Evaluation of the clinical utility of temporal subtraction using bone suppression processing in digital chest radiography.

Rationale and objectives: To evaluate the usefulness of temporal subtraction using the bone suppression method in digital chest radiography for the detection of pulmonary lesions. Materials and methods: The images of 31 patients with pulmonary lesions and 19 normal cases were included in the study. Conventional and bone suppression temporal subtraction were performed in the 50 cases selected and used for an observer performance study. Five radiologists participated in the study, and the differences between using conventional and bone suppression temporal subtraction were assessed using jackknife free-response receiver operating characteristic analysis. Results: The average figure-of-merit values for all radiologists increased significantly using the bone suppression method, from 0.619 (conventional) to 0.696 (p = 0.032). The average sensitivity for detecting pulmonary lesions improved from 67.9% to 75.4%, and the average number of false-positive per case decreased from 0.336 to 0.252 using bone suppression temporal subtraction. Conclusion: Bone suppression temporal subtraction processing can assist with the detection of subtle pulmonary lesions in digital chest radiographs.

Calculating the target exposure index using a deep convolutional neural network and a rule base.

PURPOSE: The objective of this study is to determine the quality of chest X-ray images using a deep convolutional neural network (DCNN) and a rule base without performing any visual assessment. A method is proposed for determining the minimum diagnosable exposure index (EI) and the target exposure index (EIt). METHODS: The proposed method involves transfer learning to assess the lung fields, mediastinum, and spine using GoogLeNet, which is a type of DCNN that has been trained using conventional images. Three detectors were created, and the image quality of local regions was rated. Subsequently, the results were used to determine the overall quality of chest X-ray images using a rule-based technique that was in turn based on expert assessment. The minimum EI required for diagnosis was calculated based on the distribution of the EI values, which were classified as either suitable or non-suitable and then used to ascertain the EIt. RESULTS: The accuracy rate using the DCNN and the rule base was 81%. The minimum EI required for diagnosis was 230, and the EIt was 288. CONCLUSION: The results indicated that the proposed method using the DCNN and the rule base could discriminate different image qualities without any visual assessment; moreover, it could determine both the minimum EI required for diagnosis and the EIt.

Additive value of split-bolus single-phase CT scan protocol for preoperative assessment of lung cancer patients referred for video-assisted thoracic surgery.

We aimed to assess the additive value of the split-bolus single-phase computed tomography (CT) scan protocol to preoperatively assess patients with lung cancer, who were referred for video-assisted thoracic surgery, when compared to a standard staging CT protocol. We included 160 patients with lung cancer who underwent a split-bolus single-phase CT scan protocol (split-bolus protocol), which can acquire whole-body staging CT and pulmonary artery-vein separation CT angiography (PA-PV CTA) in a single acquisition and 160 patients who underwent whole-body staging CT (standard protocol). We compared the quality of the staging CT images of hepatic parenchyma, portal vein, and hepatic vein between both protocols. We also investigated image quality on PA-PV CTA images in the split-bolus protocol and recorded the number of patients that underwent the 3D PA-PV CTA imaging process. The split-bolus protocol for staging CT images demonstrated a slightly higher enhancement with regard to the hepatic parenchyma (p = 0.007) and hepatic vein (p = 0.006) than the standard protocol. There was no significant difference in the quality of the staging CT images between both protocols (p = 0.067). The mean CT number for the main pulmonary artery and the left atrium for the PA-PV CTA images in the split-bolus protocol were 289.1 HU and 172.8 HU, respectively. Among the images associated with the split-bolus protocol, 98.1% were of appropriate quality for 3D PA-PV CTA imaging. The split-bolus protocol is a dose-efficient protocol to acquire the staging CT and PA-PV CTA images in a single session and provides sufficient image quality for preoperative assessment in patients with lung cancer.

The clinical significance of modifying X-ray tube current-time product based on prior image deviation index for digital radiography.

PURPOSE: The absorbed dose at the image receptor in digital X-ray systems increases with an incorrect adjustment of the X-ray tube current-time product (mAs). Accordingly, the exposure index, target exposure index, and deviation index (DI) are proposed as absorbed dose optimization tools. We aimed at reducing the variation of DI in a short period by employing the mAs value determined by previously used mAs and DI. METHODS: We developed software that automatically calculates mAs for subsequent X-ray examinations based on mAs and DI values from prior examinations. Portable chest X-ray examinations in an intensive care unit (ICU) were performed for 16 weeks. The software was not used for the first 10 weeks in 406 cases and was used for the remaining 6 weeks in 216 cases. The changes in the non-conformance rate of DI for 16 weeks were evaluated using the p-chart used for quality control. The effect of the software on image noise was also evaluated. RESULTS: In total, 42% of cases had a DI range of -1 to 1 without using the software; this increased to 81% when using the software. Averages and variances of DI in cases with and without the software demonstrated statistically significant differences. From the p-chart, the non-conformance rate of DI was shown to decrease when using software. The software also worked for reducing the variation in image noise. CONCLUSIONS: Our method reduced the variation in DI in a short period of time.

CT temporal subtraction method for detection of sclerotic bone metastasis in the thoracolumbar spine.

PURPOSE: To assess the effectiveness of a CT temporal subtraction (TS) method on radiologists' performance in sclerotic metastasis detection in the thoracolumbar spine. MATERIALS AND METHODS: 20 pairs (current and previous CTs) of standard-dose CT and their TS images in patients with sclerotic bone metastasis and 20 pairs (current and previous CTs) of those in patients without bone metastasis were used for an observer performance study. A total of 135 lesions were identified as the reference standard of actionable lesions (sclerotic metastasis newly appeared or increased in size or in attenuation). 4 attending radiologists and 4 radiology residents participated in this observer study. Ratings and locations of "lesions" determined by the observers were utilized for assessing the statistical significance of differences between radiologists' performances without and with the CT-TS images in JAFROC analysis. The statistical significance of differences in the reviewing time was determined by a two-tailed paired t-test. RESULTS: The average figure-of-merit (FOM) values for all but one radiologist increased to a statistically significant degree, from 0.856 without the CT-TS images to 0.884 with the images (P = .037). The average sensitivity for detecting the actionable lesions was improved from 60.7 % to 72.5% at a false-positive rate of 0.15 per case by use of the CT-TS images. The average reading time with CT-TS images was significantly shorter than that without (150.6 s vs. 166.5 s, P = .004). CONCLUSION: The use of CT-TS would improve the observer performance for the detection of the sclerotic bone metastasis in the thoracolumbar spine.

Clinical performance metrics of 3D stereoscopic digital mammography compared with 2D digital mammography: observer study.

OBJECTIVE: To assess the clinical performance of three-dimensional stereoscopic digital mammography (3DsDM) compared with two-dimensional digital mammography (2DDM) for breast lesion diagnosis with jackknife free-response receiver operating characteristics (JAFROC) observer study. METHODS: 40 pairs of standard-dose 2DDM and their 3DsDM images were used for an observer performance study. A total of 18 lesions were identified as the reference standard of actionable breast lesions (Breast Imaging Reporting and Data System Category 3 or more) by two breast radiologists. Ratings and locations of "lesions" determined by observers were utilized for assessing the statistical significance of differences between eight radiologists' performances with the 2DDM images and with the 3DsDM images in jackknife free-response receiver operating characteristic analysis. RESULTS: The average figure-of-merit values for all radiologists increased to a statistically significant degree, from 0.859 with the 2DDM images to 0.936 with the 3DsDM images (p < 0.001). The average sensitivity for detecting actionable lesions was improved from 74.3 to 92.4% at a false-positive rate of 0.2 per case by use of the 3DsDM images. The mean reading time per case with 2DDM images was not significantly different from that with 3DsDM images. CONCLUSION: The use of 3DsDM would improve the observer performance for breast lesion without considerably extending the reading time. Advances in knowledge: Use of 3DsDM improves radiologists' performance for breast lesion detection.

Detection of lung carcinoma with predominant ground-glass opacity on CT using temporal subtraction method.

PURPOSE: To evaluate the usefulness of the CT temporal subtraction (TS) method for the detection of the lung cancer with predominant ground-glass opacity (LC-pGGO). MATERIALS AND METHODS: Twenty-five pairs of CT and their TS images in patients with LC-pGGO (31 lesions) and 25 pairs of those in patients without nodules were used for an observer performance study. Eight radiologists participated and the statistical significance of differences with and without the CT-TS was assessed by JAFROC analysis. RESULTS: The average figure-of-merit (FOM) values for all radiologists increased to a statistically significant degree, from 0.861 without CT-TS to 0.912 with CT-TS (p < .001). The average sensitivity for detecting the actionable lesions improved from 73.4 % to 85.9 % using CT-TS. The reading time with CT-TS was not significantly different from that without. CONCLUSION: The use of CT-TS improves the observer performance for the detection of LC-pGGO. KEY POINTS: • CT temporal subtraction can improve the detection accuracy of lung cancer. • Reading time with temporal subtraction is not different from that without. • CT temporal subtraction improves observer performance for ground-glass/subsolid nodule detection.

Automatic classification of lung nodules on MDCT images with the temporal subtraction technique.

PURPOSE: A temporal subtraction (TS) image is obtained by subtracting a previous image, which is warped to match the structures of the previous image and the related current image. The TS technique removes normal structures and enhances interval changes such as new lesions and substitutes in existing abnormalities from a medical image. However, many artifacts remaining on the TS image can be detected as false positives. METHOD: This paper presents a novel automatic segmentation of lung nodules using the Watershed method, multiscale gradient vector flow snakes and a detection method using the extracted features and classifiers for small lung nodules (20 mm or less). RESULT: Using the proposed method, we conduct an experiment on 30 thoracic multiple-detector computed tomography cases including 31 small lung nodules. CONCLUSION: The experimental results indicate the efficiency of our segmentation method.

Evaluation of the effects of subject thickness on the exposure index in digital radiography.

The exposure index (EI) was proposed as a new X-ray dose index by the International Electrotechnical Commission (IEC) and has since been implemented as an international standard. The EI is calculated by use of an approximation equation under IEC-specified calibration conditions. However, several factors encountered in clinical practice, including the patient's body thickness and the tube voltage, differ with regard to these calibration conditions. We, therefore, require a solid water phantom-based function that can incorporate the IEC-specified conditions and different subject thicknesses to evaluate the effects of subject thickness on the EI. Here, we assumed average thicknesses of 10 cm for a child, 15 cm for slender patients, and 21 cm for an average adult abdomen and we evaluated errors, that are included in the EI, which were calculated by use of the function. Our results suggested that the EI depends on the subject thickness. At the 21-cm thickness (average adult abdomen), the display EI exhibited a small error level. In contrast, EI values calculated from the calibration conditions exhibited maximum errors that were as high as 34 % at the lower subject thicknesses (10 and 15 cm), suggesting a significant influence of the subject thickness on the EI. In conclusion, the EI should be used cautiously during the examination of children and thin patients, with a complete understanding of the discrepancy revealed by our study results.

[A Case of Locally Advanced Rectal Cancer with a Pathological Complete Response to Preoperative Chemoradiotherapy].

A 61-year-old woman presented with the chief complaint of melena. She was diagnosed with rectal cancer via colonoscopy. Computed tomography (CT) revealed a rectal cancer with wall thickening, accompanied by several regional lymph node metastases with no distant metastasis. The tumor stage was cT3, cN2a, cM0 according to the TNM Classification of Malignant Tumors (7th Edition, UICC). Preoperative chemoradiotherapy (CRT) (UFT 400 mg/day tegafur-uracil and 75 mg/day Leucovorin; 1.8 Gy in 25 fractions, total 45 Gy) was administered. Eight weeks after CRT, laparoscopy-assisted low anterior resection was performed. A pathological examination revealed that both the primary site and regional lymph nodes had no residual cancer cells, and a diagnosis of pathological complete response was made. The patient has been disease-free for 4 years since the operation. We report a case of rectal cancer that was successfully treated via preoperative CRT. This case may aid the development of a standard therapy for advanced rectal cancer.

Temporal subtraction method for lung nodule detection on successive thoracic CT soft-copy images.

PURPOSE: To assess the effects of a new computed tomographic (CT) temporal subtraction (TS) method on radiologist performance in lung nodule detection on thin-section CT images. MATERIALS AND METHODS: The institutional review board approved this study, and the informed consent requirement was waived. Fifty pairs (current and previous CT images) of standard-dose 2-mm thin-section CT images and corresponding CT TS images were used for an observer performance study. Two thoracic radiologists identified 30 nodules ranging in size from 5 to 19 mm, and these nodules served as the reference standard of actionable nodules (noncalcified nodules larger than 4 mm). Eight radiologists (four attending radiologists, four radiology residents) participated in this observer study. Ratings and locations of lesions determined by observers were used to assess the significance of differences between radiologists' performances without and with the CT TS images in jacknife free-response receiver operating characteristics analysis. RESULTS: Average figure of merit values increased significantly for all radiologists (from 0.838 without CT TS images to 0.894 with CT TS images [P = .033]). Average sensitivity for detection of actionable nodules was improved from 73.4% to 83.4%, with a false-positive rate of 0.15 per case, by using CT TS images. The reading time with CT TS images was not significantly different from that without. CONCLUSION: The novel CT TS method would increase observer performance for lung nodule detection without considerably extending the reading time.

[Analysis of patient flow by radiology information system].

HIS (hospital information system) and PACS (picture archiving and communication system) have become widely popular in clinical offices, and use of RIS (radiology information system) in the department of radiology has spread, creating networking between HIS, PACS, and diagnostic systems. RIS receives patient data and order data from HIS and sends them to the diagnostic systems. On the other hand, the RIS sends the implementation record and accounting data to HIS. When receiving and transmitting of these data are done by the RIS, the event's time is recorded in the RIS as attendant data. This paper proposes a way to analyze patient flow from the records of the event's time. The method counts the number of the accepted examinations y(i) (i = 0, 1, ... N) and the completed examinations z(i) every divided time t from the RIS work list, and computes the following three characteristic values related to patient flow. Those values are average expended time T; T = ( Sigma z(i ) i t - Sigma y(i ) i t ) / Sigma y(i) ,number of exam queue q(i); q(i) = Sigma y(i) - Sigma z(i) , and dissolved time of queue w(i); w(i) = q(i ) ( t / z(i) ). The method analyzes patient flow of radiology using these characteristic values. It also performs a simulation of the flow in cases of equipment trouble.

[Feasibility of a new initial check-up program for medical X-ray and computed radiography systems].

We investigated the feasibility of a simple, easy method that uses a digital radiography (DR) phantom for daily operational checks of the medical X-ray system and computed radiography (CR) system. First, we measured exposure indicator calibration (S value) from 12 seconds to 11 minutes after irradiation to examine the effect of fading of the photostimulable phosphor screen. We then examined the management width of the exposure indicator calibration ratio and limiting resolution of the CR system. Finally, we studied the exposure indicator calibration ratio, limiting the resolution and time necessary for the initial check-up by running the program 20 times for five weeks. Under the influence of the fading, the S value increased gradually, although the level of variation was small. From the mean and coefficient of variation of the exposure indicator calibration ratio, the management width was determined as +/-10%. The exposure indicator calibration ratio and limiting resolution were within +/-10% and +/-20%, respectively. It took three minutes to accomplish the initial check-up. The initial check-up using a DR phantom is simple and can perform the operational check of the medical X-ray system and the CR system with sufficient accuracy in only 3 minutes.

[New evaluation for osteoporosis using calcaneal computed radiographs].

Quantitative analysis of bone mass is a method mainly used for the diagnosis of osteoporosis. However, there are cases of osteoporosis that cannot be diagnosed by this method alone. This study was performed to develop a new quantitative method for the evaluation of osteoporosis using texture analysis and geometric feature analysis of trabecular bone on lateral calcaneal computed radiographs. Thirty-seven cases including 11 normal and 26 abnormal lateral calcaneal radiographs were examined. The patients' ages ranged from 24 to 89 years (average age, 58.3 years). The root mean square (RMS) variation and first moment of power spectrum of trabecular bone patterns were determined as quantitative measures for texture analysis. In addition, the total area and total length of trabecular bone were obtained from geometric feature analysis. The RMS variations in pixel values, total area, and total length of trabecular bone were decreased as bone atrophy progressed. These three quantitative measures corresponded well to radiologists' subjective evaluations of bone atrophy. Moreover, our results indicated that these three quantitative measures had strong correlations with bone mineral density of the femoral neck. Therefore, we consider the computerized method with texture analysis and geometric feature analysis of lateral calcaneal radiographs to be very useful for radiologists in evaluating osteoporosis.