Purpose: To compare the influence of visual and acoustical CAD markers on radiologist's performance with regard
to suggestive and distractive effects.
Materials and methods: Ten radiologists analyzed 150 pictures of chest CT slices. Every picture contained a visual
CAD marker. 100 pictures showed one nodule: CAD marker marked this in 50 cases and in 50 cases a false positive
finding (f.p.). The other 50 cases showed no nodule but an f.p. marker. After 3 years same images were presented to
thirteen radiologists with only a sound as CAD marker. 55 of 150 images were marked, 30 true positive and 25 f.p.
Sensitivity and f.p. rate were calculated for both marker types. Significance between sensitivities and f.p. rates were
calculated by multiple-analysis-of-variance (MANOVA).
Results: Without CAD mean sensitivity resp. f.p. were 57.7% /.13. In case of correct optical resp. acoustical marker
sensitivity increased to 75.6% resp. 63.1%. For incorrect set marker mean f.p. rate increased to .31 resp. .24.
MANOVA showed that marker's correctness highly significantly influenced sensitivity (p<.001) and f.n. (p=.005).
Type of marker showed no significant influence on sensitivity (p=.26) or f.n. (p=.23) but on f.p. (p<.001).
New work to be presented: Acoustical markers are a new means to increase radiologist's awareness of the presence
of pulmonary nodules at CT scans with much less suggestive effect compared to optical markers.
Conclusion: We found an unexpectedly low distraction effect for misplaced CAD markers. A suggestive effect was
remarkable especially for optical markers. However acoustical markers offered less increase of sensitivity.
Purpose: The efficiency of the detection of pulmonary nodules by a radiologist with the help of CAD is influenced
by the user interface of the system. Marker with a visually dominant appearance may distract the radiologist from
other parts of the screen. Purpose was to analyse the influence of different CAD markers on radiologist's
performance.
Materials and methods: 10 radiologists analysed 150 pictures of chest CT slices. Every picture contained a CAD
marker; five different types of markers were used - each respectively on 30 pictures (1: thick walled square, 2: thin
walled circle, 3: small arrow, 4: pixel sized point on nodule, 5: very subtle change of colour). One hundred images
contained one nodule: CAD markers marked this finding in 50 cases; in 50 cases a false positive finding was marked
instead. The remaining 50 images contained no nodule but a marker of a false positive finding. The radiologists had
to decide for each image if there was a nodule visible and either click on the nodule or on a button "no finding".
Sensitivity and specificity were calculated for each marker type.
Results: Mean sensitivity was 59%, 62%, 64%, 65% and 64% for marker 1 to 5, respectively. Specificity was 50%,
51%, 64%, 45% and 67%. In the cases with false positive findings sensitivity for detection of the unmarked nodule
was 41%, 58%, 59%, 49% and 54%.
New work to be presented: The study shows that the marker type influences radiologist's sensitivity and distraction
from other findings.
Conclusion: Of the tested markers a small arrow was most efficient for the presentation of the results to the
radiologist.
Purpose: To compare sensitivity and reading time when using CAD as second reader resp. concurrent reader.
Materials and Methods: Fifty chest MDCT scans due to clinical indication were analysed independently by four radiologists two times: First with CAD as concurrent reader (display of CAD results simultaneously to the primary reading by the radiologist); then after a median of 14 weeks with CAD as second reader (CAD results were shown after completion of a reading session without CAD). A prototype version of Siemens LungCAD (Siemens,Malvern,USA) was used. Sensitivities and reading times for detecting nodules ≥4mm of concurrent reading, reading without CAD and second reading were recorded. In a consensus conference false positive findings were eliminated. Student's T-Test was used to compare sensitivities and reading times. Results: 108 true positive nodules were found. Mean sensitivity was .68 for reading without CAD, .68 for concurrent reading and .75 for second reading. Differences of sensitivities were significant between concurrent and second reading (p<.001) resp. reading without CAD and second reading (p=.001). Mean reading time for concurrent reading was significant shorter (274s) compared to reading without CAD (294s;p=.04) and second reading (337s;p<.001). New work to be presented: To our knowledge this is the first study that compares sensitivities and reading times between use of CAD as concurrent resp. second reader. Conclusion: CAD can either be used to speed up reading of chest CT cases for pulmonary nodules without loss of sensitivity as concurrent reader -OR (and not AND) to increase sensitivity and reading time as second reader.
The purpose of the presented study was to determine the impact of two different CAD systems used as concur-rent reader for detection of actionable nodules (>4 mm) on the interpretation of chest CT scans during routine reporting.
Fifty consecutive MDCT scans (1 mm or 1.25 mm slice thickness, 0.8 mm reconstruction increment) were se-lected from clinical routine. All cases were read by a resident and a staff radiologist, and a written report was available in the radiology information system (RIS). The RIS report mentioned at least one actionable pulmonary nodule in 18 cases (50%) and did not report any pulmonary nodule in the remaining 32 cases. Two different recent CAD systems were independently applied to the 50 CT scans as concurrent reader with two radiologists: Siemens LungCare NEV and MEDIAN CAD-Lung. Two radiologists independently reviewed the CAD results and determined if a CAD result was a true positive or a false positive finding. Patients were classified into two groups: in group A if at least one actionable nodule was detected and in group B if no actionable nodules were found. The effect of CAD on routine reporting was simulated as set union of the findings of routine reporting and CAD thus applying CAD as concurrent reader.
According to the RIS report group A (patients with at least one actionable nodule) contained 18 cases (36% of all 50 cases), and group B contained 32 cases. Application of a CAD system as concurrent reader resulted in detec-tion of additional CT scans with actionable nodules and reclassification into group A in 16 resp. 18 cases (radi-ologist 1 resp. radiologist 2) with Siemens NEV and in 19 resp. 18 cases with MEDIAN CAD-Lung. In seven cases MEDIAN CAD-Lung and in four cases Siemens NEV reclassified a case into group A while the other CAD system missed the relevant finding. Sensitivity on a nodule (>4 mm) base was .45 for Siemens NEV and .55 for MEDIAN CAD-Lung; the difference was not yet significant (p=.077).
In our study use of CAD as second reader in routine reporting doubled the percentage of patients with actionable nodules larger than 4 mm.
This study was aimed to evaluate a morphology-based approach for prediction of postoperative forced expiratory volume in one second (FEV1) after lung resection from preoperative CT scans. Fifteen Patients with surgically treated (lobectomy or pneumonectomy) bronchogenic carcinoma were enrolled in the study. A preoperative chest CT and pulmonary function tests before and after surgery were performed. CT scans were analyzed by prototype software: automated segmentation and volumetry of lung lobes was performed with minimal user interaction. Determined volumes of different lung lobes were used to predict postoperative FEV1 as percentage of the preoperative values. Predicted FEV1 values were compared to the observed postoperative values as standard of reference. Patients underwent lobectomy in twelve cases (6 upper lobes; 1 middle lobe; 5 lower lobes; 6 right side; 6 left side) and pneumonectomy in three cases. Automated calculation of predicted postoperative lung function was successful in all cases. Predicted FEV1 ranged from 54% to 95% (mean 75% ± 11%) of the preoperative values. Two cases with obviously erroneous LFT were excluded from analysis. Mean error of predicted FEV1 was 20 ± 160 ml, indicating absence of systematic error; mean absolute error was 7.4 ± 3.3% respective 137 ± 77 ml/s. The 200 ml reproducibility criterion for FEV1 was met in 11 of 13 cases (85%). In conclusion, software-assisted prediction of postoperative lung function yielded a clinically acceptable agreement with the observed postoperative values. This method might add useful information for evaluation of functional operability of patients with lung cancer.
For differential diagnosis of pulmonary nodules, assessment of contrast enhancement at chest CT scans after administration of contrast agent has been suggested. Likelihood of malignancy is considered very low if the contrast enhancement is lower than a certain threshold (10-20 HU). Automated average density measurement methods have been developed for that purpose. However, a certain fraction of malignant nodules does not exhibit significant enhancement when averaged over the whole nodule volume. The purpose of this paper is to test a new method for reduction of false negative results. We have investigated a method of showing not only a single averaged contrast enhancement number, but a more detailed enhancement curve for each nodule, showing the enhancement as a function of distance to boundary. A test set consisting of 11 malignant and 11 benign pulmonary lesions was used for validation, with diagnoses known from biopsy or follow-up for more than 24 months. For each nodule dynamic CT scans were available: the unenhanced native scan and scans after 60, 120, 180 and 240 seconds after onset of contrast injection (1 - 4 mm reconstructed slice thickness). The suggested method for measurement and visualization of contrast enhancement as radially resolved curves has reduced false negative results (apparently unenhancing but truly malignant nodules), and thus improved sensitivity. It proved to be a valuable tool for differential diagnosis between malignant and benign lesions using dynamic CT.
Objective: Assess the performance of a computer aided diagnosis (CAD) system for automatic detection of pulmonary nodules at CT scans compared to single and double reading by radiologists. Material and methods: A nodule detection CAD system (Siemens LungCare NEV VB10) was applied to low-dose-CT (LDCT) scans of nine patients with pulmonary metastases and compared to findings of three radiologists; standard-dose-CT (SDCT) was acquired simultaneously to establish ground truth. Study design was approved by the Institutional Review Board and the appropriate German authorities. Ground truth was established by fusion of sets of detected nodules from independent reading by three radiologists at LDCT and SDCT scans and CAD results. Special focus was taken on the size of nodules detected only by CAD compared to the size of all detected nodules. Results: Average sensitivity of 54% (range 51-55%) was observed for single reading by one radiologist. Application of the CAD system demonstrated a similar sensitivity of 55%. Double reading by two radiologists increased sensitivity to an average of 67% (range 67-68%). The difference to single reading was significant (p<0.001). Use of CAD as second opinion after single reading increased the sensitivity to 79% (range 77-81%) which proved to be significantly better than double reading (p<0.001). 11% of nodules with a size of more than 4 mm were detected only by CAD. Conclusion: CAD as second reader offered a significant increase in sensitivity compared to conventional double reading. Therefore, CAD is a valuable second opinion for the detection of pulmonary nodules.
Lack of angiogenesis virtually excludes malignancy of a pulmonary nodule; assessment with quantitative contrast-enhanced CT (QECT) requires a reliable enhancement measurement technique. Diagnostic performance of different measurement methods in the distinction between malignant and benign nodules was evaluated. QECT (unenhanced scan and 4 post-contrast scans) was performed in 48 pulmonary nodules (12 malignant, 12 benign, 24 indeterminate). Nodule enhancement was the difference between the highest nodule density at any post-contrast scan and the unenhanced scan. Enhancement was determined with: A) the standard 2D method; B) a 3D method consisting of segmentation, removal of peripheral structures and density averaging. Enhancement curves were evaluated for their plausibility using a predefined set of criteria. Sensitivity and specificity were 100% and 33% for the 2D method resp. 92% and 55% for the 3D method using a threshold of 20 HU. One malignant nodule did not show significant enhancement with method B due to adjacent atelectasis which disappeared within the few minutes of the QECT examination. Better discrimination between benign and malignant lesions was achieved with a slightly higher threshold than proposed in the literature. Application of plausibility criteria to the enhancement curves rendered less plausibility faults with the 3D method. A new 3D method for analysis of QECT scans yielded less artefacts and better specificity in the discrimination between benign and malignant pulmonary nodules when using an appropriate enhancement threshold. Nevertheless, QECT results must be interpreted with care.
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