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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDigital tomosynthesis (DTS) imaging is a relatively new technique that is increasingly being used for a variety of thoracic indications. This article discusses the results of the GE Healthcare VolumeRAD Lung Nodule Detection Study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00963651\u0026amp;atom=%2Fspmdc%2F14%2F53%2F8.atom\u0022\u003ENCT00963651\u003C\/a\u003E], an international, multicenter clinical trial showing that DTS has improved sensitivity for the detection of pulmonary nodules compared with conventional conventional chest x-ray with no loss of specificity and at a similar, minimal radiation level.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eradiology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etomography\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EDigital tomosynthesis (DTS) imaging is a relatively new technique that is increasingly being used for a variety of thoracic indications. It is important that clinicians understand both the diagnostic capability of this technique and the patient dose relative to conventional chest x-ray (CXR) and computed tomography (CT). John M. Sabol, PhD, General Electric Healthcare, Waukesha, Wisconsin, USA, presented the results of the GE Healthcare VolumeRAD Lung Nodule Detection Study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00963651\u0026amp;atom=%2Fspmdc%2F14%2F53%2F8.atom\u0022\u003ENCT00963651\u003C\/a\u003E], an international, multicenter clinical trial showing that DTS has improved sensitivity for the detection of pulmonary nodules compared with conventional CXR with no loss of specificity and at a similar, minimal radiation level (\u0026lt; 0.1 mSv).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe study included 158 patients (with nodules, n = 115; without nodules, n = 43) referred for diagnostic CT as part of standard of care for suspicion of pulmonary nodules or other indications. All patients received a diagnostic chest CT scan, followed by conventional posterior-anterior (PA) and lateral (LAT) CXR and then DTS. The primary objective of the study was to determine whether adding DTS to CXR increases physician accuracy in the detection of lung nodules between 3 and 20 mm in diameter when compared to conventional PA\/LAT CXR. A secondary analysis was conducted to determine the relative ability of DTS plus CXR to identify nodules 3 to 4 mm, \u0026gt; 4 to 6 mm, \u0026gt; 6 to 8 mm, and \u0026gt; 8 to 20 mm in diameter. Other outcomes included the degree of agreement with CT for case management as defined by the Fleischner Society guidelines [MacMahon H et al. \u003Cem\u003ERadiology.\u003C\/em\u003E 2005].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EDTS was associated with a 3.6-fold improvement in sensitivity for nodules of 3 to 20 mm diameter compared with CXR. For nodules of 4 to 6 mm diameter, for which x-ray is particularly challenged, DTS showed a 7.6-fold improved sensitivity. As measured by the area under the receiver operating characteristic (ROC) curve, there was a significant increase in case management utility with tomosynthesis (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). For all nodule sizes, increases in sensitivity and area under the ROC curve were achieved with no decrease in specificity.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Case Management (Further Imaging) ROC\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1533547856\u0022 data-figure-caption=\u0022Case Management (Further Imaging) ROC\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/8\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/8\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/8\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16498\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ECase Management (Further Imaging) ROC\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ETomosynthesis requires (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01) a smaller dose than CT and the same\u003Csup\u003Ea\u003C\/sup\u003E (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01) minimal relative radiation level (\u0026lt; 0.1 mSv) as 2-view CXR.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EACR, American College of Radiology; CT, computed tomography; CXR, chest x-ray; DTS, digital tomosynthesis; ROC, receiver operating characteristic; VolumeRAD, GE VolumeRAD tomosynthesis.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003E\n               \u003Csup\u003Ea\u003C\/sup\u003EACR Appropriateness Criteria\u00ae Radiation Dose Assessment Introduction, 2012.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced with permission from JM Sabol, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EFor the effective dose calculations, digital imaging and communications in medical metadata were extracted for all image data. CT dose index and the dose-length product were calculated using the methods described in the appropriate technical reference manual. The effective dose was calculated using dose-length product conversion factors from the International Commission on Radiological Protection Publication 103 [ICRP, 2007. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP 37 (2\u20134)]. The effective dose for CXR and DTS was calculated using the PCXMC 2.0 Monte Carlo tool [Sabol JM. \u003Cem\u003EMed Phys.\u003C\/em\u003E 2009]. Calculation of absorbed dose was based on estimates of incident air kerma from exposure technique data and the assumption of average-habitus patients.\nData for dose estimation were available for all 158 patients in the study for some modalities and for 91 patients for all modalities. For the 91 cases with valid data for all modalities, the mean effective dose was 0.059, 0.088, and 4.86 mSv for CXR, DTS, and CT, respectively.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe effective dose of DTS was 1.5 times greater than that for 2-view CXR. The CXR and DTS effective doses were significantly less than that for CT (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01), and the same minimal relative radiation level (\u0026lt; 0.1 mSv) as that of 2-view CXR.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ETo conclude, DTS is a low-dose option for volumetric thoracic imaging and improves lung nodule detection.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/53\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzls81\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzls81\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}