Analysis of the impact of digital tomosynthesis in the radiological workup of patients with suspected pulmonary lesions on chest radiography

Objective To assess the impact of digital tomosynthesis (DTS) on the radiological investigation of patients with suspected pulmonary lesions on chest radiography (CXR). Methods Three hundred thirty-nine patients (200 male; age, 71.19±11.9 years) with suspected pulmonary lesion(s) on CXR underwent DTS. Two readers prospectively analysed CXR and DTS images, and recorded their diagnostic confidence: 1 or 20definite or probable benign lesion or pseudolesion deserving no further diagnostic workup; 3 0 indeterminate; 4 or 50probable or definite pulmonary lesion deserving further diagnostic workup by computed tomography (CT). Imaging follow-up by CT (n076 patients), CXR (n0256) or histology (n07) was the reference standard. Results DTS resolved doubtful CXR findings in 256/339 (76 %) patients, while 83/339 (24 %) patients proceeded to CT. The mean interpretation time for DTS (mean±SD, 220±40 s) was higher (P<0.05; Wilcoxon test) than for CXR (110±30 s), but lower than CT (600±150 s). Mean effective dose was 0.06 mSv (range 0.03–0.1 mSv) for CXR, 0.107 mSv (range 0.094–0.12 mSv) for DTS, and 3 mSv (range 2–4 mSv) for CT. Conclusions DTS avoided the need for CT in about threequarters of patients with a slight increase in the interpretation time and effective dose compared to CXR.