advances in thoracic imaging
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Heber MacMahon M.D.Department of Radiology
The University of Chicago
Advances in Thoracic ImagingAdvances in Thoracic Imaging
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Advances in Thoracic Imaging
CXR: Digital capture CR, DR
Dual Energy
Computer-aided Diagnosis
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Advances in Thoracic Imaging
CXR: Digital capture CR, DR
Dual Energy
Computer-aided Diagnosis
MDCT: Newerimage display options
Emphysema AnalysisCardiovascular imaging
Computer aided Diagnosis
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Digital Radiography
CR: ComputedRadiography with
photostimulable
phosphor plates
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Digital Radiography
CR: ComputedRadiography with
photostimulable
phosphor plates
DR: Digital
Radiography with
direct-readout detectors
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Digital Radiography
Image quality - Dynamic range - Processing
Image access
-Local - PACS
Interactive
- Window/Level
- Zoom
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University of Chicago
Chest Section 2006
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90% of peripheral cancers
visible in retrospect -Muhm 1983
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90% of peripheral cancers
visible in retrospect -Muhm 1983
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Missed Lung Cancers :JHM Austin et al. Rad 1992;182:115-122
Size: 0.6 3.4 cm (mean1.6)
Location : Upper lobes81%
Conspicuity : Overlappingbones in 82%
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Single exposure ES
uses two detectors
separated by a filter
1st CR plate 2nd CR plate
Copperfilter
X Ray
Source
Patient
Dual Energy CXR - Single Exposure Technique
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Single exposure ES
uses two detectors
separated by a filter
1st CR plate 2nd CR plate
Copperfilter
X Ray
Source
First plate recordsfull energy spectrum
for standard image
Second plate records
high energy photons
Patient
Dual Energy CXR - Single Exposure Technique
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Single exposure ES
uses two detectors
separated by a filter
1st CR plate 2nd CR plate
Copper filter
X Ray
Source
First plate recordsfull energy spectrum
for standard image
Second plate records
high energy photons
Patient
Dual Energy CXR - Single Exposure Technique
Weighted subtraction gives
soft tissue and bone images
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Dual Energy Chest Radiography
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Dual Energy Chest Radiography
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Dual Energy Chest Radiography
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Dual Energy Chest Radiography
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Dual Energy Chest Radiography
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74 y/o man with COPD and rales
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74 y/o man with COPD and rales
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74 y/o man with COPD and rales
Lung Carcinoma
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Conventional CXR Dual energy soft tissue image
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Conventional CXR Dual energy soft tissue image
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Clinical Advantages of ES
Radiography
Improved detection of pulmonary
nodules
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Calcified granuloma
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Clinical Advantages of ES
Radiography
Improved detection of pulmonary
nodules Improved rejection of false positives
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Clinical Advantages of ES
Radiography
Improved detection of pulmonary
nodules Improved rejection of false positives
Improved detection/characterization of
calcified pleural plaques Improved detection of bone metastases
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1-21-03
Current CXR
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Current CXR Energy Subtraction CXR
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1-21-03 7-18-00
Current CXR Previous CXR
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Previous and
Current CXRs
IterativeWarping of
Previous CXR
Subtraction
D
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Current CXR Temporal Soft Tissue Subtraction CXR
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Current CXR Temporal Soft Tissue Subtraction CXR
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Temporal Subtraction
Benefits
Improved detection for pulmonary, pleural,
mediastinal disease
Status
Used clinically in Japan, under investigation in the
USA
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Enhancement Detection
Nodules
Interstitial Dis
Cardiomegaly
Pneumothorax
CAD for Chest Radiographs
Energy
Subtraction
Temporal
Subtraction
Tomosynthesis
Bone subtraction
Imaging
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Nodule CAD - True positive with three false positives
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Nodule CAD - True positive with three false positives
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0False Positive Fraction
True
Positive
Fraction
Observers with CAD (
Az=0.83 )
Observers without CAD (
Az=0.73 )
P= 0.005
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Advances in CT Technology
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Advances in CT Technology
Single slice
4 Slice
8 Slice
16 Slice40 Slice
64 Slice
256 Slice
??
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3MM
1MM
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8-01 12-02
4-03 1-04
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Volume Rendering and Virtual Bronchoscopy
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MIP (Maximum Intensity Projection)
MIPtheory
3mm
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3mm
3mm
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3mm
1mm
3mm
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3mm
1mm
MIP
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Standard CXR Dual Energy CXR
Coronal
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Coronal
3mm axial
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3mm axial
3mm axial
3mm axial
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3mm axial
MIP
3mm axial
MIP
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minIPSlab
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MINIP: Severe Emphysema
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Emphysema: Quantitative Analysis
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Advances in Thoracic Imaging
CXR: Digital capture CR, DR
Dual Energy
Computer-aided Diagnosis
MDCT: Processing & Display
Cardiovascular imaging
Computer aided Diagnosis
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Automated nodule Analysis
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y
3D Nodule Analysis
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3D Nodule Analysis
Non solid and Part Solid Nodules
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Non solid and Part Solid Nodules
Benign
Benign
Malignant
Malignant
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CT scan with nodule in RUL
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Trial ELCAP Mayo MoffetSubjects 1000 1520 1150
Nodules 23% 51% 32%
Lung Cancer Screening:
Prevalence Data from 3 Major US Trials
Lik lih d f M li B d N d l Si
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0
10
20
30
40
50
60
70
80
90
100
1--9 10--19 20--29 >30
% Malignant
Likelihood of Malignancy Based on Nodule Size
Nodule Size in mm
Natural History and Evaluation of Prevalence Nodules
Midthun, Swensen, Jett et al ( Unpublished Data )
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Cardiac CT
Cardiovascular Applications: Coronary CT Angiogram
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pp y g g
Cardiovascular Applications: Coronary CT Angiogram
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Pulmonary CT Venogram Pre-ablation
C l i
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Conclusions
Energy Subtraction is a powerful tool fornodule detection on CXRs
Nodule detection CAD is available for CXRsand is improving steadily
MDCT provides routine off-axis recons withimproved depiction of pathology
CT Nodule detection/comparison has greatpotential to improve accuracy & productivity
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