Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease

Our plain-English summary of Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease, by G. Lee, Y.J. Jeong, K.I. Kim, et al (Clinical Radiology, 2013).

The study

• Authors: G. Lee, Y.J. Jeong, K.I. Kim, J.W. Song, D.M. Kang, Y.D. Kim, J.W. Lee
• Journal: Clinical Radiology
• Published: 2013;68(4):376-82
• Cited by: 33 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: To compare chest digital tomosynthesis (DTS) with digital radiography for the detection of asbestos-related pleuropulmonary disease.

Materials And Methods: The institutional review board approved this study and all participants gave informed consent. Forty-five participants with a history of asbestos exposure were examined with DTS and radiography. Low-dose multidetector computed tomography (CT) in the prone position served as the reference. Two observers evaluated all images for the presence of pleural abnormalities and asbestosis. Interobserver agreement was analysed by using the k statistic. Diagnostic performance of the two imaging methods was compared using McNemar's test.

Results: Interobserver agreement regarding DTS findings was moderate to very good (k = 0.544-0.846) and superior to the radiographic findings (k = 0.236-1.000). Overall, the diagnostic accuracy of DTS for the lesion detection was significantly better than with radiography (all p < 0.05, except that for the comparison of diagnostic accuracy of DTS versus radiographic detection of left diaphragmatic plaques and asbestosis). DTS was more sensitive than radiography for the detection of asbestosis (82% versus 27%, p = 0.031).

Conclusion: DTS is more accurate than radiography in the detection of pleural plaques and more sensitive than radiography in the detection of asbestosis. Interobserver agreements with respect to the DTS findings were superior to the radiographic findings.

Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

In plain English

This prospective study in Korea compared two X-ray methods for finding asbestos-related disease: chest digital tomosynthesis (DTS), which produces many thin image slices, and a standard frontal chest radiograph. Between May and October 2010, 45 people who had worked at an asbestos textile factory (26 women, 19 men) had both tests and a low-dose CT scan on the same day. CT served as the reference. The workers had been exposed to chrysotile (29), crocidolite (10) or mixed asbestos types (6). On CT, 11 had findings compatible with asbestosis. DTS was more accurate than radiography for pleural plaques at most sites, for example 93% versus 64% for right face-on plaques. The differences were not statistically significant for left diaphragmatic plaques or for overall accuracy in asbestosis (91% versus 82%). DTS found asbestosis more often: it detected 9 of 11 cases (82%), while radiography detected 3 of 11 (27%). The authors concluded that DTS was superior for pleural plaques, except left diaphragmatic plaques, and more sensitive for asbestosis. They noted the small number of participants and the lack of tissue confirmation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective diagnostic comparison study: chest digital tomosynthesis versus posteroanterior digital chest radiography, with low-dose prone multidetector CT as the reference standard
• Who was studied: 46 individuals who had worked at an asbestos textile factory and were registered by the Korea Research Center for Asbestos-Related Diseases were enrolled from May 2010 to October 2010. One was excluded for chronic destructive pulmonary tuberculosis, leaving 45 participants (26 female, 19 male; mean age 57.1 years, range 49 to 68).
• Exposure: Documented occupational asbestos exposure at an asbestos textile factory, with a latency of at least 10 years. Fiber types were chrysotile (29), crocidolite (10) and a mixture of different asbestos types (6). Mean work duration was 9.9 years and mean latency from first exposure was 30.2 years.
• Main results:
  • On reference CT, of 45 participants, 13 had lateral chest wall (in-profile) plaques, 20 had anterior or posterior chest wall (face-on) plaques and 17 had diaphragmatic plaques. No mediastinal pleural plaque or diffuse pleural thickening was seen. 11 had findings compatible with asbestosis.
  • Accuracy, DTS versus radiography: 88% vs 69% for right in-profile plaques, 93% vs 78% for left in-profile plaques, 93% vs 64% for right face-on plaques, 87% vs 71% for left face-on plaques, 96% vs 78% for right diaphragmatic plaques, 96% vs 93% for left diaphragmatic plaques, and 91% vs 82% for asbestosis.
  • All accuracy differences were statistically significant (p less than 0.05) except for left diaphragmatic plaques and asbestosis. For asbestosis, the accuracy p-value was 0.125.
  • For asbestosis, DTS sensitivity was 82% (9/11) versus 27% (3/11) for radiography, p = 0.031. Specificity was 94% (32/34) for DTS versus 100% (34/34) for radiography, which was not statistically different (p = 0.157).
  • For right face-on chest wall plaques, DTS sensitivity was 83% (15/18) versus 11% (2/18) for radiography.
  • Interobserver agreement (kappa) ranged from 0.544 to 0.846 for DTS and from 0.236 to 1 for radiography. The authors described DTS agreement as moderate to excellent and superior to radiography. For diaphragmatic plaques, however, radiography kappa values (1.000 right, 0.806 left) were higher than DTS values (0.688 right, 0.544 left).
  • Estimated mean effective radiation dose was 0.04 mSv for radiography, 0.14 mSv for DTS and 1.38 mSv for low-dose CT.
• The authors' conclusion: The authors concluded that DTS was more accurate than radiography for detecting pleural plaques, except left hemidiaphragmatic plaques, and more sensitive for detecting asbestosis. They also concluded that interobserver agreement was better with DTS. They suggested DTS could be used as a problem-solving or follow-up technique in people with a history of asbestos exposure.
• Limitations the authors state:
  • The relatively small number of patients weakened the statistical power.
  • There was no histopathological (tissue) confirmation of disease. CT was used as the reference.
  • DTS was not compared with other digital technologies such as dual-energy subtraction radiography.
  • The CT reference used 2.5 mm collimation, so early reticular or ground-glass opacities may have been missed.
  • The severity of asbestosis was not graded because of the small population.
  • A low-dose DTS technique was not used.
  • DTS is vulnerable to respiratory motion artefacts. False-positive DTS results for diaphragmatic plaques occurred in two patients.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Informed Consent, Asbestos Exposure, Pleural Plaques.

Related studies

• Commentary on: Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease — I. Vlahos (2013)
• Digital tomosynthesis of the chest: current and emerging applications — S.H. Chou, G.A. Kicska, et al. (2014)
• Comparison of digital with film radiographs for the classification of pneumoconiotic pleural abnormalities — T.C. Larson, D.B. Holiday, et al. (2012)
• Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography — A.C. Friedman, S.B. Fiel, et al. (1988)
• Improved detection of asbestos-related pleural plaques with digital radiography — R. Greene, C.M. Schaefer, et al. (1991)
• Agreement between chest radiography and high-resolution computed tomography in diagnosing dust-related interstitial lung fibrosis — R.R. Tiwari (2015)

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