Clinical usefulness of temporal subtraction method in screening digital chest radiography with a mobile computed radiography system

The temporal subtraction image which is obtained by subtraction of a previous image from a current image of the same patient can enhance interval changes. In this study, we applied the temporal subtraction method for lung cancer screening and evaluated the clinical usefulness by comparing the review time and the detection accuracy of lung cancers without and with subtraction images. Since 1996, we have been performing screening chest radiography for a mass survey of lung cancers in the Iwate Prefecture, Japan, by using a van equipped with a computed radiography system and a digital archive system. During the 12 years from 1997 to 2008, a total of 186,340 examinations were performed, and 121,526 (65.2%) temporal subtraction images were provided in the lung cancer screening. Twenty-four abnormal cases with lung cancer and 270 normal cases were selected from the lung cancer screening. Five radiologists participated in an observer performance study and interpreted previous and current chest radiographs without and with temporal subtraction images. In addition, radiologists interpreted previous and current images with a double-reading method. The average ROC curves demonstrated a significant improvement in the detection accuracy of lung cancers with the temporal subtraction images compared with that without the temporal subtraction images, and that with the double-reading method. Therefore, we believe strongly that the temporal subtraction method is clinically useful for radiologists in the detection of lung cancers in mass surveys.