Detectability of lung nodules using flat panel detector with dual energy subtraction by two shot method: Evaluation by ROC method

The aim of this study was to evaluate the effectiveness of dual-exposure dual energy subtraction technique in flat-panel chest radiography for lung nodules detection. Chest radiographs were acquired in 100 patients (57 men and 43 women; mean age, 60.2 years; range, 18–89 years) using a flat-panel digital chest system. These images were evaluated by seven radiologists. A continuous rating scale of 0–100 was used to represent each observer's confidence level regarding the presence or absence of lung nodules. Observer performance for detection of lung nodules with subtraction images was tested by using receiver operating characteristic (ROC) analysis of individual and averaged reader data. The average area under the ROC curve (Az value) significantly increased with subtraction images (Az = 0.79 in standard radiographs versus Az = 0.84 with subtraction images, p < 0.05). In conclusion, the two-exposure dual-energy subtraction chest radiography significantly would improve detection of lung nodules.