• Thorsten Alexander Bley, Tobias Baumann, Ulrich Saueressig, Gregor Pache, Markus Treier, Oliver Schaefer, Ulrich Neitzel, Mathias Langer, and Elmar Kotter.
• Department of Diagnostic Radiology, University Hospital Freiburg, Freiburg, Germany. thorsten.bley@uniklinik-freiburg.de
• Invest Radiol. 2008 Jun 1; 43 (6): 343-8.

ObjectivesDetection of subtle pulmonary nodules on digital radiography is a challenging task for radiologists. The aim of this study was to evaluate the performance of a newly approved computer aided detection (CAD) system.Materials And MethodsThe sensitivity of 3 radiologists and of a CAD system for the detection of pulmonary nodules from 5 to 15 mm in size on digital chest radiography of 117 patients was compared. The reference standard was established by consensus reading of computed tomography scans by 2 experienced radiologists. Computed tomography scans and chest radiographs were performed within 4 weeks. Sixty-six pulmonary nodules from 42 patients, with a mean nodule diameter of 7.5 mm (standard deviation: 2.2 mm), were included in the statistical analysis. Seventy-five of the 117 patients did not have nodules from 5 to 15 mm of size.ResultsTwo hundred and eighty-eight false-positive detections of the CAD system were found with an average of 2.5 false-positives per image. Sensitivity of the CAD system was 39.4% (95% confidence interval: 11.8%), when compared with 18.2% to 30.3% (95% confidence interval 9.3% to 11.1%) of the 3 radiologists. Substantial agreement for nodule detection ([kappa]N: 0.64-0.73) was found among the 3 radiologists, whereas only moderate agreement was found between the radiologists and the CAD performance ([kappa]N: 0.45-0.52).ConclusionsThe CAD system's diagnostic sensitivity in detecting pulmonary nodules of 5 to 15 mm of size was superior to the 1 of radiologists. The CAD system may be used for assisting the radiologist in the detection of lung nodules on digital chest radiographs.

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