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Detection of Lung Nodules on Digital Chest Radiographs: Potential Usefulness of a New Contralateral Subtraction Technique¹   

¹ From the Department of Radiology, Saitama Medical School, Saitama, Japan (S.T., A.H.); and Kurt Rossmann Laboratories for Radiologic Image Research, Department of Radiology, University of Chicago, 5481 S Maryland Ave, Chicago, IL 60637. From the 1999 RSNA scientific assembly. Received February 6, 2001; revision requested March 1; revision received August 20; accepted September 20. Supported by U.S. Public Health Service grants CA62625 and CA64370. Address correspondence to K.D. (e-mail: k-doi@uchicago.edu).

PURPOSE: To evaluate the potential usefulness of a contralateral subtraction technique developed for radiologists’ performance in the detection of subtle lung nodules on chest radiographs.

MATERIALS AND METHODS: Fifty chest radiographs (25 normal and 25 abnormal with a subtle lung nodule) that were digitized with a 0.175-mm pixel size and 4,096 gray levels were used. Twelve radiologists (10 attending and two residents) participated in observer tests and read both original and contralateral subtraction images with a sequential testing method. Radiologists’ performance was evaluated by means of receiver operating characteristic analysis with use of a continuous rating scale. The beneficial and detrimental effects of the contralateral subtraction technique on the radiologists’ performance were also evaluated.

RESULTS: The area under the receiver operating characteristic curve values obtained without and with contralateral subtraction images were 0.926 and 0.962, respectively. Results indicated that the contralateral subtraction images significantly (P < .05) improved diagnostic accuracy, particularly for radiologists with limited experience.

CONCLUSION: The contralateral subtraction technique can assist radiologists in the correct identification of subtle lung nodules on chest radiographs.

© RSNA, 2002

Index terms: Computers, diagnostic aid • Diagnostic radiology, observer performance • Lung, nodule, 68.332 • Lung neoplasms, diagnosis, 60.30

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