Tomosynthesis beats chest x-ray at guiding decision-making around pulmonary nodules

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Spots on the lung are better detected and managed by digital chest tomosynthesis than by imaging with conventional chest radiography, including when the latter is augmented by dual-energy (DE) technology—and regardless of the lack of deep, chest-specific experience in the interpreting radiologist.

That’s according to a multi-institution, multireader study lead-authored by James T. Dobbins III, PhD, of Duke University Medical Center and published online July 19 in Radiology.

Dobbins and colleagues prospectively enrolled 158 volunteer subjects, 115 of whom had one or more CT-confirmed pulmonary nodules. The remaining 43 had no nodules.

As three experienced thoracic radiologists identified true locations of 516 nodules measuring three to 20 millimeters in diameter, five other radiologists—unspecialized or less experienced in thoracic imaging—indicated nodules and directed case management by using images from four modalities: conventional chest radiography alone, conventional chest radiography plus DE imaging, tomosynthesis alone and tomosynthesis plus DE imaging.

DE, which is only used clinically as an adjunct to conventional chest radiography, was not assessed as a standalone modality.

Dobbins and team found that maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography across a range of nodule-size categories.

Additionally, case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules, and case-management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography.  

The authors conclude that, when deployed in a clinical radiology setting with both thoracic and nonthoracic specialists, tomosynthesis is superior to chest radiography for both detecting pulmonary nodules and guiding case-management decisions.

The study results, they add, “should augment the findings of previous studies in which only thoracic radiologists were used to suggest that tomosynthesis may have clinical value for a wide range of radiologist users in the detection and management of pulmonary nodules.”

Along with Duke University, the team had participants from radiology departments at the University of Pittsburgh, the University of Michigan, the University of Washington and the University of Gothenburg in Sweden.