Emilio Quaia MD, Presenter: Nothing to Disclose

Elisa Baratella MD, Abstract Co-Author: Nothing to Disclose

Arianna Lorusso MD, Abstract Co-Author: Nothing to Disclose

Federica Casagrande MD, Abstract Co-Author: Nothing to Disclose

Maria Assunta Cova MD, Abstract Co-Author: Nothing to Disclose

To assess the clinical impact of digital tomosynthesis in the management of patients with suspected pulmonary lesions on chest radiography.

Two-hundred-and-fifty-eight patients (153 male, 105 female; age, 70.4±11.2 years) with suspected pulmonary lesions after the initial analysis of chest radiography underwent digital tomosynthesis. Two independent readers (experience, 3 and 20 years) prospectively analyzed chest radiography and digital tomosynthesis images on a PACS–integrated workstation and proposed a diagnosis according to a confidence score for each lesion (1 or 2: definitely or probably extra-pulmonary or pseudolesion; 3: doubtful lesion nature; 4 or 5: probably or definitely pulmonary). Patients did not undergo chest CT when digital tomosynthesis did not confirm any pulmonary lesion (scores 1-2) and the diagnostic workflow was considered complete. Patients underwent chest CT when digital tomosynthesis identified a definite non-calcific pulmonary lesion (scores 4–5) or was not conclusive (score 3). In patients who did not undergo chest CT the digital tomosynthesis findings had to be confirmed by 6-12 months imaging follow-up. The time of hospitalization, and the mean image interpretation time for digital tomosynthesis and CT was measured.

Digital tomosynthesis identified a total number of 182 thoracic lesions, 127 pulmonary and 55 extra-pulmonary, in 159 patients while in the remaining 99 patients digital tomosynthesis did not confirm any lesion. Chest CT was performed in 94/258 (36%) patients. All lesions were correctly classified after digital tomosynthesis except for 2 doubtful lesions which were not confirmed by chest CT, 14 extra-pulmonary lesions (both readers) which were misinterpreted as pulmonary, and 10 (reader 1) or 6 (reader 2) pulmonary lesions which were misinterpreted as pleural. The mean time of hospitalization was reduced from 2 weeks to 1 week. The mean interpretation time for digital tomosynthesis (mean±SD, 200±40 secs) was higher (P<.05; Wilcoxon test) than for chest radiography (120±30 secs) but lower than chest CT (600±250 secs).

Digital tomosynthesis allowed to avoid chest CT in about two-third of patients with a suspected pulmonary lesions.

Digital tomosynthesis is a first-line imaging technique to rule out pulmonary lesions instead of CT with reduction of CT unit overload and patient day of hospitalization (1 week vs 2 weeks).

Quaia, E, Baratella, E, Lorusso, A, Casagrande, F, Cova, M, Analysis of the Clinical Impact of Chest Digital Tomosynthesis in the Management of Patients with Suspected Pulmonary Lesions on Chest Radiography.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9001707.html