Evaluating a Fully Automated Pulmonary Nodule Detection Approach and Its Impact on Radiologist Performance
Kai Liu, Qiong Li, Jiechao Ma, Zijian Zhou, Mengmeng Sun, Yufeng Deng, Wenting Tu, Yun Wang, Li Fan, Chen Xia, Yi Xiao, Rongguo Zhang, Shiyuan Liu
Author Affiliations
From the Department of Radiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China 20003 (K.L., Q.L., W.T., Y.W., L.F., Y.X., S.L.); and Infervision Advanced Institute, Beijing, China (J.M., Z.Z., M.S., Y.D., C.X., R.Z.).
Address correspondence to S.L. (e-mail: cjr.liushiyuan@vip.163.com).
Published Online:May 29 2019https://doi.org/10.1148/ryai.2019180084
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Abstract
A deep learning model showed improved overall sensitivity compared with manual identification of pulmonary nodules and was insensitive to radiation dose, patient age, or CT manufacturer; the model also enhanced manual review by increasing sensitivity and reducing reading time.

Purpose
To compare sensitivity in the detection of lung nodules between the deep learning (DL) model and radiologists using various patient population and scanning parameters and to assess whether the radiologists’ detection performance could be enhanced when using the DL model for assistance.

Materials and Methods
A total of 12 754 thin-section chest CT scans from January 2012 to June 2017 were retrospectively collected for DL model training, validation, and testing. Pulmonary nodules from these scans were categorized into four types: solid, subsolid, calcified, and pleural. The testing dataset was divided into three cohorts based on radiation dose, patient age, and CT manufacturer. Detection performance of the DL model was analyzed by using a free-response receiver operating characteristic curve. Sensitivities of the DL model and radiologists were compared by using exploratory data analysis. False-positive detection rates of the DL model were compared within each cohort. Detection performance of the same radiologist with and without the DL model were compared by using nodule-level sensitivity and patient-level localization receiver operating characteristic curves.

Results
The DL model showed elevated overall sensitivity compared with manual review of pulmonary nodules. No significant dependence regarding radiation dose, patient age range, or CT manufacturer was observed. The sensitivity of the junior radiologist was significantly dependent on patient age. When radiologists used the DL model for assistance, their performance improved and reading time was reduced.

Conclusion
DL shows promise to enhance the identification of pulmonary nodules and benefit nodule management.

© RSNA, 2019