Uncompromised Quality: Bone Suppression and Chest X-Ray Images

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No one would claim that any part of a radiologist’s job is easy, but there are some aspects of their work that pose greater challenges than others. The interpretation of chest X-rays, the most common way to screen and diagnose lung diseases, is one of those tasks that can often frustrate a radiologist.

The average radiologist has probably viewed thousands of chest X-rays over the course of a career, and is well acquainted with the challenges they pose.  A traditional 2-D image of the chest will include all of the different bones surrounding the patient’s chest cavity, often obscuring the lungs. There are ways to see around the bones, but these systems often require the use of large imagining equipment that make it difficult to get an image of an immobile patient.

The bone suppression software can potentially improve the detection of both lung nodules and pneumothorax.

The recent FDA-approved Carestream Bone Suppression Software, now gives radiologists a better solution for chest X-rays—a clear image of the lungs without the expense of difficulties of a full 3-D image. Employing machine learning and pattern recognition technologies, the software accurately detects a patient’s ribs and clavicle structure and suppress these structures on the X-ray image, giving the radiologist an unobstructed view of the lung tissue. By focusing on the ribs and clavicle—the two most distracting bone structures—the software provides a high-quality, clear image that stays as close as possible to the quality of the original image. Five board certified radiologists put the bone suppression software to the test.  They were asked to interpret a series of chest x-rays with and without the bone suppression software, and to rate any change they may have noticed. In studies measuring both lung nodule detection and pneumothorax detection the radiologists recorded a statistically significant increase in detection sensitivity, with no significant increase in false positives when using Carestream’s bone suppression software.

On average, the radiologists who participated in the study reported being 58% more confident in their ability to accurately diagnose patients when presented with the images generated by Carestream’s software.

In addition to the advantages of image interpretation, the bone suppression software works in tandem with traditional 2-D x-rays.  Therefore, there is no need to subject a patient to any additional radiation.   Further, thanks to the portability of 2-D x-ray systems, such as Carestream’s DRX-Revolution, ICU patients no longer need to be physically brought to imaging equipment in order to get a reliable chest x-ray; a reliable chest x-ray can be taken right in the patient’s room.  Radiologists should not be forced to compromise between image quality and practicality when it comes to the health of their patients. Applications such as the bone suppression software are designed to help alleviate the need for compromise by providing a high-quality, low-dose image in a manner that is efficient and practical for both radiologists and patients.

Additional details about Carestream’s bone suppression software can also be found in the white paper, Bone Suppression for Chest Radiographic Images.

Zhimin Huo, Ph.D., is a lead scientist at Carestream. She participated in and co-authored the study, Bone Suppression Technique for Chest Radiographs. She also presented a paper at RSNA on this topic, as well as the paper, Computer-Aided Detection of Malpositioned Endotracheal Tubes in Portable Chest Radiographs for ICU Patients.