Advances in Thoracic Imaging

8/4/2019 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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Dual Energy


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



Copperfilter

X Ray

Source

First plate recordsfull energy spectrum

for standard image

Second plate records

high energy photons

Patient



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Single exposure ES

uses two detectors



Copper filter

X Ray

Source

First plate recordsfull energy spectrum

for standard image

Second plate records

high energy photons

Patient


Weighted subtraction gives

soft tissue and bone images


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Dual Energy Chest Radiography


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74 y/o man with COPD and rales


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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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Radiography


nodules Improved rejection of false positives


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Radiography


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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Dual Energy


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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Documents

Advances in Thoracic Imaging