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Correlation between model observer and human observer performance in CT imaging when lesion location is uncertain

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TLDR
In CT imaging of different sizes of low-contrast lesions (-15 HU), the performance of CHO with Gabor channels was highly correlated with human observer performance for the detection and localization tasks with uncertain lesion location in CT imaging at four clinically relevant dose levels.
Abstract
Purpose: The purpose of this study was to investigate the correlation between model observer and human observer performance in CT imaging for the task of lesion detection and localization when the lesion location is uncertain. Methods: Two cylindrical rods (3-mm and 5-mm diameters) were placed in a 35 × 26 cm torso-shaped water phantom to simulate lesions with −15 HU contrast at 120 kV. The phantom was scanned 100 times on a 128-slice CT scanner at each of four dose levels (CTDIvol = 5.7, 11.4, 17.1, and 22.8 mGy). Regions of interest (ROIs) around each lesion were extracted to generate images with signal-present, with each ROI containing 128 × 128 pixels. Corresponding ROIs of signal-absent images were generated from images without lesion mimicking rods. The location of the lesion (rod) in each ROI was randomly distributed by moving the ROIs around each lesion. Human observer studies were performed by having three trained observers identify the presence or absence of lesions, indicating the lesion location in each image and scoring confidence for the detection task on a 6-point scale. The same image data were analyzed using a channelized Hotelling model observer (CHO) with Gabor channels. Internal noise was added to the decision variables for the model observer study. Area under the curve (AUC) of ROC and localization ROC (LROC) curves were calculated using a nonparametric approach. The Spearman's rank order correlation between the average performance of the human observers and the model observer performance was calculated for the AUC of both ROC and LROC curves for both the 3- and 5-mm diameter lesions. Results: In both ROC and LROC analyses, AUC values for the model observer agreed well with the average values across the three human observers. The Spearman's rank order correlation values for both ROC and LROC analyses for both the 3- and 5-mm diameter lesions were all 1.0, indicating perfect rank ordering agreement of the figures of merit (AUC) between the average performance of the human observers and the model observer performance. Conclusions: In CT imaging of different sizes of low-contrast lesions (−15 HU), the performance of CHO with Gabor channels was highly correlated with human observer performance for the detection and localization tasks with uncertain lesion location in CT imaging at four clinically relevant dose levels. This suggests the ability of Gabor CHO model observers to meaningfully assess CT image quality for the purpose of optimizing scan protocols and radiation dose levels in detection and localization tasks for low-contrast lesions.

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Citations
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Image quality in CT: From physical measurements to model observers.

TL;DR: The spectrum of various methods that have been used to characterise image quality in CT: from objective measurements of physical parameters to clinically task-based approaches (i.e. model observer (MO) approach) including pure human observer approach are presented.
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Prediction of human observer performance in a 2-alternative forced choice low-contrast detection task using channelized Hotelling observer: Impact of radiation dose and reconstruction algorithms

TL;DR: Human observer performance on a 2AFC lesion detection task in CT with a uniform background can be accurately predicted by a channelized Hotelling observer at different radiation dose levels and for both FBP and IR methods.
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State of the Art in Abdominal CT: The Limits of Iterative Reconstruction Algorithms.

TL;DR: The principles of IR algorithm technology are reviewed, the various commercial implementations of IR in CT are described, and published studies that have evaluated the ability of IR to preserve diagnostic performance for low-contrast diagnostic tasks are reviewed.
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Objective assessment of image quality and dose reduction in CT iterative reconstruction

TL;DR: This review paper seeks to consolidate information relevant to objectively assessing the quality of CT IR images, and thereby measuring the level of dose reduction that a given IR algorithm can achieve, to consolidate recent literature relevant to the development and implementation of task-based methods for the assessment of CTIR image quality.
References
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Computed Tomography — An Increasing Source of Radiation Exposure

TL;DR: The facts are summarized about CT scans, which involve much higher doses of radiation than plain films, and the implications for public health are summarized.
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Projected cancer risks from computed tomographic scans performed in the United States in 2007.

TL;DR: These detailed estimates highlight several areas of CT scan use that make large contributions to the total cancer risk, including several scan types and age groups with a high frequency of use or scans involving relatively high doses, in which risk-reduction efforts may be warranted.
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Addressing Overutilization in Medical Imaging

TL;DR: The causes of the overutilization of imaging are examined and ways of addressing the causes so that overutilized services can be reduced are identified.
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