Efficiency and reporting confidence analysis of sequential dual-energy subtraction for thoracic x-ray examinations

Abstract

Rationale and objectives: We aimed to report and compare accuracy, reproducibility, and reporting confidence between thoracic dual-energy subtraction (DES) and routine posterior–anterior chest radiography (PA-CR) techniques. Materials (patients) and methods: We obtained DES (D1–D4) images from 96 patients using DES and a high-resolution dynamic flat-panel detector in combination. We compared the DES images of these patients with their PA-CR images. The maximum time interval between performing DES and PA-CR was nine weeks. Two radiologists evaluated abnormal findings on DES and PA-CR images using a three-point scale, and reporting confidence was scored using a four-point scale. The intra- and interobserver agreement values of the scores were analyzed. Further, the radiation exposure doses during PA-CR and DES acquisitions were calculated. Results: The intra- and interobserver agreement values of PA-CR and DES images were good. The reporting confidence scores for DES were generally higher than those for PA-CR. Between bone-subtracted (D3) and soft-tissue-subtracted (D4) images, the former was more successful and useful in the evaluation of bone structures, whereas the latter was better in the evaluation of consolidation and/or solitary nodules. Conclusions: DES has the potential to improve the accuracy, reproducibility, and reporting confidence of thoracic radiography. It also has the potential to provide a better diagnosis of chest pathologies using relatively low dose radiation.

Effectiveness of one-shot dual-energy subtraction chest radiography with flat-panel detector in distinguishing between calcified and non-calcified nodules

“…Nevertheless, most previous studies have evaluated the detectability of the lung nodules rather than the presence or absence of nodule calcification 2 , 3 , 5 – 10 . In addition, most previous studies used dual-shot DES 3 , 6 , 9 , 10 or used one-shot DES with film-screen radiography or computed radiography 4 , 5 , 8 , 11 ; these studies did not use one-shot DES with a flat-panel detector. To the best of our knowledge, the present study is the first to evaluate the effectiveness of one-shot DES with a flat-panel detector to differentiate between calcified and non-calcified nodules.…”

“…Although the usefulness of DES has already been reported on chest radiography, most studies have not evaluated distinguishability between calcified and non-calcified nodules, but rather evaluated nodule detectability 2 , 3 , 5 – 10 . In addition, most studies have used two-shot DES 3 , 6 , 9 , 10 or have used one-shot DES by means of film-screen radiography or computed radiography instead of flat-panel detectors 4 , 5 , 8 , 11 . Therefore, the diagnostic performance of one-shot DES with a flat-panel detector for calcified nodules is not well established.…”

Diagnostic Performance of Dual-Energy Subtraction Radiography for the Detection of Pulmonary Emphysema: An Intra-Individual Comparison

“…DE is a new imaging modality with the potential to overcome these difficulties. In DE, a post-processing algorithm separates calcium-containing structures from soft-tissue components and overcomes the problem of superimposition of several structures [34].…”

“…In fact, previous studies could show that DE improves the sensitivity for shading lesions, such as the detection of infectious consolidations, tumors, interstitial lung changes, and aortic or tracheal calcification compared to CR images [18][19][20][21]. Other studies have shown that DE can reduce diagnostic errors of chest pathologies and prevent misdiagnosis of consolidations or lung nodules, for example, also by less-experienced radiologists [34,36]. The higher accuracy for detecting focal opacities (i.e., lung nodules or infectious infiltrates) was attributed to the better accentuation of lung abnormalities [37].…”

Dual-Energy Radiography in the Diagnostics of the Thoracic Diseases: Prospective Study

“…По данным ряда работ эффективность ДЭР в диагностике различных заболеваний легких превосходит стандартную цифровую рентгенографию (ЦР) при сопоставимой дозовой нагрузке, тем не менее двухэнергетическая методика пока не нашла свое место в алгоритме лучевого обследования органов грудной клетки [3][4][5].…”