Diagnostic imaging costs before and after digital tomosynthesis implementation in patient management after detection of suspected thoracic lesions on chest radiography.

OBJECTIVES: To evaluate diagnostic imaging costs before and after DTS implementation in patients with suspected thoracic lesions on CXR. METHODS: Four hundred sixty-five patients (263 male, 202 female; age, 72.47 ± 11.33 years) with suspected thoracic lesion(s) after CXR underwent DTS. Each patient underwent CT when a pulmonary non-calcified lesion was identified by DTS while CT was not performed when a benign pulmonary or extrapulmonary lesion or pseudolesion was identified. The average per-patient imaging cost was calculated by normalising the costs before and after DTS implementation. RESULTS: In 229/465 patients who underwent DTS after suspicious CXR, DTS showed 193 pulmonary lesions and 36 pleural lesions, while in the remaining 236/465 patients, lesions were ruled out as pseudolesions of CXR. Chest CT examination was performed in 127/465 (27 %) patients while in the remaining 338/465 patients (73 %) CXR doubtful findings were resolved by DTS. The average per-patient costs of CXR, DTS and CT were 15.15, 41.55 and 113.66. DTS allowed an annual cost saving of 8,090.2 considering unenhanced CT and 19,298.12 considering contrast-enhanced CT. Considering a DTS reimbursement rate of 62.7 the break even point corresponds to 479 DTS examinations. CONCLUSION: Per-patient diagnostic imaging costs decreased after DTS implementation in patients with suspected thoracic lesions. MAIN MESSAGES: • Digital tomosynthesis improves the diagnostic accuracy and confidence in chest radiography • Digital tomosynthesis reduces the need for CT for a suspected pulmonary lesion • Digital tomosynthesis requires a dose level equivalent to that of around two chest radiographies • Digital tomosynthesis produces a significant per-patient saving in diagnostic imaging costs.

The value of digital tomosynthesis in the diagnosis of suspected pulmonary lesions on chest radiography: analysis of diagnostic accuracy and confidence.

RATIONALE AND OBJECTIVES: The aim of this study was to investigate the value of digital tomosynthesis in the diagnosis of suspected pulmonary lesions on chest radiography. MATERIALS AND METHODS: Two-hundred twenty-eight patients (133 men, 95 women; mean age, 70.8 ± 11.1 years) with suspected pulmonary lesions after initial analysis of chest radiography underwent digital tomosynthesis. Two independent readers (with 3 and 20 years of experience) prospectively analyzed the chest radiographic and digital tomosynthesis images on a picture archiving and communication system workstation and proposed a diagnostic confidence score for each lesion (1 or 2 = definitely or probably extrapulmonary lesion or pseudolesion, 3 = indeterminate, 4 or 5 = probably or definitely pulmonary lesion). Chest computed tomography was the reference standard examination. RESULTS: A total of 251 suspected pulmonary lesions were identified. In 71 patients, digital tomosynthesis and computed tomography did not confirm any lesion. In the remaining 157 patients, 180 lesions were identified, including 112 pulmonary and 68 extrapulmonary lesions. In 110 (reader 1) and 123 (reader 2) lesions, correct diagnoses were provided after analysis of the chest radiographs. All lesions were correctly classified after digital tomosynthesis except for 14 extrapulmonary lesions (both readers) that were misinterpreted as pulmonary and 10 (reader 1) and six (reader 2) pulmonary lesions that were misinterpreted as pleural. Digital radiography versus tomosynthesis differed in accuracy (reader 1, 43% vs 90%; reader 2, 49% vs 92%; P < .05) and confidence by area under the receiver-operating characteristic curve (reader 1, 0.788 vs 0.944; reader 2, 0.840 vs 0.997; P < .05). CONCLUSIONS: Digital tomosynthesis improved diagnostic accuracy and confidence in the diagnosis of suspected pulmonary lesions on chest radiography.