Effectiveness of Bone Suppression Imaging in the Detection of Lung Nodules on Chest Radiographs: Relevance to Anatomic Location and Observer’s Experience

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To evaluate the effectiveness of bone suppression imaging (BSI) software in lung-nodule detection on chest radiographs (CXRs) in relation to nodule location and observer’s experience.

Materials and Methods:

The CXRs of 80 patients, of which 40 had a lung nodule (8 to 30 mm in diameter) and 40 did not have any nodules, were interpreted by 20 observers comprising of 7 pulmonologists with >10 years of experience and 13 pulmonology residents. Each patient’s image was sequentially read, first using the standard CXR and thereafter with the BSI software. The nodule location and confidence level with regard to the presence of a lung nodule were recorded. Receiver operating characteristic analysis was used to evaluate observer performance.


The average area under the curve (AUC) for the observers’ receiver operating characteristic significantly improved from 0.867 to 0.900 (P=0.004) with the use of the BSI software. The average AUC for experienced pulmonologists improved from 0.877 to 0.924 (P=0.017) for lung nodules located in the apical and peripheral areas but not for those in the inner area. The average AUC for residents improved regardless of nodule location.


The use of BSI software improved the performance in lung-nodule detection on CXRs regardless of observer’s experience and was more effective for observers with limited experience.

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