{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:23:53Z","timestamp":1790652233960,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T00:00:00Z","timestamp":1617926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare a novel thick\u2010slab projection technique for ultra\u2010low dose computed tomography (CT; thoracic tomogram) with conventional chest x ray with respect to 13 diagnostic categories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>With the approval of the institutional ethics board, a dataset was retrospectively collected of 22 consecutive patients who had undergone a clinically requested emergency room conventional chest x ray (CXR) and a same\u2010day standard\u2010of\u2010care non\u2010contrast CT. Scanner specific noise was added to the CT images to simulate a target dose of 0.18\u00a0mSv. A novel algorithm was used to post\u2010process CT images as coronal isotropic reformats by applying a voxel\u2010based, locally normalized weighted\u2010intensity projection to generate 2\u00a0cm thick slabs with 1\u00a0cm overlap. Three chest radiologists with no prior training for the study reviewed the CXR and thoracic tomogram for each case and assessed each diagnostic category (pneumonic infiltrates, pulmonary edema, interstitial lung disease, nodules\u00a0&gt;\u00a05\u00a0mm, nodules\u00a0&lt;\u00a05\u00a0mm, pleural effusion, pericardial effusion, heart size, acute bone fractures, foreign bodies, pneumothorax, mediastinal vessel diameter, free abdominal air) on a Likert scale from \u22124 (definitely absent\/normal) to +4 (definitely present\/abnormal). MRMC ROC curves were generated for each category. Time for interpretation and subjective image quality score (0\u201310) were also assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For focal lung disease (pneumonic infiltrates, nodules\u00a0&lt;\u00a05\u00a0mm, nodules\u00a0&gt;\u00a05mm), the area under the ROC curve (AUC) was significantly higher for thoracic tomograms than CXR (0.803 vs 0.648, respectively, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02). For non\u2010focal lung disease (pulmonary edema, interstitial lung disease) and effusions (pulmonary, pericardial), the AUC was larger for thoracic tomograms than CXR but the difference did not reach significance (0.870 vs 0.833, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.141; and 0.823 vs 0.752, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.296, respectively). For acute bone fractures and foreign bodies, the AUC was smaller for thoracic tomograms than CXR, the difference was however not significant (0.491 vs 0.532, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.42; and 0.871 vs 0.971, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.39, respectively). Other diagnostic categories had no true positive cases in the dataset. The mean time for interpretation for each was 36.9 and 24.0\u00a0s with standard deviations of 0.857 and 5.977. The image quality score for each was 8.2 and 7.8 with standard deviations of 0.970 and 1.614.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Thoracic tomograms were found to be diagnostically superior to CXR for focal lung disease, at no increased radiation dose. The thoracic tomogram presents an opportunity to improve the standard\u2010of\u2010care for patients who would otherwise receive a conventional CXR.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.14142","type":"journal-article","created":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T09:21:10Z","timestamp":1584436870000},"page":"2809-2815","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Comparison of conventional chest x ray with a novel projection technique for ultra\u2010low dose CT"],"prefix":"10.1002","volume":"48","author":[{"given":"Sean","family":"Carey","sequence":"first","affiliation":[{"name":"Joint Department of Medical Imaging UHN Toronto General Hospital 200 Elizabeth St. Toronto ON M5G 2C4 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Kandel","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging UHN Toronto General Hospital 200 Elizabeth St. Toronto ON M5G 2C4 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christin","family":"Farrell","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging UHN Toronto General Hospital 200 Elizabeth St. Toronto ON M5G 2C4 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging UHN Toronto General Hospital 200 Elizabeth St. Toronto ON M5G 2C4 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TaeBong","family":"Chung","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging UHN Toronto General Hospital 200 Elizabeth St. Toronto ON M5G 2C4 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging UHN Toronto General Hospital 200 Elizabeth St. Toronto ON M5G 2C4 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Rogalla","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging University of Toronto Princess Margaret Cancer Centre 610 University Avenue Toronto ON M5G 2M9 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"20","article-title":"False\u2010negative chest radiographs in emergency department diagnosis of pneumonia","volume":"97","author":"Maughan BC","year":"2013","journal-title":"R I Med J"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4329\/wjr.v7.i8.189"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2012.08.041"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1752-2897-7-2"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/rpd\/ncq092"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.342135057"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2017.08.18"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.162.2.8310908"},{"key":"e_1_2_8_10_1","article-title":"Submillisievert chest dual energy computed tomography: a pilot study","volume":"91","author":"Canellas R","year":"2018","journal-title":"Br J Radiol"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carj.2013.09.004"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.12.5.1529128"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/rpd\/ncm379"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-009-1617-x"},{"key":"e_1_2_8_15_1","first-page":"113160K","article-title":"Multi\u2010reader multi\u2010case analysis of variance software for diagnostic performance comparison of imaging modalities","volume":"11316","author":"Smith BJ","year":"2020","journal-title":"Proc SPIE Int Soc Opt Eng"},{"key":"e_1_2_8_16_1","unstructured":"ZaiontzC.Real Statistics Resource Pack Software(Release 6.2);2019.www.real\u2010statistics.com. Accessed June 25 2019."},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2492080304"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481107700427"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.72.864.10703472"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.102.6.1697"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1177\/000313480106700715","article-title":"Efficacy of thoracic computerized tomography in blunt chest trauma","volume":"67","author":"Omert L","year":"2001","journal-title":"Am Surg"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.04.021"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.08.060"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2015.11.036"},{"key":"e_1_2_8_25_1","first-page":"3642","article-title":"Performance of ultralow\u2010dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest x\u2010ray imaging","volume":"26","author":"Huber A","year":"2016","journal-title":"Eur J Radiol"},{"key":"e_1_2_8_26_1","first-page":"2769","article-title":"Comparison of low\u2010dose and standard\u2010dose helical CT in the evaluation of pulmonary nodules","volume":"12","author":"Karabulut N","year":"2002","journal-title":"Aur J Radiol"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2015.12.013"},{"key":"e_1_2_8_28_1","unstructured":"Van Der VeldenLL.Technical analysis and potential added clinical value of Ultra\u2010Low Dose Computed Tomography compared to chest X\u2010ray. University of Twente Masters Thesis;2017."},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/RTI.0000000000000404"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-012-2627-7"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.14.13629"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.2989"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003300000787"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/RCT.0b013e31812e4b37"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10278-007-9075-y"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6604351"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.11101913"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmp.14142","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.14142","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mp.14142","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.14142","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T19:10:19Z","timestamp":1692817819000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.14142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,9]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1002\/mp.14142"],"URL":"https:\/\/doi.org\/10.1002\/mp.14142","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,9]]},"assertion":[{"value":"2019-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}