Comparison of sensitivity of lung nodule detection between radiologists and technologists on low-dose CT lung cancer screening images

Kakinuma, Ryutaro; Ashizawa, Kazuto; Kobayashi, Toshiaki; Fukushima, A; Hayashi, Hiroyuki; Kondo, T; Machida, Manabu; Matsusako, Masaki; Minami, Kazunori; Oikado, Katsunori; Okuda, Masumi; Takamatsu, Shigeru; Sugawara, Masaaki; Gomi, Shiho; Hanai, Kouzou; Muramatsu, Yoshihisa; Kaneko, Masahiro; Tsuchiya, Ryosuke; Moriyama, Noriyuki

doi:10.1259/bjr/75768386

Cited by 16 publications

(11 citation statements)

References 19 publications

(24 reference statements)

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“…Many lung cancers are found at a relatively late stage, resulting in a 5-year survival of only 15% or less [2]. Low-dose CT is a promising screening method for early detection of lung cancer [3][4][5][6][7]. The first result indicates that CT lung cancer screening can reduce lung cancer-specific mortality [8].…”

Section: Advances In Knowledgementioning

confidence: 99%

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Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Xie¹,

Willemink²,

Zhao³

et al. 2013

BJR

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Objective: To assess inter-and intrascanner variability in volumetry of solid pulmonary nodules in an anthropomorphic thoracic phantom using low-dose CT. Methods: Five spherical solid artificial nodules [diameters 3, 5, 8, 10 and 12 mm; CT density 1100 Hounsfield units (HU)] were randomly placed inside an anthropomorphic thoracic phantom in different combinations. The phantom was examined on two 64-row multidetector CT (64-MDCT) systems (CT-A and CT-B) from different vendors with a low-dose protocol. Each CT examination was performed three times. The CT examinations were evaluated twice by independent blinded observers. Nodule volume was semi-automatically measured by dedicated software. Interscanner variability was evaluated by Bland-Altman analysis and expressed as 95% confidence interval (CI) of relative differences. Intrascanner variability was expressed as 95% CI of relative variation from the mean.Results: No significant difference in CT-derived volume was found between CT-A and CT-B, except for the 3-mm nodules (p,0.05). The 95% CI of interscanner variability was within 641.6%, 618.2% and 64.9% for 3, 5 and $8 mm nodules, respectively. The 95% CI of intrascanner variability was within 628.6%, 613.4% and 62.6% for 3, 5 and $8 mm nodules, respectively. Conclusion: Different 64-MDCT scanners in low-dose settings yield good agreement in volumetry of artificial pulmonary nodules between 5 mm and 12 mm in diameter. Inter-and intrascanner variability decreases at a larger nodule size to a maximum of 4.9% for $8 mm nodules. Advances in knowledge:The commonly accepted cut-off of 25% to determine nodule growth has the potential to be reduced for $8 mm nodules. This offers the possibility of reducing the interval for repeated CT scans in lung cancer screenings.Lung cancer is the primary cancer in males and the second most common cancer in females worldwide, causing 18% of the total number of deaths [1]. Many lung cancers are found at a relatively late stage, resulting in a 5-year survival of only 15% or less [2]. Low-dose CT is a promising screening method for early detection of lung cancer [3][4][5][6][7]. The first result indicates that CT lung cancer screening can reduce lung cancer-specific mortality [8].

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Section: Advances In Knowledgementioning

confidence: 99%

“…That protocol has been widely applied in lung cancer screening [3]. However, variability of nodule volumetry depends on acquisition and algorithm in individual settings [7,35]. When discussing the results, we linked to the studies based on the same CT acquisition protocol [5,10,11,17].…”

Section: Limitationsmentioning

confidence: 99%

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Xie¹,

Willemink²,

Zhao³

et al. 2013

BJR

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“…11,12,[21][22][23][24][25][26][27] Caution should always be exercised when comparing sensitivities between nodule detection studies, as differences in the derivation and stringency of the reference standard (as indicated in Table 4) 28 and in the types of patients undergoing CT examinations (e.g. patients with multiple metastases vs lung screening studies) may profoundly affect sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…Radiographers may be suited for this task, as they have a basic understanding of both the technical and anatomical aspects of thoracic CT. Radiographers have already been assessed as readers in screening mammography 7,8 and screening CT colonography, 9,10 but their role as readers in CT lung cancer screening has not yet been fully explored in a prospective study. 11,12 However, before radiographers can be incorporated into the CT reading process, it is imperative that: (1) they are provided with a basic level of training; and (2) their performance is then assessed against the established methodology of various screening trials, in which radiologists perform all reading. The aim of this investigation was therefore to evaluate the performance of radiographers in lung nodule detection on CT (following a period of training) compared with radiologists in the setting of the UK Lung Screening (UKLS) pilot trial.…”

Section: Introductionmentioning

confidence: 99%

Comparing the performance of trained radiographers against experienced radiologists in the UK lung cancer screening (UKLS) trial

Nair

Gartland

Barton

et al. 2016

BJR

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“…To optimise screening efficiency, sensitive lung nodule detection and accurate nodule classification are two important issues [10][11][12]. Little is known about the impact of readers in lung cancer screening on screening efficiency, in terms of reduction of false-positive results.…”

Section: Introductionmentioning

confidence: 99%

The impact of radiologists’ expertise on screen results decisions in a CT lung cancer screening trial

et al. 2014

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Objective To evaluate the impact of radiological expertise on screen result decisions in a CT lung cancer screening trial. Methods In the NELSON lung cancer screening trial, the baseline CT result was based on the largest lung nodule's volume. The protocol allowed radiologists to manually adjust screen results in cases of high suspicion of benign or malignant nodule nature. Participants whose baseline CT result was based on a solid or part-solid nodule were included in this study. Adjustments by radiologists at baseline were evaluated. Histology was the reference for diagnosis or to confirm benignity and stability on subsequent CT examinations. Results A total of 3,318 participants (2,796 male, median age 58.0 years) were included. In 195 participants (5.9 %) the initial baseline screen result was adjusted by the radiologist. Adjustment was downwards from positive or indeterminate to negative in two and 119 participants, respectively, and from positive to indeterminate in 65 participants. None of these nodules turned out to be malignant. In 9/195 participants (4.6 %) the screen result was adjusted upwards from negative to indeterminate or indeterminate to positive; two nodules were malignant. Conclusion In one in 20 cases of baseline lung cancer screening, nodules were reclassified by the radiologist, leading to a reduction of false-positive screen results. Key Points • The NELSON study allowed radiologists to manually adjust the screen result • At baseline, radiologists adjusted the result in about one in 20 cases (95.4 % downwards) • Radiologists' adjustments led to a 22 % reduction of falsepositive screen results • Radiologists' expertise can improve nodule classification in addition to a nodule protocol

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Comparison of sensitivity of lung nodule detection between radiologists and technologists on low-dose CT lung cancer screening images

Cited by 16 publications

References 19 publications

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Comparing the performance of trained radiographers against experienced radiologists in the UK lung cancer screening (UKLS) trial

The impact of radiologists’ expertise on screen results decisions in a CT lung cancer screening trial

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