Effect of dual-energy subtraction on performance of a commercial computer-assisted diagnosis system in detection of pulmonary nodules

Eliot Siegel, Bruce Reiner, Khan Siddiqui, Amy Musk, Susan Wood, Xiaolan Zeng, Nabile Safdar, Paul Nagy, Frank Hooper, Ryan Moffitt, Steve Severance

Research output: Contribution to journalConference articlepeer-review


The relatively low (20%-25%) sensitivity of conventional radiography for lung nodules is an impetus for investigations into computer-assisted diagnostic (CAD) algorithms and into alternative acquisition techniques (such as dual-energy subtraction [DES]), both of which have been shown to increase diagnostic sensitivity for lung nodule detection. This pilot study combined these synergistic techniques in the diagnosis of digital clinical chest radiographs in 26 individuals. A total of 59 marks were identified by the CAD algorithm as suspicious for a nodule using a "conventional" chest direct radiography posterior/anterior image (an average of 2.3 marks per radiograph). Only 39 marks were identified on the soft tissue image of the corresponding DES radiographs (an average of 1.5 marks per radiograph). The sensitivity for nodules considered subtle but "actionable" in the 10-15-mm range was 0% (correctly identifying 0 of 4 nodules), whereas the sensitivity for the same radiographs with DES was 75% (correctly identifying 3 of 4 nodules). These pilot data suggest that the algorithms for at least one commercial CAD system may not be fully able to differentiate overlying bones and other calcifications from pulmonary lesions (which is also a difficult task for radiologists) and that the combination of CAD and DES acquisition may result in a substantial improvement in both sensitivity and specificity in the detection of relatively subtle lung nodules. This study has been expanded to evaluate a much larger set of images to further investigate the potential for the routine use of CAD with DES.

Original languageEnglish (US)
Article number5748-50
Pages (from-to)392-398
Number of pages7
JournalProgress in Biomedical Optics and Imaging - Proceedings of SPIE
StatePublished - Aug 25 2005
Externally publishedYes
EventMedical Imaging 2005 - PACS and Imaging Informatics - San Diego, CA, United States
Duration: Feb 15 2005Feb 17 2005


  • Accuracy
  • Computer-assisted diagnosis
  • Dual-energy
  • PACS
  • Radiography
  • Subtraction

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging

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