Ahmet A. Tirpan, Zeliha Gider & Aytekin Buyukozer - The Temple of Hekate at Lagina.pdf
Randy D Ernst 1 , Russell C Hardie 2 , Metin N Gurcan 3 , Aytekin Oto 1 ,
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Transcript of Randy D Ernst 1 , Russell C Hardie 2 , Metin N Gurcan 3 , Aytekin Oto 1 ,
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CAD Performance Analysis for Pulmonary Nodule Detection: Comparison of Thick- and Thin-
Slice Helical CT ScansRandy D Ernst1, Russell C Hardie2,
Metin N Gurcan3, Aytekin Oto1, Steve K Rogers3, Jeffrey W Hoffmeister3
1. Department of Radiology, The University of Texas Medical Branch, Galveston TX
2. iCAD Inc. and University of Dayton, Dayton OH 3. iCAD Inc., Beavercreek OH
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Introduction
This study compares the performance of a CAD (QuickCue™, iCAD, Inc.) system in detecting lung nodules from thick- and thin-slice multi-detector row CT scans, and to evaluate the potential benefit of CAD on radiologist sensitivity.
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Methods and Materials57 reports reviewed retrospectively Case selection:Obtained during a 5-month periodReferred from multiple departmentsContain at least 1 pulmonary nodule but
fewer than 10 nodules to localizeHave no significant breathing miss -
registration, post surgical changes, pleural effusions & atelectasis
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Methods and Materials
4-detector LightSpeed QX/I Scanner, GE systemsHQ setting with 5.0 collimation, helical pitch of 0.75/1.0Standard-dose (160 - 270 mA, 120 kVp)Images were reconstructed at 5 mm (thick) and 2.5 mm (thin) slice thicknesses.
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Methods and Materials140 nodules (3 mm - 25 mm) were identified pre-CAD by radiologists From thick-slice cases only.
Cases with multiple nodules were excluded.Truth marks were mapped to the thin-slice dataMean nodule size 7.3 ± 4.2 mm (3 – 25 mm)Gold standard for nodule truth comes for post-CAD Radiologist review One gold standard for thick-slice and one for thin-
slice
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CAD System (QuickCue™, iCAD Inc.)
3D LungSegmentation
3D CandidateSegmentation
CalculateFeatures
DICOMImages
Classifier
DetectionMask
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CAD detected 72.1% (101/140) of the pre-CAD truth nodulesCAD detected 35 additional radiologist-confirmed nodules, an increase of 25% (35/140) in sensitivity5.6 (317/57) false-positives per case55 due to atelectasis18 due to scarring
Review of Thick-Slice CAD Results
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Venn Diagram for Thick
3
39 35
317
CADPre-CAD Review
Post-CAD ReviewGold Standard
101
0 0
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CAD detected 80.7% (113/140) of the pre-CAD truth nodules.CAD detected 94 additional radiologist-confirmed nodules, an increase of 67.1% (94/140).4.6 (262/57) false-positives per case.70 due to atelectasis39 due to scarring
Review of Thin-Slice CAD Results
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Venn Diagram for Thin
0
26 94
262
CAD using thin-slicePre-CAD Review using thick-slice with detections mapped to thin-slice
Post-CAD Review of thin-sliceGold Standard
113
0 0
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ComparisonThick-slice cases
Thin-slice cases
CAD sensitivity
72.1% 80.7%
Radiologist sensitivity increase after CAD
+25% +67.1%
FPs 5.6 4.6
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FROC Curve for CAD
0 2 4 6 8 10 12 140
0.2
0.4
0.6
0.8
1
Average False Positives Per Case
Prob
abili
ty o
f Det
ectio
n
Thin SliceThick Slice
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CAD detections in Thick-Slice
0 5 10 15 20 250
5
10
15
20
25
30
35
Size (mm)
Num
ber o
f Nod
ules
Radiologist DetectedRadiologist MissedAdditional Detections
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CAD detections in Thin-Slice
0 5 10 15 20 250
10
20
30
40
50
Size (mm)
Num
ber o
f Nod
ules
Radiologist DetectedRadiologist MissedAdditional Detections
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5 primary lung cancers24 cases of metastatic cancer including 7 lymphomas, 4 breast, 4 head and neck, 2
colon, 2 pancreas, 1 carcinoid, 1 seminoma, 1 ovarian, 1 melanoma and 1 tracheal papillomatosis
23 cases of infection, including19 granulomatous disease either calcified,
stable on follow-up or biopsy proven. 4 were presumed infection that resolved with follow-up
1 case proved to be a thrombosed AVM4 cases lost to follow up
Case Follow-up
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Example TPsExamples of nodules that are detected by both radiologist and CAD
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Example TPsExamples of nodules that are initially missed by radiologists then detected after reviewing CAD
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Review of CAD ResultsSources of false positivesVessel intersections Inaccurate lung segmentationPartial volume effectsOther lung abnormalities (scarring,
atelectasis)
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Example FPs
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Review of CAD ResultsSources of false negatives (missed nodules)Low density, irregularStrong connectivity with vessels Imperfect candidate segmentation Inaccurate lung segmentation
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Example FNs
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ConclusionsPreliminary results indicate that both sensitivity and specificity of the CAD system increases when used with thin-slice scans versus thick-slice scans.The CAD system operating on both thick- and thin-slice scans improved radiologist sensitivity Improvement was greater for CAD
operating on thin-slice scans