type. Ninety screening images were retrospectively selected; each image was originally acquired under automatic exposure conditions, corresponding to an average glandular dose of 1.3 mGy for a standard breast (50 mm compressed breast thickness with 50% glandularity). For each study, one to three simulated lesions were added to each of 40 images (abnormals) while 50 were kept without lesions (normals). Two levels of simulated system noise were added to the images yielding two new image sets, corresponding to simulated dose levels of 50% and 30% of the original images (100%). The manufacturers standard display processing was subsequently applied to all images. Four radiologists experienced in mammography evaluated the images by searching for lesions and marking and assigning confidence levels to suspicious regions. The search data were analyzed using jackknife free-response (JA-FROC) methodology. For the detection of masses, the mean figure-of-merit (FOM) averaged over all readers was 0.74, 0.71, and 0.68 corresponding to dose levels of 100%, 50%, and 30%, respectively. These values were not statistically different from each other (F= 1.67, p=0.19) but showed a decreasing trend. In contrast, in the microcalcification study the mean FOM was 0.93, 0.67, and 0.38 for the same dose levels and these values were all significantly different from each other (F = 109.84, p < 0.0001). The results indicate that lowering the present dose level by a factor of two compromised the detection of microcalcifications but had a weaker effect on mass detection.

In-plane visibility of lesions using breast tomosynthesis and digital mammography.

PURPOSEnThe purpose of this work was to evaluate the visibility of simulated lesions in 2D digita mammography (DM) and breast tomosynthesis (BT) images of patients.nnnMETHODSnImages of the same women were acquired on both a DM system (Mammomat Novation, Siemens Healthcare, Erlangen, Germany) and a BT prototype system adapted from the same type of DM system. Using the geometrical properties of the two systems, simulated lesions were projected and added to each DM image as well as to each BT projection image prior to 3D reconstruction. The same beam quality and approximately the same total absorbed dose to the glandular tissue were used for each breast image acquisition on the two systems. A series of four-alternative forced choice human observer experiments was conducted for each of five simulated lesion diameters: 0.2, 1, 3, 8, and 25 mm. An additional experiment was conducted for the 0.2 mm lesion in BT only at twice the dose level (BT2x). Threshold signal was defined as the lesion signal intensity required for a detectability index (d) of 2.5. Four medical physicists participated in all experiments. One experiment, consisting of 60 cases, was conducted per test condition (i.e., lesion size and signal combination).nnnRESULTSnFor the smallest lesions (0.2 mm), the threshold signal for DM was 21% lower than for BT at equivalent dose levels, and BT2x was 26% lower than DM. For the lesions larger than 1 mm, the threshold signal increased linearly (in log space) with the lesion diameter for both DM and BT, with DM requiring around twice the signal as BT. The difference in the threshold signal between BT and DM at each lesion size was statistically significant, except for the 0.2 mm lesion between BT2x and DM.nnnCONCLUSIONSnThe results of this study indicate that low-signal lesions larger than 1.0 mm may be more visible in BT compared to DM, whereas 0.2 mm lesions may be better visualized with DM compared to BT, when compared at equal dose.

Visibility of microcalcification clusters and masses in breast tomosynthesis image volumes and digital mammography: A 4AFC human observer study

PURPOSEnTo investigate the visibility of simulated lesions in digital breast tomosynthesis (BT) image volumes compared with 2D digital mammography (DM).nnnMETHODSnSimulated lesions (masses and microcalcifications) were added to images of the same women acquired on a DM system (Mammomat Novation, Siemens) and a BT prototype. The same beam quality was used for the DM and BT acquisitions. The total absorbed dose resulting from a 25-projection BT acquisition and reconstruction (BT(25)) was approximately twice that of a single DM view. By excluding every other projection image from the reconstruction (BT(13)), approximately the same dose as in DM was effected. Simulated microcalcifications were digitally added with varying contrast to the DM and BT images. Simulated masses with 8 mm diameter were also added to BT images. A series of 4-alternative forced choice (4AFC) human observer experiments were conducted. Four medical physicists participated in all experiments, each consisting of 60 trials per experimental condition. The observers interpreted the BT image volumes in cine-mode at a fixed image sequence speed. The required threshold contrast (S(t)) to achieve a detectability index (d) of 2.5 (i.e., 92.5% correct decisions) was determined.nnnRESULTSnThe S(t) for mass detection in DM was approximately a factor of 2 higher than required in BT indicating that the detection of masses was improved under BT conditions compared to DM. S(t) for microcalcification detection was higher for BT than for DM at both BT dose levels (BT(25) and BT(13)), with a statistically significant difference in S(t) between DM and BT(13). These results indicate a dose-dependent decrease in detection performance in BT for detection of microcalcifications.nnnCONCLUSIONSnIn agreement with previous investigations, masses of size 8 mm can be detected with less contrast in BT than in DM indicating improved detection performance for BT. However, for the investigated microcalcifications, the results of this study indicate potentially worse performance for BT than for DM at the same dose level.

Comparison of two methods for evaluation of image quality of lumbar spine radiographs

To evaluate the image quality of clinical radiographs with two different methods, and to find correlations between the two methods. Based on fifteen lumbar spine radiographs, two new sets of images were created. A hybrid image set was created by adding two distributions of artificial lesions to each original image. The image quality parameters spatial resolution and noise were manipulated and a total of 210 hybrid images were created. A set of 105 disease-free images was created by applying the same combinations of spatial resolution and noise to the original images. The hybrid images were evaluated with the free-response forced error experiment (FFE) and the normal images with visual grading analysis (VGA) by nine experienced radiologists. The VGA study showed that images with low noise are preferred over images with higher noise levels. The alteration of the MTF had a limited influence on the VGA score. For the FFE study the visibility of the lesions was independent of the spatial resolution and the noise level. In this study we found no correlation between the two methods, probably because the detectability of the artificial lesions was not influenced by the manipulations of noise level and resolution. Hence, the detection of lesions in lumbar spine radiography may not be a quantum-noise limited task. The results show the strength of the VGA technique in terms of detecting small changes in the two image quality parameters. The method is more robust and has a higher statistical power than the ROC related method and could therefore, in some cases, be more suitable for use in optimization studies.

A simple method to retrospectively estimate patient dose-area product for chest tomosynthesis examinations performed using VolumeRAD

PURPOSEnThe purpose of the present work was to develop and validate a method of retrospectively estimating the dose-area product (DAP) of a chest tomosynthesis examination performed using the VolumeRAD system (GE Healthcare, Chalfont St. Giles, UK) from digital imaging and communications in medicine (DICOM) data available in the scout image.nnnMETHODSnDICOM data were retrieved for 20 patients undergoing chest tomosynthesis using VolumeRAD. Using information about how the exposure parameters for the tomosynthesis examination are determined by the scout image, a correction factor for the adjustment in field size with projection angle was determined. The correction factor was used to estimate the DAP for 20 additional chest tomosynthesis examinations from DICOM data available in the scout images, which was compared with the actual DAP registered for the projection radiographs acquired during the tomosynthesis examination.nnnRESULTSnA field size correction factor of 0.935 was determined. Applying the developed method using this factor, the average difference between the estimated DAP and the actual DAP was 0.2%, with a standard deviation of 0.8%. However, the difference was not normally distributed and the maximum error was only 1.0%. The validity and reliability of the presented method were thus very high.nnnCONCLUSIONSnA method to estimate the DAP of a chest tomosynthesis examination performed using the VolumeRAD system from DICOM data in the scout image was developed and validated. As the scout image normally is the only image connected to the tomosynthesis examination stored in the picture archiving and communication system (PACS) containing dose data, the method may be of value for retrospectively estimating patient dose in clinical use of chest tomosynthesis.

High-Resolution Computed Tomography with 16-Row MDCT: A Comparison Regarding Visibility and Motion Artifacts of Dose-Modulated Thin Slices and “Step and Shoot” Images

Background: Dose modulation can be used to reduce the radiation dose in computed tomography (CT) examinations while still obtaining the necessary diagnostic image quality. Multidetector-row computed tomography (MDCT) provides the possibility of simultaneous reconstruction of thin and thick slices from the same raw data. Purpose: To compare thin slices reconstructed from a dose-modulated helical acquisition and conventional high-resolution computed tomography (HRCT) images taken with the “step and shoot” technique in terms of visibility and motion artifacts, in order to investigate the possibility of excluding “step and shoot” acquisition from the HRCT examination. Material and Methods: Twenty patients were examined by a dose-modulated helical acquisition, “MDCT smart mA,” and by a noncontiguous cross-sectional high-resolution 16-row MDCT examination, “MDCT step and shoot.” Images from four anatomical levels, made anonymous regarding identity and technical data, were analyzed in random order by four thoracic radiologists. Results: “MDCT smart mA” was worse than “MDCT step and shoot” in terms of visibility. Concerning motion artifacts, “MDCT smart mA” was better than “MDCT step and shoot.” Conclusion: Thin images reconstructed from a dose-modulated 16-row helical MDCT acquisition (“MDCT smart mA”), as performed in our study, do not provide sufficient image quality regarding visibility compared to the “MDCT step and shoot” technique for the latter technique to be excluded from the HRCT examination.

Automated detection of changes in patient exposure in digital projection radiography using exposure index from DICOM header metadata

Abstract Purpose. Automated collection of image data from DICOM headers enables monitoring of patient dose and image quality parameters. Manual monitoring is time consuming, owing to the large number of exposure scenarios, thus automated methods for monitoring needs to be investigated. The aim of the present work was to develop and optimise such a method. Material and methods. Exposure index values from digital systems in projection radiography were collected over a period of five years, representing data from 1.2 million projection images. The exposure index values were converted to detector dose and an automated method for detection of sustained level shifts in the resulting detector dose time series was applied using the statistical analysis tool R. The method combined handling of outliers, filtering and estimation of variation in combination with two different statistical rank tests for level shift detection. A set of 304 time series representing central body parts was selected and the level shift detection method was optimised using level shifts identified by ocular evaluation as the gold standard. Results. Two hundred and eighty-one level changes were identified that were deemed in need of further investigation. The majority of these changes were abrupt. The sensitivity and specificity of the optimised and automated detection method concerning the ocular evaluation were 0.870 and 0.997, respectively, for detected abrupt changes. Conclusions. An automated analysis of exposure index values, with the purpose of detecting changes in exposure, can be performed using the R software in combination with a DICOM header metadata repository containing the exposure index values from the images. The routine described has good sensitivity and acceptable specificity for a wide range of central body part projections and can be optimised for more specialised purposes.

Improved in-plane visibility of tumors using breast tomosynthesis

The purpose of this work was to evaluate and compare the visibility of tumors in digital mammography (DM) and breast tomosynthesis (BT) images. Images of the same women were acquired on both a DM system (Mammomat Novation, Siemens) and a BT prototype system adapted from the same type of DM system. Simulated 3D tumors (average dimension: 8.4 mm x 6.6 mm x 5 mm) were projected and added to each DM image as well as each BT projection image prior to 3D reconstruction. The same beam quality and approximately the same total absorbed dose were used for each breast image acquisition on both systems. Two simulated tumors were added to each of thirty breast scans, yielding sixty cases. A series of 4-alternative forced choice (4-AFC) human observer performance experiments were conducted in order to determine what projected tumor signal intensity in the DM images would be needed to achieve the same detectability as in the reconstructed BT images. Nine observers participated. For the BT experiment, when the tumor signal intensity on the central projection was 0.010 the mean percent of correct responses (PC) was measured to be 81.5%, which converted to a detectability index value (d) of 1.96. For the DM experiments, the same detectability was achieved at a signal intensity determined to be 0.038. Equivalent tumor detection in BT images were thus achieved at around four times less projected signal intensity than in DM images, indicating that the use of BT may lead to earlier detection of breast cancer.

ViewDEX: A java-based software for presentation and evaluation of medical images in observer performance studies

Observer performance studies are time-consuming tasks, both for the participating observers and for the scientists collecting and analyzing the data. A possible way to optimize such studies is to perform the study in a completely digital environment. A software tool - ViewDEX (Viewer for Digital Evaluation of X-ray images) - has been developed in Java, enabling it to function on almost any computer. ViewDEX is a DICOM-compatible software tool that can be used to display medical images with simultaneous registration of the observers response. ViewDEX is designed so that the user in a simple way can alter the types of questions and images presented to the observers, enabling ROC, MAFC and visual grading studies to be conducted in a fast and efficient way. The software can also be used for bench marking and for educational purposes. The results from each observer are saved in a log file, which can be exported for further analysis. The software is freely available for non-commercial purposes.