Digital tomosynthesis of the chest: current and emerging applications

Our plain-English summary of Digital tomosynthesis of the chest: current and emerging applications, by S.H. Chou, G.A. Kicska, S.N. Pipavath, et al (Radiographics, 2014).

The study

• Authors: S.H. Chou, G.A. Kicska, S.N. Pipavath, G.P. Reddy
• Journal: Radiographics
• Published: 2014;34(2):359-72
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Digital tomosynthesis (DTS) of the chest is a technique whose basic components are similar to those of digital radiography, but that also provides some of the benefits of computed tomography (CT). The major advantages of DTS over conventional chest radiography are improved visibility of the pulmonary parenchyma and depiction of abnormalities such as pulmonary nodules. Calcifications, vessels, airways, and chest wall abnormalities are also much more readily visualized at DTS than at chest radiography. DTS could potentially be combined with chest radiography to follow up known nodules, confirm or rule out suspected nodules seen at radiography, or evaluate individuals who are at high risk for lung cancer or pulmonary metastases. DTS generates coronal "slices" through the chest whose resolution is superior to that of coronal reconstructed CT images, but it is limited by its suboptimal depth resolution and susceptibility to motion; consequently, potential pitfalls in recognizing lesions adjacent to the pleura, diaphragm, central vessels, and mediastinum can occur. However, the radiation dose and projected cost of chest DTS are lower than those of standard chest CT. Besides pulmonary nodule detection, specific applications of DTS that are under investigation include evaluation of pulmonary tuberculous and nontuberculous mycobacterial disease, cystic fibrosis, interstitial lung disease, and asbestos-related thoracic diseases. A basic understanding of chest DTS and of the emerging applications of this technique can prove useful to the radiologist. Online supplemental material is available for this article.

©RSNA, 2014.

In plain English

This article was a review of digital tomosynthesis (DTS), an X-ray technique that produces slice-like images of the chest. It did not report new patient data. The authors explained how DTS works and summarized published studies by other researchers. They reported that the estimated effective radiation dose of a chest DTS study is 0.08–0.13 mSv, compared with an estimated 1–4 mSv for typical chest CT. On asbestos, the authors cited a study by Lee et al. That study found DTS gave higher diagnostic accuracy than chest radiography for detecting pleural plaques, with or without calcifications. The authors also reported, citing the same work, that pleural plaques along the left hemidiaphragm and lung findings of asbestosis remained hard to detect at DTS. In that study, DTS was more sensitive than radiography for asbestosis, but there was no statistically significant difference in specificity. The authors listed limitations of DTS, including motion artifact and limited depth resolution. They concluded that all the applications they described were only potential or theoretical, without sufficient proof of efficacy, and that well-designed prospective studies would be needed.

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: Narrative review (educational article) of chest digital tomosynthesis, drawing on published literature and illustrated with example cases; no original study data
• Who was studied: No study population; the article reviewed published research on chest DTS, including its potential applications and suggested indications
• Exposure: The subject is an imaging technique (chest DTS), not an exposure. Asbestos-related pleural disease (pleural plaques) and asbestosis are discussed as one potential application, based on a cited study by Lee et al (reference 21).
• Main results:
  • Citing Lee et al (reference 21), the authors reported that, compared with radiography, DTS provides higher diagnostic accuracy for detecting pleural plaques with or without calcifications.
  • Citing the same study, the authors reported that detection of pleural plaques along the left hemidiaphragm and of lung findings of asbestosis remains elusive at DTS.
  • In the cited study by Lee et al, chest DTS was more sensitive than radiography for detecting asbestosis, but there was no statistically significant difference in specificity.
  • The estimated effective radiation dose for a chest DTS study is 0.08–0.13 mSv, compared with an estimated 1–4 mSv for typical chest CT (figures taken from cited literature).
  • The authors stated that limitations of DTS compared with conventional radiography include greater susceptibility to motion artifact, limited depth resolution, and lack of portability.
• The authors' conclusion: The authors concluded that all the applications described in the article are only potential or theoretical at this point, without sufficient proof or validation of their efficacy.
• Limitations the authors state:
  • The authors stated that well-designed prospective studies will be needed to demonstrate the ultimate usefulness of the applications described.

Topics

Medical terms in this study, explained in our Lexicon: Parenchyma, Lung Cancer, Pleura, Diaphragm, Mediastinum, Fibrosis, Interstitial Lung Disease.

Related studies

• Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease — G. Lee, Y.J. Jeong, et al. (2013)
• Commentary on: Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease — I. Vlahos (2013)
• Comparison of digital with film radiographs for the classification of pneumoconiotic pleural abnormalities — T.C. Larson, D.B. Holiday, et al. (2012)
• Dual-energy digital subtraction chest radiography: technical considerations — G.J. Whitman, L.T. Niklason, et al. (2002)
• Screening for asbestos-related pleural disease with digital storage phosphor radiography — C.M. Schaefer, R. Greene, et al. (1990)
• Improved detection of asbestos-related pleural plaques with digital radiography — R. Greene, C.M. Schaefer, et al. (1991)

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