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Dual-Energy Chest Radiography with a Flat-Panel Digital Detector: Revealing Calcified Chest Abnormalities

Frank Fischbach1, Torsten Freund, Rainer Röttgen, Ulrike Engert, Roland Felix and Jens Ricke

1 All authors: Department of Radiology, Charité, Campus Virchow-Klinikum, Humboldt-University Medical School, Augustenburgerplatz 1, 13353 Berlin, Germany.



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  		Fig. 1. —Graph shows results of Brunner and Langer's test [14] comparing accuracy of standard digital chest radiography (CXR) alone and in combination with dual-energy (CXR + DE) review. Values between 0 and 1 are calculated for each individual reviewer (A–D). Improvement contributed by adding DE images was significant (p < 0.01). Slope of line connecting reviewers' scores inclines upwards, reflecting increase in accuracy of detection.

 


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  		Fig. 2A. —75-year-old woman with medical history of small cell bronchial carcinoma. Standard chest radiograph (A) is less effective than dual-energy bone image (B) in clearly showing calcifications in pulmonary nodule of upper left field and multiple mediastinal calcified lymph nodes (arrows, B). Note motion artifacts visible as dense line along left heart border and outline of pacemaker cables.

 


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  		Fig. 2B. —75-year-old woman with medical history of small cell bronchial carcinoma. Standard chest radiograph (A) is less effective than dual-energy bone image (B) in clearly showing calcifications in pulmonary nodule of upper left field and multiple mediastinal calcified lymph nodes (arrows, B). Note motion artifacts visible as dense line along left heart border and outline of pacemaker cables.

 


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  		Fig. 2C. —75-year-old woman with medical history of small cell bronchial carcinoma. Dual-energy standard posteroanterior soft-tissue image has potential to show lesions obscured by ribs.

 


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  		Fig. 2D. —75-year-old woman with medical history of small cell bronchial carcinoma. CT scans confirm diagnosis of calcifications (arrows) in mediastinum and upper left lung field shown in B.

 


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  		Fig. 2E. —75-year-old woman with medical history of small cell bronchial carcinoma. CT scans confirm diagnosis of calcifications (arrows) in mediastinum and upper left lung field shown in B.

 


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  		Fig. 3A. —73-year-old woman with pulmonary calcifications. Standard chest radiograph (A) is less effective than dual-energy bone image (B) in clearly showing pleural calcification and calcified nodule (arrows, B) in upper right lung field. Note motion artifacts along aortic arc.

 


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  		Fig. 3B. —73-year-old woman with pulmonary calcifications. Standard chest radiograph (A) is less effective than dual-energy bone image (B) in clearly showing pleural calcification and calcified nodule (arrows, B) in upper right lung field. Note motion artifacts along aortic arc.

 


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  		Fig. 3C. —73-year-old woman with pulmonary calcifications. Dual-energy standard posteroanterior soft-tissue image has potential to show lesions obscured by ribs.

 


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  		Fig. 3D. —73-year-old woman with pulmonary calcifications. CT scans confirm diagnosis of pleural and pulmonary calcifications (arrows) shown in B.

 


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  		Fig. 3E. —73-year-old woman with pulmonary calcifications. CT scans confirm diagnosis of pleural and pulmonary calcifications (arrows) shown in B.

 

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