Detectability of pulmonary nodules on chest radiographs: bone suppression versus standard technique with single...

To evaluate the diagnostic accuracy of bone suppression imaging (BSI) in the detection of pulmonary nodules on chest radiographs (CXRs) and the effect of visualization method (single or dual monitors) on diagnostic accuracy.

Ten observers interpreted the CXRs of 100 patients: 50 with a T1 lung cancer nodule and 50 without nodules. Each standard CXR was first read alone and then in combination with the corresponding BSI. Two sessions of viewing were conducted: (1) the standard CXR and BSI were placed side by side on dual monitors and (2) both images were shown on the same monitor in alternation. The nodule location, confidence level, and interpretation time were recorded and analyzed statistically.

When BSI was added, the area under the receiver operating characteristic curve (AUC) improved with dual monitors and a single monitor. The AUC was not significantly different between the dual-monitor and single-monitor sessions; however, the specificity with BSI and dual monitors decreased. The total interpretation time was significantly shorter with a single monitor than with dual monitors.

The use of BSI improved detectability of T1 lung cancer nodules on CXRs; however, specificity and reading time were affected by the visualization method.